Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug 6:17:1613566.
doi: 10.3389/fnagi.2025.1613566. eCollection 2025.

Choline alphoscerate: insights between acquired certainties and future perspectives

Giovanni Biggio  1   2 , Claudio Mencacci  3
Affiliations
Review

Choline alphoscerate: insights between acquired certainties and future perspectives

Giovanni Biggio et al. Front Aging Neurosci. .

Abstract

While mild cognitive impairment (MCI) is a risk factor for dementia, it is currently impossible to predict which patients will go on to develop dementia or Alzheimer's disease. Given the projected global increase in dementia due to an increasingly aging population, there is an urgent need to develop pharmacological therapies to reduce symptoms of MCI, and to help delay its possible progression to dementia. Choline alphoscerate is a cholinergic precursor naturally found in the brain that has been identified as an essential nutrient and is available as a prescription drug. While the efficacy of choline alphoscerate on cognitive function is well established in patients with MCI, Alzheimer's disease, and cognitive impairment of vascular origin, emerging evidence suggests that it has neuroprotective effects against β-amyloid injury and may be useful as a preventive therapy against development of Alzheimer's disease in patients with MCI. Recent data also show that choline alphoscerate may be effective against non-cognitive symptoms of MCI (e.g., depression, anxiety, irritability, aggression, and apathy). Here we review pharmacological and clinical evidence regarding choline alphoscerate in order to highlight its usefulness in patients with MCI. The potential role of choline alphoscerate in promoting healthy sleep architecture is also explored.

Keywords: aging; choline alphoscerate; cognitive dysfunction; mild cognitive impairment; sleep disorders.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Metabolism and physiology of choline (Goh et al., 2021). Permission to reproduce this figure (Goh et al., 2021) obtained from the license holder, The American Chemical Society.
Figure 2
Figure 2
The role of choline-containing compounds [i.e., choline alphoscerate, citicoline (CDP-choline)] in acetylcholine synthetic pathways (Amenta et al., 2001; Traini et al., 2013). Permission to reproduce this figure obtained from license holder, Elsevier Science Ac-CoA, acetyl coenzyme A; ACh, acetylcholine; ADP, adenosine diphosphate; ATP, adenosine triphosphate; CDP, cythidin diphosphate; ChAT, choline acetyltransferase; ChK, choline kinase; CoA, coenzyme A; CTP, cythidin triphosphate; GDP, glyceryl-phosphorylcholine diesterase; P, phosphate; PAT, phosphocholine acydil transferase.
Figure 3
Figure 3
Metabolism of choline alphoscerate.
Figure 4
Figure 4
With increasing neuronal arousal, cognitive performance also increases due to activation of orexin and excitatory neurotransmitters. Green indicates strengthening of synaptic connections, whereas red denotes weakening of synaptic connections. Ach, acetylcholine; DA, dopamine; GABA, gamma-aminobutyric acid; NA, noradrenalin; NREM, non-rapid eye movement; REM, rapid eye movement.
See this image and copyright information in PMC

References

    1. Abbati C., Rondi G., Rosola R., Vavassori F., Bosio A. (1991). Nootropic therapy of cerebral aging. Adv. Ther. 8, 268–276.
    1. Amenta F., Carotenuto A., Fasanaro A. M., Rea R., Traini E. (2012). The ASCOMALVA trial: association between the cholinesterase inhibitor donepezil and the cholinergic precursor choline alphoscerate in Alzheimer's disease with cerebrovascular injury: interim results. J. Neurol. Sci. 322, 96–101. doi: 10.1016/j.jns.2012.07.003, PMID: - DOI - PubMed
    1. Amenta F., Carotenuto A., Fasanaro A. M., Rea R., Traini E. (2014). 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. 42, S281–S288. doi: 10.3233/jad-140150, PMID: - DOI - PubMed
    1. Amenta F., Carotenuto A., Rea R., Traini E., Fasanaro A. M. (2016). Sintesi dei risultati dello studio “Effetto dell’associazione tra donepezil e il precursore colinergico colina alfoscerato (Delecit®) sui sintomi della malattia di Alzheimer con danno vascolare associato (ASCOMALVA)”. Riv. SMIG 6:54.
    1. Amenta F., Parnetti L., Gallai V., Wallin A. (2001). Treatment of cognitive dysfunction associated with Alzheimer's disease with cholinergic precursors. Ineffective treatments or inappropriate approaches? Mech. Ageing Dev. 122, 2025–2040. doi: 10.1016/s0047-6374(01)00310-4, PMID: - DOI - PubMed

LinkOut - more resources