Long-term citicoline (cytidine diphosphate choline) use in patients with vascular dementia: neuroimaging and neuropsychological outcomes.
BACKGROUND
Cytidine diphosphate choline (citicoline) has been previously shown to have efficacy in reducing the functional impairments associated with acute stroke. Citicoline is thought to have neuroprotective benefits and has been used for the treatment of chronic cerebrovascular disorders, though its effectiveness has not been fully tested. This randomized, double-blind clinical trial was conducted to determine whether daily citicoline treatment improves neurocognitive and neuroimaging outcome over 12 months among patients diagnosed with vascular dementia (VaD).


METHODS
30 patients diagnosed with VaD, based upon NINDS-AIREN and DSM-IV criteria, were randomized and treated with either 500 mg of citicoline or placebo twice per day. Patients were assessed at baseline, and at 6, and 12 months on a battery of neurocognitive tests. Neuroimaging measures of total brain volume and subcortical/periventricular hyperintensity (SH) volume on magnetic resonance imaging (MRI) were collected at baseline and the 12-month follow-up.


RESULTS
The citicoline and placebo treatment groups did not differ in their neuropsychological performance at baseline and the 12-month follow-up. Significant declines in neuropsychological performance were noted, as well as significantly increased SH and reduced total brain volumes on MRI for both groups at the 12-month follow-up.


CONCLUSIONS
The efficacy of long-term citicoline treatment for cognitive impairment and neuropathological decline in those patients already meeting criteria for VaD does not appear to be substantiated by the current study.
Cohen
Ronald A
RA
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, R.I., USA. rcohen@lifespan.org
Browndyke
Jeffrey N
JN
Moser
David J
DJ
Paul
Robert H
RH
Gordon
Norman
N
Sweet
Lawrence
L
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D003566:Cytidine Diphosphate Choline / Q000008:administration & dosage* / Q000627:therapeutic use*; D015140:Dementia, Vascular / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D013997:Time Factors
D018697:Nootropic Agents; D003566:Cytidine Diphosphate Choline