title: Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial.
abstract: The aim of this study was to investigate the effects of ALC treatment on cognitive functions in patients with severe hepatic encephalopathy. This was a randomized, double-blind, placebo-controlled study. 61 patients with severe hepatic encephalopathy were recruited to the study. The 2 groups received either 2 g ALC twice a day (n = 30) or placebo (n = 30) for 90 days. Clinical and laboratory assessment, psychometric tests and automated electroencephalogram (EEG) analysis were performed for all patients. At the end of the study period, between the 2 groups we observed a significant difference in Everyday Memory Questionnaire -23.9 vs 4.4 (p < 0.001), Logical Memory (Paragraph recall) test 22.3 vs 0.7 (p < 0.001), Trail Making Test A -7.5 vs -2.6 (p < 0.001), Trail Making Test B -10.5 vs -3.1 (p < 0.001), Controlled Oral Word Association Test 4.2 vs 0.5 (p < 0.001), Hooper test 2.6 vs 0.1 (p < 0.05), Judgement of line orientation 2.8 vs 0.3 (p < 0.001), Digit Cancellation time -24.5 vs -2.4 (p < 0.001), NH₄⁺ 30.5 vs 13.5 (p < 0.001), prothrombin time 2 vs 2.4 (p < 0.05), alanine transaminase -10.7 vs -13.6 (p < 0.001). 88% of patients treated with ALC vs 72% of patients treated with placebo showed a significant improvement in EEG. The improvement of cognitive deficits, the reduction of ammonia, and the modification of EEG in patients treated with ALC suggest that ALC could represent a new tool in the treatment of severe hepatic encephalopathy.
authors.affiliation: Research Center "The Great Senescence", University of Catania, Ospedale Cannizzaro, Catania, Italy. m.malaguarnera@email.it
authors.forename: Michele
authors.initials: M
authors.lastname: Malaguarnera
authors.forename: Marco
authors.initials: M
authors.lastname: Vacante
authors.forename: Massimo
authors.initials: M
authors.lastname: Motta
authors.forename: Maria
authors.initials: M
authors.lastname: Giordano
authors.forename: Giulia
authors.initials: G
authors.lastname: Malaguarnera
authors.forename: Rita
authors.initials: R
authors.lastname: Bella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
authors.forename: Liborio
authors.initials: L
authors.lastname: Rampello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pennisi
mesh_terms: D000108:Acetylcarnitine / Q000627:therapeutic use*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D003071:Cognition / Q000502:physiology*; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use*; D011517:Prothrombin Time; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018697:Nootropic Agents; D012709:Serum Albumin; D000108:Acetylcarnitine; D000641:Ammonia; D000410:Alanine Transaminase; D001663:Bilirubin