Choline alfoscerate in the correction of cognitive impairment

In preclinical and clinical studies, choline alfoscerate (CA) has proven to be highly effective in the correction of cognitive impairment (CI). The clinical effect of CA is seen in the improvement of mental activity, concentration, ability to remember and recall information, cognitive and behavioural responses, elimination of emotional instability and apathy. Experimental studies have shown the effectiveness of CA in preventing atrophic changes in the cerebral cortex. Based on several studies conducted on the use of CA in the treatment of CI, it can be concluded that oral administration of CA at a dose of 600 mg/day can be recommended both as monotherapy and as part of complex therapy in patients with cerebrovascular diseases such as chronic cerebral ischemia. As part of complex therapy for CI in Alzheimer's disease, a combination of CA at a dose of 1200 mg/day with donepezil at a dose of 10 mg/day may be recommended. Several studies have demonstrated the efficacy of CA in the treatment of post-COVID and post-traumatic CI. The efficacy of CA administration in the treatment of CI (including vascular dementia) following ischemic stroke and transient ischemic attacks has been demonstrated. When CA is taken, there is also a reduction in anxiety and depressive disorders, asthenia, the severity of pain symptoms and changes in coordination. The duration of therapy should be 60 to 90 days, depending on the severity of CI, followed by an observation phase of up to 2 years. For successful treatment with CA, it is necessary to carry out repeated courses of CI treatment. Today, a new drug Cerpechol (600 mg/7 ml) has appeared on the Russian market, which has all the effects of CA. The convenience of the new form (oral solution) makes it possible to use it in patients with swallowing disorders.

1. Kansakar U, Trimarco V, Mone P, et al. Choline supplements: An update. Front Endocrinol (Lausanne). 2023 Mar 7;14:1148166. doi: 10.3389/fendo.2023.1148166

2. Derbyshire E, Obeid R, Schön C. Habitual Choline Intakes across the Childbearing Years: A Review. Nutrients. 2021 Dec 8;13(12):4390. doi: 10.3390/nu13124390

3. Chugunov AV, Pyshkina LI, Osmayeva ZKh. Correction of post-stroke cognitive and motor disorders. RMZh. Meditsinskoe obozrenie = RMJ. Medical Review. 2020;4(9):584-9. doi: 10.32364/2587-6821-2020-4-9-584-589 (In Russ.).

4. Parfenov VA. Management of patients with cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(1):97-102. doi: 10.14412/2074-2711-2023-1-97-102 (In Russ.).

5. Ajenikoko MK, Ajagbe AO, Onigbinde OA, et al. Review of Alzheimer's disease drugs and their relationship with neuron-glia interaction. IBRO Neurosci Rep. 2022 Nov 19;14:6476. doi: 10.1016/j.ibneur.2022.11.005

6. Jeong Yu H, Lin Kim Y, Jung Kim M, et al. The effect of choline alphoscerate on non spatial memory and neuronal differentiation in a rat model of dual stress. Brain Res. 2022 Jul 1;1786:147900. doi: 10.1016/j.brainres.2022.147900. Epub 2022 Apr 6.

7. Han SH, Chul Youn Y. Quantitative electroencephalography changes in patients with mild cognitive impairment after choline alphoscerate administration. J Clin Neurosci. 2022 Aug;102:42-8. doi: 10.1016/j.jocn.2022.06.006. Epub 2022 Jun 14.

8. Amenta F, Carotenuto A, Fasanaro AM, et al. The ASCOMALVA (Association between the Cholinesterase Inhibitor Donepezil and the Cholinergic Precursor Choline Alphoscerate in Alzheimer's Disease) Trial: interim results after two years of treatment. J Alzheimers Dis. 2014;42 Suppl 3:S281-8. doi: 10.3233/JAD-140150

9. Traini E, Carotenuto A, Fasanaro AM, Amenta F. Volume Analysis of Brain Cognitive Areas in Alzheimer's Disease: Interim 3-Year Results from the ASCOMALVA Trial. J Alzheimers Dis. 2020;76(1):317-29. doi: 10.3233/JAD-190623

10. Carotenuto A, Fasanaro AM, Manzo V, et al. Association Between the Cholinesterase Inhibitor Donepezil and the Cholinergic Precursor Choline Alphoscerate in the Treatment of Depression in Patients with Alzheimer's Disease. J Alzheimers Dis Rep. 2022 May 23;6(1):235-43. doi: 10.3233/ADR-200269

11. Kolykhalov IV, Gavrilova SI. Prolonged alfoscerate effects in patients with the syndrome of amnestic mild cognitive impairment. Tikhookeanskii meditsinskii zhurnal = Pacific Medical Journal. 2019;1(75):18-22. doi: 10.17238/PmJ1609-1175.2019.1.18-22 (In Russ.).

12. Kolykhalov IV, Androsova LV, Gavrilova SI. Clinical and immunological effects of choline alfoscerate in the treatment of amnestic type mild cognitive impairment. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2022;122(112):59-66. doi: 10.17116/jnevro202212211259 (In Russ.).

13. Selezneva ND, Kolykhalov IV, Gavrilova SI. A comparative prospective multidisciplinary research of efficiency of choline alphoscerate in prevention of cognitive deficiency progressing in relatives of patients with Alzheimer’s disease. Psikhiatriya = Psychiatry. 2020;18(1):6-15. doi: 10.30629/2618-6667-2020-18-1-6-15 (In Russ.).

14. Zanon Zotin MC, Sveikata L, Viswanathan A, Yilmaz P. Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management. Curr Opin Neurol. 2021 Apr 1;34(2):246-57. doi: 10.1097/WCO.0000000000000913

15. Smith EE, Barber P, Field TS, et al. Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD)5: Guidelines for management of vascular cognitive impairment. Alzheimers Dement (N Y). 2020 Nov 11;6(1):e12056. doi: 10.1002/trc2.12056

16. Salvadori E, Poggesi A, Donnini I, et al. Association of nimodipine and choline alphoscerate in the treatment of cognitive impairment in patients with cerebral small vessel disease: study protocol for a randomized placebo-controlled trial-the CONIVaD trial. Aging Clin Exp Res. 2020 Mar;32(3):449-57. doi: 10.1007/s40520-019-01229-z. Epub 2019 May 30.

17. Salvadori E, Poggesi A, Donnini I, et al. Efficacy and Safety of the Association of Nimodipine and Choline Alphoscerate in the Treatment of Cognitive Impairment in Patients with Cerebral Small Vessel Disease. The CONIVaD Trial. Drugs Aging. 2021 Jun;38(6):481-91. doi: 10.1007/s40266-02100852-8. Epub 2021 Apr 15.

18. Kostenko EV, Petrova LV. Transient ischemic attacks: their importance in the progression of cerebrovascular diseases and topical issues of medical rehabilitation. Meditsinskii sovet = Medical Council. 2019;9:22-30. doi: 10.21518/2079-701X-2019-9-22-30 (In Russ.).

19. Shishkova VN, Malyukova NG, Tokareva RB. The study of Cereton efficacy in complex neurorehabilitation therapy. Lechebnoe delo. 2020;(1):55-62. doi: 10.24411/2071-5315-2020-12193 (In Russ.).

20. Cherevashchenko LA, Dadova LYu, Tsogoev AS, et al. Physical factors in the medical rehabilitation of patients with chronic cerebral ischemia in the outpatient stage. Voprosy kurortologii, fizioterapii i lechebnoi fizicheskoi kul'tury. 2022;99(6-2):12-8. doi: 10.17116/kurort20229906212 (In Russ.).

21. Kostenko EV, Petrova LV, Ganzhula PA, et al. Cerepro as a Part of Complex Rehabilitation of Outpatients with Posttraumatic Encephalopathy. Lechebnoe delo. 2013;(2):92-102. Available from: https://elibrary.ru/item.asp?id=20452162 (In Russ.).

22. Bogolepova AN, Osinovskaya NA, Kovalenko EA, Makhnovich EV. Fatigue and cognitive impairment in post-COVID syndrome: possible treatment approaches. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):88-93. doi: 10.14412/2074-2711-2021-4-88-93 (In Russ.).

23. Instructions for medical use of the drug Cerpechol. Available from: https://ozonpharm.ru/catalog/tserpekhol/ (In Russ.).

24. Shavlovskaya OA. Using experience medicine drug Cereton (choline alfoscerate) in clinical practice. RMZh. 2011;19(9):557-61. Available from: https://www.elibrary.ru/item.asp?id=20168653 (In Russ.).