Citicoline and Alpha-GPC

Q: What are citicoline and alpha-GPC?

Two different choline-containing compounds sold for memory and focus. Citicoline (CDP-choline) is made by the body, and alpha-GPC (choline alfoscerate) is a choline phospholipid. Neither is the essential nutrient choline.

Q: Do they help memory in healthy people?

One trial in 100 healthy adults aged 50 to 85 found larger memory-test gains with citicoline, but its authors are linked to the product maker. Single doses of alpha-GPC raised one attention test score in 20 men. Evidence is thin.

Q: Is alpha-GPC better than citicoline?

A 2025 analysis of three trials in dementia found one rating scale favoured alpha-GPC, while memory and word-fluency tests did not differ. It compares the two with each other, so it cannot show either works better than no treatment.

Q: Does citicoline help recovery after a stroke?

No. The ICTUS trial of 2,298 patients found recovery similar to placebo and stopped early. A Cochrane review of 10 trials found little or no difference in death or disability.

Q: Does citicoline help glaucoma?

A 2023 review of 10 studies found no significant difference in eye pressure, visual field or other measures. It is not a replacement for prescribed eye treatment.

Q: Is alpha-GPC linked to stroke?

In about 12 million Korean adults, people prescribed alpha-GPC had more strokes over 10 years (total stroke aHR 1.46). This shows an association, not that alpha-GPC caused strokes. A mouse study found it worsened artery plaque.

Q: What are the side effects?

Side effects of citicoline are poorly reported. The big stroke trial found no significant difference in adverse events from placebo, but Cochrane says the safety profile remains unknown. Alpha-GPC has the stroke signal above.

Q: Do they interact with medicines?

A review says citicoline allowed levodopa to be reduced in Parkinson's patients. Alpha-GPC has been studied added to donepezil, but side effects were not reported in the abstracts. No interaction study with blood thinners was found. Ask a doctor or pharmacist.

CDP-choline; choline alfoscerate · also called CDP-choline, alpha-GPC, GPC, choline alfoscerate

Citicoline and alpha-GPC are two choline-containing compounds sold for memory and focus. Most trials are in older people who already have memory or thinking problems, and the evidence is weak to mixed. Citicoline did not help stroke recovery in the largest trial. One very large study linked alpha-GPC to more strokes, so ask a doctor first if you have heart or stroke risks.

General information, not medical advice. Last substantive update October 26, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

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About Citicoline and Alpha-GPC

Citicoline and alpha-GPC are two different choline-containing compounds, often grouped together. Trials in older patients report small gains in memory and thinking, but the studies are few, short and often poor quality. They did not help stroke recovery or glaucoma in the larger tests. A very large Korean study linked alpha-GPC to more strokes.

What citicoline and alpha-GPC are

Citicoline, also called CDP-choline, is a compound the body makes itself. A Cochrane review describes it as a building block for phosphatidylcholine, a part of cell membranes, and says it is a frequently prescribed drug for cognitive impairment in several European countries.

Alpha-GPC, also called choline alfoscerate, is a choline-containing phospholipid used as a medicine or supplement. A 2023 review says it has had a marketing authorization since 1985 and that countries disagree on whether it is a prescription medicine. They are separate compounds, not one product, and neither is the essential nutrient choline.

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Where they come from

These are sold as capsules, powders and blends. Choline itself, the essential nutrient, comes from food and has its own page. No source read gave amounts of citicoline or alpha-GPC in foods, so this page gives none.

A 2020 laboratory paper shows alpha-GPC can be made from soy lecithin by an enzyme process. A capsule is not the same as the medicine-grade citicoline given in hospitals, often by vein, in many trials.

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What the research shows

Reviews of older patients report some benefit for memory and behaviour with citicoline, and small gains in thinking when alpha-GPC is added to donepezil. The authors describe the studies as small, varied and often poor quality. One trial in healthy older adults found memory-test gains, but it was linked to the product maker.

The big stroke trial found no benefit, and a glaucoma review found no measurable gain. A 2025 analysis comparing alpha-GPC with citicoline found one rating scale favoured alpha-GPC, but it cannot show that either beats no treatment.

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Pills versus food choline

Trials test the pure compounds, a citicoline-and-caffeine drink, or alpha-GPC added to donepezil. None read compared them with choline from eggs, meat, fish or soy. Blends hide which ingredient does what. This page gives no amounts to take; ask a doctor, pharmacist or dietitian.

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At a glance

Traditional uses history, not proof

Not a traditional remedy: citicoline is a compound the body makes itself
Prescribed in some countries for thinking problems linked to blood-vessel disease of the brain
Sold as capsules and powders for memory and focus, often in blends

Studied for research

Memory and behaviour in older people with chronic brain disorders (citicoline), low certainty
Thinking and daily function in cognitive impairment (alpha-GPC), low certainty
Memory in healthy older adults (citicoline), low certainty
Short-term attention in healthy adults, very low certainty
Stroke recovery (citicoline), evidence against
Glaucoma (citicoline), insufficient evidence
Parkinson's disease add-on (citicoline), very low certainty

Main compounds

Citicoline (CDP-choline)
Alpha-GPC (choline alfoscerate)
Caffeine (in one combination trial)

Common forms

Capsules, tablets and powders
Blends with caffeine or other brain ingredients
Medicine-grade forms by mouth or injection, used in hospitals in some countries

Research links: 2005 Cochrane review: CDP-choline for chronic brain disorders in the elderly (14 trials) · 2020 Cochrane review: citicoline for acute ischemic stroke (10 trials) · 2012 ICTUS trial: citicoline in acute stroke (2,298 people) · 2023 meta-analysis: alpha-GPC in adult-onset cognitive dysfunction · 2021 cohort study: alpha-GPC and stroke risk over 10 years · 2019 FDA warning letter on disease claims for alpha-GPC and CDP-choline capsules · Research Library · Genes & Biomarkers Library

What it is and its history

Accepted scientific name: Citicoline (cytidine diphosphate-choline, CDP-choline) and alpha-GPC (choline alfoscerate, L-alpha-glycerylphosphorylcholine) are two different choline-containing compounds, grouped on this page.
Synonyms: CDP-choline; cytidine diphosphate-choline; choline alfoscerate; choline alphoscerate; L-alpha-glycerylphosphorylcholine; glycerophosphocholine (GPC)
Common names: Citicoline (English); CDP-choline (English); Alpha-GPC (English); Choline alfoscerate (English)
Family or group: Choline-containing compounds that act as precursors of acetylcholine and cell-membrane phospholipids (sold as nootropics).
Look-alikes and adulterants: Name: Choline (the essential nutrient); Note: A different substance; choline is found in food and has official intake levels. Citicoline and alpha-GPC are choline-containing compounds, not the same thing.; Name: Phosphatidylserine; Note: A different membrane phospholipid sold for memory, with its own evidence.
Sustainability and conservation: Not assessed.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
		PubMed 36683513 abstract, read 2026-10-26.
		PubMed 15846601 abstract, read 2026-10-26.

Traditional use shows how it was used. It does not show that it works or is safe today.

What is inside, and how it may work

What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Citicoline (CDP-choline) PubChem 13804	nucleotide-choline compound	Not read from a source.	Tested for memory, stroke recovery, glaucoma and Parkinson's disease; see the Benefits tab. ^{6 13}	Human data
Alpha-GPC (choline alfoscerate) PubChem 657272	choline-containing phospholipid	Not read from a source.	Tested for cognitive impairment and dementia and for single-dose attention; see the Benefits tab. ^{17 7}	Human data

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Cell-membrane building (phosphatidylcholine)	Not specified in the abstracts read	A Cochrane review describes CDP-choline as a precursor needed to make phosphatidylcholine, a cell-membrane component, and says animal studies suggest it may protect membranes by speeding their repair. ⁶	Animal and proposed
Acetylcholine supply	Not specified in the abstracts read	A 2024 trial abstract describes alpha-GPC as a phospholipid that includes choline, which increases the release of acetylcholine. A 2023 review calls citicoline, alpha-GPC, choline bitartrate and lecithin acetylcholine precursors. ^{12 7}	Proposed (not shown in people)
Dopamine	Not specified in the abstract	The authors of a 2021 review say citicoline increases dopamine synthesis and inhibits dopamine uptake. ¹⁶	Stated by review authors; source type not specified
Gut bacteria and TMAO	Choline trimethylamine lyase (cutC) bacteria, NF-kB and MAPK signalling	In mice, alpha-GPC shifted gut bacteria, raised cutC-carrying bacteria and could be metabolised to TMAO; in human coronary artery cells it raised inflammation signals. A 2026 review says the TMAO harm evidence is inconsistent. ^{21 3}	Mouse and cell

Absorption, metabolism and elimination

Absorption: A 2026 review says how alpha-GPC is absorbed and metabolised in the gut is still elusive.
Distribution: Not found in the sources read.
Metabolism: Alpha-GPC can be turned into TMAO in mice (2021 study). The human pathway was not described in the abstracts read.
Elimination: Not found in the sources read.
Bioavailability: Not compared between citicoline or alpha-GPC products and food choline in the sources read.

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Isolated compounds versus whole extracts

Trials test the pure compounds, a citicoline-and-caffeine drink, or alpha-GPC added to donepezil. No trial read compared these with dietary choline from eggs, meat, fish or soy. Choline in food is a different intake from a capsule of citicoline or alpha-GPC.

Nutritional composition

No USDA or NIH Office of Dietary Supplements table giving citicoline or alpha-GPC per food portion was read (the ODS page was blocked), so this page gives no food amounts for these two compounds. Choline itself, the essential nutrient, has its own page.

9benefits and uses looked at

24studies and sources checked

Low certaintybest evidence rating found

7lab markers tracked in trials

3 low certainty3 very low certainty2 not enough evidence1 evidence against

What was looked at

The 9 benefits and uses checked for Citicoline and Alpha-GPC, each with how strong the evidence is. Tap one to open it.

Memory and behaviour in older people with chronic brain disorders (citicoline)Low certainty
Thinking and daily function in adults with cognitive impairment (alpha-GPC)Low certainty
Memory in healthy older adults with age-related memory slips (citicoline)Low certainty
Short-term attention in healthy adults (citicoline with caffeine; alpha-GPC)Very low certainty
Recovery after acute ischaemic stroke (citicoline)Evidence against
Glaucoma (citicoline)Not enough evidence
Parkinson's disease add-on (citicoline)Very low certainty
Thinking in ADHD, mood, substance-use disorders and schizophrenia (citicoline and phosphatidylserine)Not enough evidence
Long-term outcomes in dementia (alpha-GPC, insurance-record study)Very low certainty

Lab markers tracked in the studies

Episodic memory test score (Paired Associate)Mini-Mental State Examination (MMSE) scoreADAS-Cog score (Alzheimer's thinking scale)Stroop test scoreRecovery at 90 days after strokeDeath from any cause after strokeEye pressure (intraocular pressure) in glaucoma

What is Citicoline and Alpha-GPC good for?

The main studied uses and how strong the human evidence is for each. Most results are from older people who already had memory or thinking problems, so they do not carry over to healthy people.

Memory and behaviour in older people with chronic brain disorders (citicoline)Low certaintyA Cochrane review of 14 mostly short trials found some benefit for memory and behaviour but none for attention. A 2023 pooled analysis reported better thinking scores but called the studies poor quality. Thinking and daily function in adults with cognitive impairment (alpha-GPC)Low certaintyPooled trials, mostly adding alpha-GPC to donepezil, reported small gains in thinking, function and behaviour. A 36-person diabetes trial and a direct comparison with citicoline add little. The trials are few and small. Memory in healthy older adults (citicoline)Low certaintyOne 12-week trial in 100 healthy people aged 50 to 85 found larger memory-test gains with citicoline than placebo. It is a single trial by authors linked to the citicoline maker. Short-term attention in healthy adultsVery low certaintyA citicoline-and-caffeine drink and single doses of alpha-GPC gave better scores on some attention tests in two small trials. Most other tests showed no difference. Recovery after acute ischaemic stroke (citicoline)Evidence againstThe ICTUS trial of 2,298 stroke patients found recovery no better than placebo and stopped early for futility. A Cochrane review of 10 trials found little or no difference in death or disability. Glaucoma (citicoline)Not enough evidenceA 2023 review of 10 studies in 424 people found no significant difference in eye pressure, visual field, nerve fibre layer or retinal signal. Parkinson's disease add-on (citicoline)Very low certaintyA 2021 review of seven small, varied studies reported better movement symptoms and the ability to cut levodopa by up to half. The authors say more high-quality studies are needed. Thinking in ADHD, mood, substance-use disorders and schizophreniaNot enough evidenceA 2026 review of 11 controlled trials of citicoline or phosphatidylserine found mixed, inconsistent results and concluded the evidence does not support them as cognitive enhancers in these conditions. Long-term outcomes in dementia (alpha-GPC, insurance records)Very low certaintyA study of 11,463 older Koreans with dementia found an unclear link with disease progression and about 20% fewer deaths among alpha-GPC users. It cannot show cause and effect.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Memory and behaviour in older people with chronic brain disorders (citicoline)

Low certainty

A Cochrane review found some benefit for memory and behaviour, but none for attention, in older people with long-term brain problems. A 2023 pooled analysis reported better thinking scores too, but called the studies poor quality.

2 studiesCiticoline (CDP-choline), mostly as a prescribed medicine by mouth or…

Studies, doses and limits

What the trials found

A 2005 Cochrane review pooled 14 double-blind placebo-controlled trials, mostly lasting three months or less. A 2023 review pooled six more recent studies in mild cognitive impairment, Alzheimer's disease and post-stroke dementia.

Results

No benefit on attention. Some benefit on memory and behaviour in the short to medium term, with stronger results on overall clinical impression. The 2023 analysis found higher thinking scores with citicoline, but the authors say study quality is poor and risk of bias favours the treatment.

Effect sizes as reported

2005 review: no pooled numbers in the abstract. 2023 review: standardised mean difference 0.56 (95% CI 0.37 to 0.75) up to 1.57 (95% CI 0.77 to 2.37) depending on the analysis.

Why this rating

The older trials were short and varied, and the 2023 authors rate the studies poor quality with bias that favours citicoline. The Cochrane lead reviewer had helped run some of the trials.

Form and dose studied

Citicoline (CDP-choline), mostly as a prescribed medicine by mouth or injection in these trials. Trial amounts are in the studies table, not advice. A capsule bought as a supplement is not the same as a prescribed medicine.

Who was studied

Older people with age-related memory complaints, mild vascular cognitive impairment, vascular or senile dementia, mild cognitive impairment, Alzheimer's disease and post-stroke dementia.

Limits

Short trials, mixed methods and doses, poor quality, no intention-to-treat data in the older review, and a lead reviewer with a link to included trials. Results in patients do not carry over to healthy people.

Why researchers looked

Citicoline is a prescribed medicine in several European countries for thinking problems linked to blood-vessel disease of the brain, so researchers pooled the trials.

Traditional use

Not a traditional remedy and not an essential nutrient. Citicoline (also called CDP-choline) is a compound the body makes itself, according to a Cochrane review, and it is a frequently prescribed medicine for cognitive problems in several European countries. Alpha-GPC (choline alphoscerate) has been sold as a medicine since 1985 in some countries, and a 2023 review says countries differ on whether it is approved as a prescription drug.

Proposed mechanism Animal and proposed

Not established in people. A Cochrane review says citicoline is a building block for phosphatidylcholine, a part of cell membranes, and that animal studies suggest it may protect membranes. These are proposals, not shown benefits.

A proposed mechanism does not show that the effect happens in people.

The 2005 review says the drug was well tolerated. See the Safety tab.

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Thinking and daily function in adults with cognitive impairment (alpha-GPC)

Low certainty

Pooled trials, mostly in people also taking the dementia medicine donepezil, reported small gains in thinking, daily function and behaviour with alpha-GPC. The trials are few and small.

4 studiesAlpha-GPC (choline alfoscerate), by mouth, alone or added to donepezi…

Studies, doses and limits

What the trials found

A 2023 meta-analysis pooled seven randomised trials and one cohort study. A 2024 Korean trial added alpha-GPC to donepezil in 119 patients. A 2025 trial gave alpha-GPC or placebo to 36 people with type 2 diabetes and mild cognitive impairment. A 2025 meta-analysis of three trials compared alpha-GPC directly with citicoline.

Results

Added to donepezil, alpha-GPC was linked to better cognition, function and behaviour scores. In the 2024 trial the ADAS-Cog score improved 18.5% with donepezil plus alpha-GPC against 9.4% with donepezil alone at 24 weeks, but part of that trial was open-label. In the diabetes trial the MMSE difference was +1.4 at 6 months (not significant) and +1.7 at 12 months. Against citicoline directly, one rating scale favoured alpha-GPC while memory and word-fluency tests did not differ.

Effect sizes as reported

Meta-analysis, added to donepezil: cognition MD 1.72 (95% CI 0.20 to 3.25), function MD 0.79 (0.34 to 1.23), behaviour MD -7.61 (-10.31 to -4.91). Versus placebo or other medicines: MD 3.50 (0.36 to 6.63). Versus citicoline on the SCAG scale: WMD -3.92 (-7.41 to -0.42).

Why this rating

Few trials, small groups, intervals that are wide, part of one trial open-label, and the comparison with citicoline cannot show either beats no treatment.

Form and dose studied

Alpha-GPC (choline alfoscerate), by mouth, alone or added to donepezil. Trial amounts are in the studies table, not advice.

Who was studied

Adults with cognitive impairment, dementia or cognitive decline, many with cerebrovascular injury; South Korean adults with type 2 diabetes and mild cognitive impairment.

Limits

Small trials, a mix of designs, one open-label trial, and little long-term data. See the Safety tab for the large study linking alpha-GPC to more strokes.

Why researchers looked

Alpha-GPC is a choline-containing compound used as a medicine in some countries for thinking problems after brain-blood-vessel injury and in dementia.

Traditional use

Proposed mechanism Proposed not established

Not established. Alpha-GPC contains choline, which the body uses to make the nerve messenger acetylcholine, and a trial paper says it is thought to increase acetylcholine release. How it is absorbed and processed in the gut is still unclear, according to a 2026 review.

A proposed mechanism does not show that the effect happens in people.

A very large Korean cohort linked alpha-GPC prescriptions to more strokes. See the Safety tab before drawing conclusions from the thinking scores.

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Memory in healthy older adults with age-related memory slips (citicoline)

Low certainty

One 12-week trial in 100 healthy people aged 50 to 85 found larger memory-test gains with citicoline than with placebo. It is a single trial, linked to the citicoline maker.

1 studiesA branded oral citicoline product. The amount is in the studies table…

Studies, doses and limits

What the trials found

A randomised, double-blind, placebo-controlled trial in 100 healthy men and women aged 50 to 85 with age-associated memory impairment; 99 finished.

Results

Episodic memory (the Paired Associate test) improved more with citicoline than placebo (0.15 vs 0.06, P = 0.0025) and so did a composite memory score (3.78 vs 0.72, P = 0.0052). The abstract reports these as secondary outcomes.

Effect sizes as reported

Paired Associate test 0.15 vs 0.06; composite memory 3.78 vs 0.72 (confidence intervals not given in the abstract).

Why this rating

A single trial, 12 weeks, computer tests, gains reported as secondary outcomes, and the authors work for the citicoline maker.

Form and dose studied

A branded oral citicoline product. The amount is in the studies table, not advice.

Who was studied

Healthy men and women aged 50 to 85 with age-associated memory impairment.

Limits

One trial. Test-room scores are not the same as everyday memory. No second group has confirmed it.

Why researchers looked

Most citicoline trials are in patients. Researchers asked whether it helps ordinary older adults whose memory is slipping with age.

Traditional use

Proposed mechanism Animal and proposed

A proposed mechanism does not show that the effect happens in people.

The trial recorded safety checks; the abstract does not list side effects. See the Safety tab.

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Short-term attention in healthy adults (citicoline with caffeine; alpha-GPC)

Very low certainty

Two small trials in healthy adults found better scores on some attention tests, one for a citicoline-and-caffeine drink and one for single doses of alpha-GPC. Most other tests showed no difference.

2 studiesA citicoline-and-caffeine drink; single oral amounts of a branded alp…

Studies, doses and limits

What the trials found

A randomised placebo-controlled trial in 60 healthy adults tested a citicoline-and-caffeine drink. A crossover trial in 20 healthy resistance-trained men tested two single amounts of alpha-GPC.

Results

The citicoline-caffeine drink gave faster reaction times, fewer errors and a higher P450 brain-wave signal than placebo, but caffeine was in the drink too. Alpha-GPC raised the Stroop test score and speed after the higher amount, with no difference on the Flanker or N-Back tests, mood or physical performance.

Effect sizes as reported

Alpha-GPC Stroop total score change 13.0 vs 5.2 for placebo (p = 0.013) and 10.8 vs 5.2 (p = 0.046). The drink trial gave no effect sizes in the abstract.

Why this rating

Small trials, one combined with caffeine, one a single day, most tests null, and the alpha-GPC trial's author advises the sponsor.

Form and dose studied

A citicoline-and-caffeine drink; single oral amounts of a branded alpha-GPC product. Amounts are in the studies table, not advice.

Who was studied

Healthy adults (60 in the drink trial; 20 young resistance-trained men in the alpha-GPC trial).

Limits

Tiny samples, short follow-up, mixed results across tests, caffeine as a confounder, and industry links. Not shown to improve real-life focus.

Why researchers looked

People take these compounds for focus, so researchers tested single doses or a short course in healthy volunteers.

Traditional use

Proposed mechanism Proposed not established

Not established. Both compounds supply choline, which the body uses to make acetylcholine, but the trials did not show this is why scores changed.

A proposed mechanism does not show that the effect happens in people.

Heart rate and blood pressure changed within normal ranges in the alpha-GPC trial, in all groups including placebo.

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Recovery after acute ischaemic stroke (citicoline)

Evidence against

The biggest trial, in 2,298 stroke patients, found recovery no better than placebo and was stopped early. A Cochrane review of 10 trials also found little or no difference.

2 studiesGiven by vein first and then by mouth in ICTUS; by mouth, vein or bot…

Studies, doses and limits

What the trials found

The 2012 ICTUS trial randomised 2,298 people with moderate-to-severe ischaemic stroke to citicoline or placebo within 24 hours. A 2020 Cochrane review pooled 10 randomised trials with 4,281 people.

Results

ICTUS: global recovery at 90 days was similar in both groups, with no significant difference in safety measures or adverse events. Cochrane: little or no difference in death, disability, recovery scores, or serious cardiovascular events. Harms were poorly reported and no trial measured quality of life.

Effect sizes as reported

ICTUS odds ratio 1.03 (95% CI 0.86 to 1.25). Cochrane: death RR 0.94 (0.83 to 1.07), disability RR 1.11 (0.97 to 1.26), serious cardiovascular events RR 1.04 (0.84 to 1.29).

Why this rating

The largest well-run trial was stopped for futility and the Cochrane review found low-certainty evidence of little or no difference. The ICTUS trial was funded by a citicoline maker.

Form and dose studied

Given by vein first and then by mouth in ICTUS; by mouth, vein or both in the other trials. This is hospital treatment, not a capsule bought as a supplement.

Who was studied

Adults in hospital with acute ischaemic stroke.

Limits

All Cochrane trials were at high risk of bias; six were drug-company sponsored; harms were poorly reported.

Why researchers looked

Citicoline has been given in hospital after stroke in some countries in the hope of protecting brain cells.

Traditional use

Proposed mechanism Animal and proposed

A proposed mechanism does not show that the effect happens in people.

Cochrane says the safety profile of citicoline remains unknown because harms were poorly reported.

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Glaucoma (citicoline)

Not enough evidence

A 2023 review of 10 studies in 424 people with glaucoma found no significant difference in eye pressure, visual field, nerve fibre layer or retinal signal.

1 studiesCiticoline as a supplement; the abstract does not give the form or am…

Studies, doses and limits

What the trials found

A systematic review of 10 clinical studies, 424 patients, average follow-up 12.1 months, average age 56.7.

Results

No significant difference from the control group, and no improvement from the start of treatment, in eye pressure, the visual-field measure, retinal nerve fibre layer thickness or the pattern electroretinogram. The authors say there is not enough evidence that citicoline slows glaucoma.

Effect sizes as reported

No significant differences; no numbers given in the abstract.

Why this rating

Ten small studies of mixed design and no measurable gain on any of four measures.

Form and dose studied

Citicoline as a supplement; the abstract does not give the form or amounts.

Who was studied

Adults with glaucoma (average age 56.7).

Limits

Mixed designs, small groups, follow-up about a year.

Why researchers looked

Glaucoma damages nerve cells in the eye, and citicoline has shown protective effects on nerve cells in other brain diseases, so researchers tested it as an add-on.

Traditional use

Proposed mechanism Proposed not established

Not established. The review notes citicoline showed neuroprotective properties in central nervous system diseases; this was not shown for glaucoma.

A proposed mechanism does not show that the effect happens in people.

Never a replacement for prescribed eye treatment; ask an eye doctor.

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Parkinson's disease add-on (citicoline)

Very low certainty

A 2021 review of seven small studies reported better movement symptoms and the ability to cut levodopa by up to half, but the studies were too varied to be sure.

1 studiesCiticoline added to usual Parkinson's medicines; details vary.

Studies, doses and limits

What the trials found

A systematic review of seven studies up to 2019: two crossover trials, three randomised trials and two open prospective studies.

Results

The authors report improvement in rigidity, slowness of movement, tremor, handwriting, speech and cognition, and that levodopa could be reduced by up to 50%. They say the studies were too different to be sure and more high-quality studies are needed.

Effect sizes as reported

No pooled numbers in the abstract.

Why this rating

Small, varied studies, two without a control group, no pooled analysis or bias rating in the abstract.

Form and dose studied

Citicoline added to usual Parkinson's medicines; details vary.

Who was studied

Adults with Parkinson's disease.

Limits

Small, mixed studies and unclear bias. Changing Parkinson's medicines should only be done by the treating doctor.

Why researchers looked

The review authors say citicoline increases dopamine production and slows dopamine removal, and Parkinson's medicines are not available everywhere.

Traditional use

Proposed mechanism Proposed not established

Proposed by the review authors: citicoline increases dopamine synthesis and inhibits dopamine uptake. Not shown as the reason for any benefit.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab on levodopa.

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Thinking in ADHD, mood, substance-use disorders and schizophrenia (citicoline and phosphatidylserine)

Not enough evidence

A 2026 review of 11 controlled trials found mixed, inconsistent results and concluded the evidence does not support citicoline or phosphatidylserine as cognitive enhancers in mental disorders.

1 studiesCiticoline or phosphatidylserine, alone or as an add-on; details vary…

Studies, doses and limits

What the trials found

A systematic review of 11 controlled trials, 10 of them randomised: five in children with ADHD and others in adults with mood disorders, alcohol and substance use disorders, or schizophrenia.

Results

In ADHD, phosphatidylserine-containing supplements improved attention and impulsivity in three studies and not in two. One schizophrenia study found better verbal free recall but no overall gain. Results in mood and substance-use disorders were mixed.

Effect sizes as reported

No pooled numbers in the abstract.

Why this rating

Inconsistent results, small studies, high risk of bias, and citicoline and phosphatidylserine results blended in the abstract.

Form and dose studied

Citicoline or phosphatidylserine, alone or as an add-on; details vary by study.

Who was studied

Children with ADHD and adults with mood, substance-use or psychotic disorders.

Limits

The abstract does not separate citicoline from phosphatidylserine for each result.

Why researchers looked

Researchers asked whether these supplements could help attention and thinking skills in children and adults with mental-health conditions.

Traditional use

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

Ask the treating doctor before adding any supplement to mental-health treatment.

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Long-term outcomes in dementia (alpha-GPC, insurance-record study)

Very low certainty

An insurance-records study of 11,463 older Koreans with dementia found an unclear link with disease progression and about 20% fewer deaths among alpha-GPC users. It cannot show cause and effect.

1 studiesPrescribed alpha-GPC (choline alfoscerate); amounts are not in the ab…

Studies, doses and limits

What the trials found

A 2024 observational study of the National Health Insurance Service Senior Cohort: 11,463 people with dementia diagnosed 2003 to 2014, about 19% exposed to alpha-GPC, at least 12 months of follow-up.

Results

The link between alpha-GPC and treatment failure was unclear. Use was linked to about 20% lower risk of death from any cause, and a slight reduction in progression only in the early stage.

Effect sizes as reported

About 20% lower all-cause mortality association (confidence interval not given in the abstract).

Why this rating

Observational insurance data, where people who got the drug may differ from those who did not.

Form and dose studied

Prescribed alpha-GPC (choline alfoscerate); amounts are not in the abstract.

Who was studied

Older South Korean adults with dementia, about 73% women.

Limits

Association only. This sits beside a separate Korean study linking alpha-GPC prescriptions to more strokes; see the Safety tab.

Why researchers looked

Alpha-GPC is paid for by Korean insurance, so researchers looked at long-term outcomes in people who used it.

Traditional use

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

⁴

Connections to the rest of health

How Citicoline and Alpha-GPC connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Evidence status	Context	Studies
Memory Support	Low certainty	Memory and behaviour in older people with chronic brain disorders (citicoline): A Cochrane review found some benefit for memory and behaviour, but none for attention, in older people with long-term brain problems. A 2023 pooled analysis reported better thinking scores too, but called the studies poor quality. Thinking and daily function in adults with cognitive impairment (alpha-GPC): Pooled trials, mostly in people also taking the dementia medicine donepezil, reported small gains in thinking, daily function and behaviour with alpha-GPC. The trials are few and small.	^{6 1 17 12 19 18}
Brain Health	Low certainty	Memory and behaviour in older people with chronic brain disorders (citicoline): A Cochrane review found some benefit for memory and behaviour, but none for attention, in older people with long-term brain problems. A 2023 pooled analysis reported better thinking scores too, but called the studies poor quality.	^{6 1}
Healthy Aging	Low certainty	Thinking and daily function in adults with cognitive impairment (alpha-GPC): Pooled trials, mostly in people also taking the dementia medicine donepezil, reported small gains in thinking, daily function and behaviour with alpha-GPC. The trials are few and small.	^{17 12 19 18}
Memory Support	Low certainty	Memory in healthy older adults with age-related memory slips (citicoline): One 12-week trial in 100 healthy people aged 50 to 85 found larger memory-test gains with citicoline than with placebo. It is a single trial, linked to the citicoline maker. Short-term attention in healthy adults (citicoline with caffeine; alpha-GPC): Two small trials in healthy adults found better scores on some attention tests, one for a citicoline-and-caffeine drink and one for single doses of alpha-GPC. Most other tests showed no difference.	^{14 2 8}
Healthy Aging	Low certainty	Memory in healthy older adults with age-related memory slips (citicoline): One 12-week trial in 100 healthy people aged 50 to 85 found larger memory-test gains with citicoline than with placebo. It is a single trial, linked to the citicoline maker.	¹⁴
Brain Health	Very low certainty	Short-term attention in healthy adults (citicoline with caffeine; alpha-GPC): Two small trials in healthy adults found better scores on some attention tests, one for a citicoline-and-caffeine drink and one for single doses of alpha-GPC. Most other tests showed no difference.	^{2 8}
Brain Health	Evidence against	Recovery after acute ischaemic stroke (citicoline): The biggest trial, in 2,298 stroke patients, found recovery no better than placebo and was stopped early. A Cochrane review of 10 trials also found little or no difference.	^{5 13}
Healthy Aging	Not enough evidence	Glaucoma (citicoline): A 2023 review of 10 studies in 424 people with glaucoma found no significant difference in eye pressure, visual field, nerve fibre layer or retinal signal.	¹⁵
Brain Health	Very low certainty	Parkinson's disease add-on (citicoline): A 2021 review of seven small studies reported better movement symptoms and the ability to cut levodopa by up to half, but the studies were too varied to be sure.	¹⁶
Brain Health	Not enough evidence	Thinking in ADHD, mood, substance-use disorders and schizophrenia (citicoline and phosphatidylserine): A 2026 review of 11 controlled trials found mixed, inconsistent results and concluded the evidence does not support citicoline or phosphatidylserine as cognitive enhancers in mental disorders.	¹⁰
Healthy Aging	Very low certainty	Long-term outcomes in dementia (alpha-GPC, insurance-record study): An insurance-records study of 11,463 older Koreans with dementia found an unclear link with disease progression and about 20% fewer deaths among alpha-GPC users. It cannot show cause and effect.	⁴

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Brain Focus	Biological association	Low certainty	Studied for: Memory and behaviour in older people with chronic brain disorders (citicoline) Studied for: Thinking and daily function in adults with cognitive impairment (alpha-GPC)	^{6 1 17 12 19 18 14 2 8 5 13 10}
Nervous System	Biological association	Low certainty	Studied for: Memory and behaviour in older people with chronic brain disorders (citicoline) Studied for: Thinking and daily function in adults with cognitive impairment (alpha-GPC)	^{6 1 17 12 19 18 5 13 15 16 10 4}
Eyes	Biological association	Not enough evidence	Studied for: Glaucoma (citicoline)	¹⁵

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Episodic memory test score (Paired Associate)	Biological association	Low certainty	Measured in trials: higher with citicoline than placebo. A lab change is not the same as a health benefit.	¹⁴
Mini-Mental State Examination (MMSE) score	Biological association	Low certainty	Measured in trials: higher with alpha-GPC than placebo at 12 months. A lab change is not the same as a health benefit.	¹⁹
ADAS-Cog score (Alzheimer's thinking scale)	Biological association	Low certainty	Measured in trials: improved more with donepezil plus alpha-GPC than donepezil alone. A lab change is not the same as a health benefit.	¹²
Stroop test score	Biological association	Very low certainty	Measured in trials: higher after alpha-GPC than placebo. A lab change is not the same as a health benefit.	⁸
Recovery at 90 days after stroke	Biological association	Evidence against	Measured in trials: no difference from placebo. A lab change is not the same as a health benefit.	⁵
Death from any cause after stroke	Biological association	Low certainty	Measured in trials: no clear difference. A lab change is not the same as a health benefit.	¹³
Eye pressure (intraocular pressure) in glaucoma	Biological association	Not enough evidence	Measured in trials: no significant change. A lab change is not the same as a health benefit.	¹⁵

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
Choline	Preliminary mechanism	Review	Both compounds supply choline.	⁷
Phosphatidylserine	Preliminary mechanism	Human	Reviewed with citicoline in mental disorders.	¹⁰
TMAO (trimethylamine N-oxide)	Preliminary mechanism	Mouse and cell	Made by gut bacteria from choline-containing compounds; linked to artery disease in mice.	^{21 3}

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Citicoline (CDP-choline)	Biological association	Human	Tested for memory, stroke recovery, glaucoma and Parkinson's disease; see the Benefits tab.	^{6 13}
Alpha-GPC (choline alfoscerate)	Biological association	Human	Tested for cognitive impairment and dementia and for single-dose attention; see the Benefits tab.	^{17 7}

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 26, 2026).

Evidence at a glance: what the research found for 9 outcomes

3Low certainty

3Very low certainty

2Not enough evidence

1Evidence against

Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.

Memory and behaviour in older people with chronic brain disorders (citicoline) 2 studies Low certainty Thinking and daily function in adults with cognitive impairment (alpha-GPC) 4 studies Low certainty Memory in healthy older adults with age-related memory slips (citicoline) 1 study Low certainty Short-term attention in healthy adults (citicoline with caffeine; alpha-GPC) 2 studies Very low certainty Recovery after acute ischaemic stroke (citicoline) 2 studies Evidence against Glaucoma (citicoline) 1 study Not enough evidence Parkinson's disease add-on (citicoline) 1 study Very low certainty Thinking in ADHD, mood, substance-use disorders and schizophrenia (citicoline and phosphatidylserine) 1 study Not enough evidence Long-term outcomes in dementia (alpha-GPC, insurance-record study) 1 study Very low certainty

The evidence

The research centre for Citicoline and Alpha-GPC. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We started from our existing summary and re-read PubMed abstracts for the reviews and trials, an FDA warning letter and a National Institute on Aging page. Only abstracts were read for studies. The NIH Office of Dietary Supplements page was blocked and is marked unread.

Study library: every study we checked 24

Design Research type Year from Search

Study	Design	People	Product, dose, length	Result
Bonvicini 2023 Is Citicoline Effective in Preventing and Slowing Down Dementia?-A Systematic Review and a Meta-Analysis. Nutrients · PMID 36678257 · DOI	Systematic review meta analysis	Seven studies (six pooled) in people with mild cognitive impairment, Alzheimer's disease or post-stroke dementia; studies published 2010 to 2022.	Citicoline Oral supplement or injection (see population) Varied; see the review Varied · vs Control groups (placebo or usual care)	All seven studies showed a positive effect. Pooled standardised mean differences ranged from 0.56 to 1.57 depending on the sensitivity analysis. The authors rated overall quality poor, with significant risk of bias in favour of the intervention. Pooled SMD 0.56 to 1.57 across sensitivity analyses (0.37 to 0.75 (lowest estimate); 0.77 to 2.37 (highest)) Methods, limits and funding Outcomes: Cognitive status scores Limitations: Poor study quality and high risk of bias in favour of citicoline; searched only PubMed and Cochrane Library. Funding and conflicts: The authors declare no conflict of interest. Read: abstract
Bruce 2014 Improvements in concentration, working memory and sustained attention following consumption of a natural citicoline-caffeine beverage. Int J Food Sci Nutr · PMID 25046515 · DOI	Randomised controlled trial	60 60 healthy adults.	Citicoline plus caffeine (a drink; a combination product) Oral drink Not given in the abstract Short-term; not stated in the abstract · vs Placebo drink	Faster maze learning and reaction times, fewer errors on a go/no-go task, better information-processing accuracy and a higher P450 brain-wave amplitude than placebo. The authors read this as better sustained attention. No effect sizes in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: EEG measures and tests of attention, concentration, reaction time and maze learning Limitations: Citicoline was given together with caffeine, so the two effects cannot be separated; small trial; short term. Funding and conflicts: The authors report no conflicts of interest; the abstract does not state who funded the trial. Read: abstract
Chen 2026 A Friend or Foe: Understanding the Physiological Significance, Therapeutic Uses, and Potential Risks of Glycerophosphocholine-A Narrative Review. Nutrients · PMID 42196986 · DOI	Narrative review	Narrative review of glycerophosphocholine (GPC, the alpha-GPC compound): body roles, uses and risks.	Glycerophosphocholine (alpha-GPC) Oral supplement or injection (see population)	Says GPC has shown potential in ageing-related conditions, but how it is absorbed and metabolised in the gut is still unclear. High intake of choline-containing compounds is linked with TMAO, which is tied to artery disease, but the authors say the evidence on TMAO harm is inconsistent and debatable. No numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Absorption, metabolism, TMAO link, therapeutic uses Limitations: Narrative review; only the abstract was read. Funding and conflicts: The authors declare no conflicts of interest. Read: abstract
Duong 2024 Effect of choline alfoscerate in older adult patients with dementia: an observational study from the claims data of national health insurance. BMC Geriatr · PMID 39548376 · DOI	Cohort observational	11463 11,463 older South Korean adults diagnosed with dementia in 2003 to 2014; about 19% had used alpha-GPC.	Alpha-GPC (choline alfoscerate), prescribed Oral supplement or injection (see population) At least 12 months of follow-up · vs People with dementia who did not use it	The link between alpha-GPC and treatment failure was unclear. Alpha-GPC use was linked to about 20% lower risk of death from any cause, and a slight reduction in progression only in the early stage of diagnosis. About 20% lower all-cause mortality (association) (Not given in the abstract) Methods, limits and funding Outcomes: Treatment failure (disease progression events) and all-cause death Limitations: Insurance-claims data: people who got the drug may differ from those who did not, so cause cannot be shown. Funding and conflicts: The authors declare no competing interests. Read: abstract
Dávalos 2012 Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet · PMID 22691567 · DOI	Randomised controlled trial	2298 2,298 people with moderate-to-severe acute ischaemic stroke in Germany, Portugal and Spain, treated within 24 hours of symptoms.	Citicoline, first by vein then by mouth Citicoline by vein then by mouth 1000 mg every 12 hours by vein for 3 days, then 2 x 500 mg tablets every 12 hours 6 weeks of treatment; outcome at 90 days · vs Placebo	Recovery was similar in both groups (odds ratio 1.03). The trial was stopped early for futility. No significant differences in safety measures or adverse events. The authors concluded citicoline was not efficacious here. Odds ratio 1.03 (0.86 to 1.25) Methods, limits and funding Outcomes: A combined recovery score at 90 days (stroke scale, disability and daily-living measures); safety Limitations: Moderate-to-severe stroke only, started within 24 hours; the first doses were given by vein, not as a capsule. Funding and conflicts: Funded by Ferrer Grupo, which makes citicoline. Registration: NCT00331890 Read: abstract
Fioravanti 2005 Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev · PMID 15846601 · DOI	Systematic review meta analysis	14 double-blind placebo-controlled randomised trials of CDP-choline (citicoline) in older people, from those with subjective memory complaints to mild-to-moderate vascular cognitive impairment, vascular dementia or senile dementia.	Citicoline (CDP-choline) Oral supplement or injection (see population) Varied between trials; not pooled in the abstract Mostly 20 days to 3 months; one trial 6 weeks, one 12 months · vs Placebo	No evidence of benefit on attention. Evidence of benefit on memory and behaviour. The drug was well tolerated. Evidence from global impression was stronger but limited by short trial length. No pooled numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Attention, memory, behaviour rating scales, global clinical impression, tolerability Limitations: Heterogeneous trials, no intention-to-treat data, short follow-up; the abstract calls for longer studies using current diagnostic criteria. Search ended April 2004. Funding and conflicts: The principal reviewer had been an investigator in some of the included studies. Read: abstract
Kansakar 2023 Choline supplements: An update. Front Endocrinol (Lausanne) · PMID 36950691 · DOI	Narrative review	Review of studies of choline supplement forms: alpha-GPC (choline alfoscerate), choline bitartrate, lecithin and citicoline.	Several choline-related supplements Oral supplement or injection (see population)	The authors call these acetylcholine precursors and say they have been shown to be an effective strategy to boost memory and cognition. This is the authors' view in a narrative review; the pooled reviews on this page are less positive. No numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Memory and cognitive function Limitations: Narrative review, not systematic; only the abstract was read. Funding and conflicts: The authors declare no commercial or financial relationships. Read: abstract
Kerksick 2024 Acute Alpha-Glycerylphosphorylcholine Supplementation Enhances Cognitive Performance in Healthy Men. Nutrients · PMID 39683633 · DOI	Randomised controlled trial	20 20 healthy resistance-trained men, average age 31.3.	Alpha-GPC (a branded product), single doses Oral supplement or injection (see population) 315 mg or 630 mg, one time Single occasion; tests 60 minutes later, then after exercise · vs Placebo (crossover: each man tried all three)	Stroop total score rose more than placebo after both doses (13.0 and 10.8 vs 5.2) and the Stroop test was faster after the higher dose. No differences on the Flanker or N-Back tests, mood scales, physical performance or growth hormone. Heart rate and blood pressure changes were within normal ranges in all groups. Stroop change 13.0 vs 5.2 (p = 0.013) and 10.8 vs 5.2 (p = 0.046) (Not given in the abstract) Methods, limits and funding Outcomes: Stroop, N-Back and Flanker tests, mood scales, jumps, hormones, heart rate and blood pressure Limitations: Only 20 men, one dose, one day; most tests showed no difference; trial registered after it was run. Funding and conflicts: Industry-linked: the author is a paid scientific adviser to the sponsor (NNB Nutrition), which made the product; a plan to manage the conflict was followed. Registration: NCT06690619 (retrospective) Read: abstract
Kim 2020 Enzymatic preparation of food-grade l-α-glycerylphosphorylcholine from soy phosphatidylcholine or fractionated soy lecithin. Biotechnol Prog · PMID 31513729 · DOI	Laboratory method n/a	A laboratory process for making alpha-GPC from soy phosphatidylcholine or soy lecithin.	Alpha-GPC manufacturing Soy-derived material	Shows alpha-GPC can be made by an enzyme process from soy material, giving 98.6 area% alpha-GPC from soy phosphatidylcholine. 98.6 area% purity from soy phosphatidylcholine (Not applicable) Methods, limits and funding Outcomes: Purity of the product Limitations: A manufacturing study, not a health study; it does not say how commercial products are made. Funding and conflicts: Funding not stated in the abstract. Read: abstract
Kucuksahin 2026 The Impact of Citicoline/Phosphatidylserine Supplementation on Cognitive Performance and Executive Functions in Mental Disorders: A Systematic Review of Controlled Trials. Hum Psychopharmacol · PMID 42538853 · DOI	Systematic review	Eleven controlled trials (ten randomised) in children with ADHD (five studies) and adults with mood disorders, alcohol and substance use disorders or schizophrenia.	Citicoline or phosphatidylserine, alone or as an add-on Oral supplement or injection (see population) Varied Varied · vs Placebo or usual care	Findings were mixed and inconsistent. In ADHD, phosphatidylserine-containing supplements improved attention and impulsivity in three studies and not in two. In schizophrenia, one study found better verbal free recall but no global gain. The authors conclude the evidence does not support these as cognitive enhancers in mental disorders. No pooled numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Attention, impulsivity, verbal recall, executive function Limitations: High risk of bias, small studies; citicoline and phosphatidylserine results are combined in the abstract. Funding and conflicts: The authors declare no conflicts of interest. Read: abstract
Lee 2021 Association of L-α Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years. JAMA Netw Open · PMID 34817582 · DOI	Cohort observational	12008977 12,008,977 South Korean adults aged 50 or older without prior stroke or Alzheimer disease; 108,877 were prescribed alpha-GPC in 2006 to 2008.	Alpha-GPC (choline alphoscerate), prescribed Oral supplement or injection (see population) Follow-up January 2009 to January 2018 · vs People not prescribed alpha-GPC	Users had more strokes: total stroke aHR 1.46, ischaemic 1.36, bleeding 1.36. After matching, aHR 1.43, 1.34 and 1.37. Risk rose with longer use. The authors say this is an association and mechanisms need study. An erratum to this paper was published in September 2026; its content was not read. Total stroke aHR 1.46; matched 1.43 (Total 1.43 to 1.48; matched 1.41 to 1.46) Methods, limits and funding Outcomes: New stroke (total, ischaemic, bleeding) Limitations: Observational: users were older and may have had other risks; prescription records only, so actual use is unknown; an erratum exists whose content was not read. Funding and conflicts: Authors report no conflicts of interest. Read: abstract
Lee 2024 Comparative study of choline alfoscerate as a combination therapy with donepezil: A mixed double-blind randomized controlled and open-label observation trial. Medicine (Baltimore) · PMID 38875437 · DOI	Randomised controlled trial	119 119 patients in South Korea with cognitive decline (MMSE 26 or less) who were eligible for donepezil.	Alpha-GPC (choline alfoscerate) added to donepezil Oral supplement or injection (see population) Not given in the abstract 24 weeks · vs Donepezil alone; donepezil with acetyl-L-carnitine; donepezil with ginkgo biloba extract	At 24 weeks the ADAS-Cog improved 18.5% with donepezil plus alpha-GPC and 9.4% with donepezil alone. MMSE rose 1.61% and 1.07% respectively. The non-cognitive scale also favoured the alpha-GPC group. ADAS-Cog change 18.5% vs 9.4% at 24 weeks (Not given in the abstract) Methods, limits and funding Outcomes: MMSE, ADAS-Cog, clinical dementia rating, non-cognitive scale Limitations: Part of the design was open-label (people knew their treatment); small groups; changes are shown as percentages; the authors set out to repeat an earlier Italian trial. Funding and conflicts: The authors report no conflicts of interest. Read: abstract
Martí-Carvajal 2020 Citicoline for treating people with acute ischemic stroke. Cochrane Database Syst Rev · PMID 32860632 · DOI	Systematic review meta analysis	4281 10 randomised trials, 4,281 people with acute ischemic stroke; all judged at high risk of bias; six were sponsored by drug companies.	Citicoline by mouth, by vein, or both Oral supplement or injection (see population) 500 to 2000 mg per day across trials Varied · vs Placebo or standard care	Little or no difference in death (17.3% vs 18.5%), disability or dependence (21.7% vs 19.2%), serious cardiovascular events (8.8% vs 7.8%), Barthel Index recovery or stroke-scale scores. Side effects were poorly reported, so harms may have been underestimated. No trial measured quality of life. Death RR 0.94; disability RR 1.11; serious cardiovascular events RR 1.04 (Death 0.83 to 1.07; disability 0.97 to 1.26; cardiovascular 0.84 to 1.29) Methods, limits and funding Outcomes: Death from any cause, disability at 90 days, serious heart or blood-vessel events, recovery scores Limitations: All trials at high risk of bias; evidence rated low quality; harms poorly reported. Funding and conflicts: Review authors: none known. Drug companies sponsored six of the ten included trials. Read: abstract
Nakazaki 2021 Citicoline and Memory Function in Healthy Older Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Nutr · PMID 33978188 · DOI	Randomised controlled trial	100 100 healthy men and women aged 50 to 85 with age-associated memory impairment; 99 finished.	Citicoline (a branded oral product) Oral supplement or injection (see population) 500 mg per day 12 weeks · vs Placebo	Episodic memory (Paired Associate test) improved more with citicoline than placebo (mean 0.15 vs 0.06, P = 0.0025). A composite memory score also improved more (3.78 vs 0.72, P = 0.0052). The abstract reports these as secondary outcomes. Paired Associate 0.15 vs 0.06; composite memory 3.78 vs 0.72 (Not given in the abstract) Methods, limits and funding Outcomes: Computerised memory tests (episodic memory, composite memory); safety checks Limitations: One trial, 12 weeks, computer tests rather than everyday memory; the abstract reports the gains as secondary outcomes. Funding and conflicts: Industry-linked: the authors work for the citicoline maker (Kyowa Hakko Bio) or its US arm, and a research company; the abstract names the branded product. Registration: NCT03369925 Read: abstract
Prinz 2023 Efficacy of citicoline as a supplement in glaucoma patients: A systematic review. PLoS One · PMID 37768938 · DOI	Systematic review	424 Ten studies, 424 people with glaucoma, followed on average 12.1 months, average age 56.7.	Citicoline Oral supplement or injection (see population) Varied Average 12.1 months · vs Control groups	No significant difference from controls on any of the four measures, and no improvement from the start of treatment to the last follow-up. The authors say there is not enough evidence that citicoline slows glaucoma progression. No significant differences (Not applicable) Methods, limits and funding Outcomes: Eye pressure, visual-field loss (MD 24-2), nerve fibre layer thickness, pattern electroretinogram Limitations: Mixed study designs; the review judged overall risk of bias low to moderate. Funding and conflicts: The authors declare no competing interests. Read: abstract
Que 2021 Citicoline as Adjuvant Therapy in Parkinson's Disease: A Systematic Review. Clin Ther · PMID 33279231 · DOI	Systematic review	Seven studies (2 crossover, 3 randomised, 2 open prospective) of citicoline added to usual Parkinson's treatment, published up to 2019.	Citicoline as an add-on Oral supplement or injection (see population) Varied Varied · vs Usual treatment or placebo	The authors report improvement in rigidity, akinesia, tremor, handwriting, speech and cognition, and that citicoline allowed levodopa to be reduced by up to 50%. They call for more high-quality studies because the studies differed so much. No pooled numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Rigidity, slowness of movement, tremor, handwriting, speech, cognition, levodopa dose Limitations: Small, varied studies, some open-label; no pooled analysis or bias rating in the abstract. Funding and conflicts: The abstract does not state funding or conflicts. Read: abstract
Sagaro 2023 Activity of Choline Alphoscerate on Adult-Onset Cognitive Dysfunctions: A Systematic Review and Meta-Analysis. J Alzheimers Dis · PMID 36683513 · DOI	Systematic review meta analysis	Seven randomised trials and one prospective cohort study of alpha-GPC (choline alphoscerate), alone or with other compounds, in adult-onset cognitive impairment.	Alpha-GPC (choline alphoscerate), alone or with donepezil Oral supplement or injection (see population) Varied Varied · vs Placebo or other medicines	Added to donepezil, alpha-GPC was linked to better cognition (4 trials), function (3 trials) and behaviour (4 trials). Patients given alpha-GPC also had better cognition than those given placebo or other medicines in one comparison. Cognition MD 1.72 (with donepezil); function MD 0.79; behaviour MD -7.61; cognition vs placebo or other medicines MD 3.50 (Cognition 0.20 to 3.25; function 0.34 to 1.23; behaviour -10.31 to -4.91; vs placebo or other 0.36 to 6.63) Methods, limits and funding Outcomes: Cognition, function, behaviour Limitations: Few trials; the abstract does not give a risk-of-bias result; some patients had cerebrovascular injury. Funding and conflicts: The authors report no conflict of interest. Read: abstract
Sagaro 2025 Comparison of the effects of choline alphoscerate and citicoline in patients with dementia disorders: a systematic review and meta-analysis. Front Neurol · PMID 41426989 · DOI	Systematic review meta analysis	358 Three randomised trials, 358 people with dementia disorders, comparing alpha-GPC with citicoline directly.	Alpha-GPC compared with citicoline Oral supplement or injection (see population) Varied Varied · vs Each other (no placebo group in this comparison)	The SCAG rating favoured alpha-GPC (weighted mean difference -3.92). Memory and word-fluency tests did not differ. Dropouts were 9.4% with alpha-GPC and 6.7% with citicoline, not significantly different. SCAG WMD -3.92; dropout odds ratio 1.44 (SCAG -7.41 to -0.42; dropout 0.66 to 3.13) Methods, limits and funding Outcomes: A clinical rating scale (SCAG), memory and word-fluency tests, dropout Limitations: Only three trials; it compares the two products with each other, so it cannot show that either beats no treatment. Funding and conflicts: The authors declare no commercial or financial relationships; the registration is PROSPERO CRD42024626782. Registration: PROSPERO CRD42024626782 Read: abstract
Sohn 2025 Effects of choline alfoscerate on cognitive function and quality of life in type 2 diabetes: A double-blind, randomized, placebo-controlled trial. Diabetes Obes Metab · PMID 39703111 · DOI	Randomised controlled trial	36 36 adults with type 2 diabetes and mild cognitive impairment (MMSE 25 to 28), average age 71.8, 69.4% women.	Alpha-GPC (choline alfoscerate) Oral supplement or injection (see population) 1200 mg per day 12 months · vs Placebo	At 6 months the MMSE difference between groups was +1.4 and not statistically significant (p = 0.059). At 12 months it was +1.7 (p < 0.001). Physical health on the SF-36 survey was better with alpha-GPC. MMSE difference +1.4 at 6 months, +1.7 at 12 months (Not given in the abstract) Methods, limits and funding Outcomes: MMSE, quality of life, daily living, mood questionnaires Limitations: Only 36 people; one centre; a small score difference on a screening test. Funding and conflicts: The abstract does not state funding or conflicts. Read: abstract
Sun 2022 Validated quantitative (31)P NMR spectroscopy for positional isomeric impurity determination in L-α-glycerylphosphorylcholine (L-α-GPC). J Pharm Biomed Anal · PMID 36179504 · DOI	Laboratory method n/a	A laboratory test method to measure an impurity (beta-GPC) in commercial alpha-GPC products.	Alpha-GPC quality testing Commercial alpha-GPC products	Describes a test that can measure the beta-GPC impurity in the range 0.03 to 0.25% of the alpha-GPC. The abstract does not report impurity levels found in products. Method range 0.03 to 0.25% impurity (Not applicable) Methods, limits and funding Outcomes: Method accuracy Limitations: A testing-method paper, not a survey of products. Funding and conflicts: The authors declare no competing interests. Read: abstract
Wang 2021 The Nutritional Supplement L-Alpha Glycerylphosphorylcholine Promotes Atherosclerosis. Int J Mol Sci · PMID 34948275 · DOI	Animal study mouse	Mice prone to high cholesterol (Apoe-/-) fed alpha-GPC, plus human coronary artery cells in the lab.	Alpha-GPC in the diet Oral supplement or injection (see population) · vs Mice not given alpha-GPC	Alpha-GPC worsened artery plaque in the mice. It could be turned into TMAO, a substance linked to artery disease, shifted gut bacteria, and raised inflammation signals in human artery cells in the lab. The authors advise caution with alpha-GPC supplements. No numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Artery plaque, gut bacteria, TMAO, inflammation signals Limitations: Mice and cells, not people; shows a possible pathway only. Funding and conflicts: Two authors hold patents and receive royalties or consulting fees related to heart-disease tests and treatments, including from large companies. Read: abstract
s-fda-pure-nootropics-2019 US Food and Drug Administration, Warning Letter to Pure Nootropics, LLC (dated 2019-02-05) · Source	Reference database n/a			Methods, limits and funding Read: full-text
s-nia-alzheimers-prevention National Institute on Aging: Preventing Alzheimer's Disease: What Do We Know? · Source	Reference database n/a			Methods, limits and funding Read: full-text
s-ods-choline NIH Office of Dietary Supplements: Choline fact sheet for health professionals · Source	Reference database n/a			Methods, limits and funding Read: not-read

What we do not know yet

No large, independent, placebo-controlled trial of either compound in healthy adults lasting months was found.
The memory trial in healthy older adults has not been confirmed by a second group.
The 2026 erratum to the Korean alpha-GPC stroke study was not read.
No pregnancy, breastfeeding or product-quality data were found.
No official intake or upper-limit figure was read (the NIH page was blocked).
Only abstracts were read.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue before the page changes.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 7

●

Episodic memory test score (Paired Associate)

Higher with citicoline than placebo in trials

A computer test of how well a person learns and recalls pairs of items.

Low certainty

Results and what it means

Why it was measured

To see whether citicoline changes memory in healthy older adults.

Statistical vs. clinical meaning

A computer-test gain; it does not show better everyday memory.

Safety implication

None reported in the abstract.

Study	Result	People	Product
¹⁴	Improvement 0.15 with citicoline vs 0.06 with placebo (P = 0.0025)	100 healthy adults aged 50 to 85 with age-associated memory impairment	Branded oral citicoline for 12 weeks

¹⁴

●

Mini-Mental State Examination (MMSE) score

Higher with alpha-GPC than placebo at 12 months in trials

A short 30-point screening test of thinking and memory.

Low certainty

Results and what it means

Why it was measured

To track thinking in people with cognitive decline.

Statistical vs. clinical meaning

A small difference on a screening test in a small trial; it does not show slower decline in daily life.

Safety implication

None reported in the abstract.

Study	Result	People	Product
¹⁹	Difference +1.4 at 6 months (p = 0.059) and +1.7 at 12 months (p < 0.001)	36 adults with type 2 diabetes and mild cognitive impairment (average age 71.8)	Alpha-GPC by mouth for 12 months vs placebo

¹⁹

●

ADAS-Cog score (Alzheimer's thinking scale)

Improved more with donepezil plus alpha-GPC than donepezil alone in trials

A longer clinician-rated scale of thinking and memory used in Alzheimer's trials.

Low certainty

Results and what it means

Why it was measured

To see whether adding alpha-GPC to donepezil changes thinking.

Statistical vs. clinical meaning

Part of the trial was open-label, groups were small and changes are given as percentages.

Safety implication

None described in the abstract.

Study	Result	People	Product
¹²	Improved 18.5% with donepezil plus alpha-GPC vs 9.4% with donepezil alone at 24 weeks	119 patients with cognitive decline in South Korea	Alpha-GPC added to donepezil

¹²

●

Stroop test score

Higher after alpha-GPC than placebo in trials

A timed test of how well a person ignores a distracting cue, such as a colour word printed in a different colour.

Very low certainty

Results and what it means

Why it was measured

A simple lab measure of attention and mental control.

Statistical vs. clinical meaning

One test on one day in 20 men; two other tests showed no difference.

Safety implication

Heart rate and blood pressure stayed within normal ranges.

Study	Result	People	Product
⁸	Change 13.0 and 10.8 for the two amounts vs 5.2 for placebo	20 healthy resistance-trained men	Single amounts of branded alpha-GPC, 60 minutes before testing

⁸

●

Recovery at 90 days after stroke

No difference from placebo in trials

A combined score of stroke scale, disability and daily-living measures three months after the stroke.

Evidence against

Results and what it means

Why it was measured

To see whether citicoline helps people recover after an ischaemic stroke.

Statistical vs. clinical meaning

A large, well-run trial that found no benefit.

Safety implication

No significant difference in adverse events.

Study	Result	People	Product
⁵	Odds ratio 1.03 (95% CI 0.86 to 1.25); stopped for futility	2,298 people with moderate-to-severe ischaemic stroke	Citicoline by vein then by mouth for 6 weeks vs placebo

⁵

●

Death from any cause after stroke

No clear difference in trials

The share of people who died during follow-up.

Low certainty

Results and what it means

Why it was measured

A hard outcome that does not depend on test scores.

Statistical vs. clinical meaning

Little or no difference; trials were at high risk of bias.

Safety implication

Harms were poorly reported, so safety remains unknown.

Study	Result	People	Product
¹³	17.3% with citicoline vs 18.5% with control (RR 0.94, 95% CI 0.83 to 1.07)	Eight trials of people with acute ischemic stroke	Citicoline by mouth, vein or both vs placebo or standard care

¹³

●

Eye pressure (intraocular pressure) in glaucoma

No significant change in trials

The fluid pressure inside the eye, the main modifiable risk factor in glaucoma.

Not enough evidence

Results and what it means

Why it was measured

To see whether citicoline changes the main glaucoma risk factor.

Statistical vs. clinical meaning

No sign it protects the eye; usual glaucoma treatment is needed regardless.

Safety implication

None described in the abstract.

Study	Result	People	Product
¹⁵	No significant difference from controls and no improvement from baseline	424 people with glaucoma in 10 studies	Citicoline as a supplement

¹⁵

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 3

Alpha-GPC was linked to more strokes in a very large Korean study. In about 12 million South Korean adults aged 50 and over, people prescribed alpha-GPC had more strokes over 10 years: total stroke aHR 1.46, ischaemic stroke 1.36 and bleeding stroke 1.36. Risk rose with longer use. This is an association in prescription records, not proof that alpha-GPC caused strokes, and users were older. A mouse study found alpha-GPC worsened artery plaque and could be turned into TMAO, a substance linked to artery disease. A 2026 review says the evidence on TMAO harm is inconsistent. An erratum to the Korean paper was published in September 2026; its content was not read. Anyone with stroke or heart-and-blood-vessel disease, or at higher risk, should ask a doctor first. Observational cohort (association) and mouse and lab data ^{11 21 3}
Side effects of citicoline are poorly reported. A 2020 Cochrane review of 10 stroke trials says side effects were poorly reported, harms may have been underestimated, and the safety profile of citicoline remains unknown. The large ICTUS trial found no significant difference in adverse events against placebo, and a 2005 Cochrane review of memory trials said the drug was well tolerated. Those trials used medicine-grade citicoline, often by vein, which is not the same as a capsule from a shop. Systematic reviews and a randomised trial ^{13 5 6}
Memory loss and stroke need a doctor, not a supplement. The US FDA told one online seller in 2019 that its alpha-GPC and CDP-choline capsules were unapproved new drugs because of disease claims such as preventing Alzheimer's disease. That letter was about one seller's claims. The National Institute on Aging advises checking with a doctor before trying any pill or supplement that promises to prevent Alzheimer's, which might be unsafe, a waste of money, or both. Regulator and authoritative guidance ^{22 23}

Side effects 5

Effect	How often	Severity and recovery	Evidence
No significant difference in adverse events against placebo in the largest citicoline trial Patients were in hospital with stroke; results may not apply to healthy people taking capsules.	The ICTUS trial of 2,298 stroke patients reported no significant difference in the rate of adverse events or in safety variables.	Not specified in the abstract Not specified	Randomised trial (industry funded) ⁵
Poorly reported adverse events across 10 stroke trials Cochrane says other effects (nervous system, stomach and gut, muscle) were poorly reported, so the specific side effects of citicoline are not described in the abstract.	Serious cardiovascular events were 8.83% with citicoline and 7.77% with control (RR 1.04, 95% CI 0.84 to 1.29), a result Cochrane judged to show little or no difference.	Not applicable Not applicable	Systematic review (low certainty evidence) ¹³
Dropout from treatment was similar for alpha-GPC and citicoline Reasons for stopping are not given in the abstract.	9.4% of people stopped alpha-GPC and 6.7% stopped citicoline in three trials in dementia (odds ratio 1.44, 95% CI 0.66 to 3.13).	Not applicable Not applicable	Meta-analysis ¹⁸
Short-lived heart rate and blood pressure changes after single alpha-GPC doses Twenty young men on one day; not evidence about long-term use.	Statistically significant changes in heart rate and blood pressure were seen in all groups, including placebo, with all values in normal ranges.	Not applicable (normal ranges) Not specified	Small randomised crossover trial (industry linked) ⁸
More strokes in people prescribed alpha-GPC (association) See the first key warning. The cause, if any, is not known.	Total stroke aHR 1.46 (95% CI 1.43 to 1.48) against non-users over 10 years; higher with longer use.	Serious Not applicable	Observational cohort of 12 million people (association, not proof of cause) ¹¹

Liver

No liver injury from citicoline or alpha-GPC was found in the sources read. The LiverTox database was not checked, so this is not a statement that they are safe for the liver. ¹³

How often. No frequency was found.

Monitoring. No agency monitoring advice was found.

This is a safety connection. It is not evidence that Citicoline and Alpha-GPC supports liver health.

Medicines and supplements 4

With	Why it matters	Importance	Evidence	What to do
Levodopa and other Parkinson's disease medicines prescription	Proposed by a review: citicoline raises dopamine production and slows its removal.	A 2021 review of seven small Parkinson's studies says citicoline allowed levodopa to be reduced by up to 50%. That implies an effect on how much of the medicine is needed. Any change to Parkinson's medicines must come from the treating doctor.	Systematic review of small, mixed studies (no interaction trial) Very low certainty ¹⁶	Ask the treating neurologist or a pharmacist before adding citicoline.
Donepezil and other dementia medicines prescription	Not established. Both aim at acetylcholine pathways.	Alpha-GPC has been tested added to donepezil in trials, and the abstracts report better scores, not harm. Those abstracts do not report side effects, so no safety conclusion can be drawn.	Randomised trials and meta analysis (efficacy focus) Very low certainty ^{17 12}	Ask the doctor who prescribes the dementia medicine.
Blood thinners, antiplatelet medicines and other stroke-prevention medicines prescription	Not established. Alpha-GPC prescriptions were linked to both blocked-vessel and bleeding strokes in a cohort.	No interaction study was found. The stroke association is the reason to ask first.	No direct data; observational cohort Not enough evidence ¹¹	Ask a doctor or pharmacist before combining.
Caffeine and other brain or choline supplements supplement	Not established.	A citicoline-and-caffeine drink was tested in 60 healthy adults and the abstract reports benefits, not harms. A review lists alpha-GPC, choline bitartrate, lecithin and citicoline as related acetylcholine precursors, but no study of taking them together was read.	Small trial and narrative review Not enough evidence ^{2 7}	Ask a doctor or pharmacist before combining with other supplements.

Who should check first 5

Situation	Advice	Evidence
Stroke, heart-and-blood-vessel disease or higher stroke risk (alpha-GPC)	A very large cohort linked alpha-GPC prescriptions to more strokes. No agency contraindication was read, but people at risk should ask a doctor first.	Observational cohort ¹¹
Pregnancy	No pregnancy data for citicoline or alpha-GPC were found in the sources read. Ask a doctor.	No data found
Breastfeeding	No breastfeeding information was found in the sources read; a LactMed record was not found. Ask a doctor.	No data found
Children	A 2026 review included five studies in children with ADHD, mostly of phosphatidylserine-containing supplements, and found mixed results. Its abstract does not report safety. No official guidance for children was read. Ask a doctor.	Systematic review ¹⁰
Allergy to soy or other source ingredients	A 2020 laboratory paper shows alpha-GPC can be made from soy lecithin or soy phosphatidylcholine. How commercial products are made was not read. If you have a soy allergy, ask a pharmacist.	Laboratory method paper ⁹

Overdose, product quality and regulators

Summary. No animal toxicity or human overdose studies for citicoline or alpha-GPC were read.

Animal. A mouse study found alpha-GPC worsened artery plaque in mice bred for high cholesterol; see the key warning.

High dose or long term signals. A cohort linked longer alpha-GPC prescription use to a higher stroke risk.

Overdose response. No overdose reports were read.

Genotoxicity. Not researched.

No survey of what is in citicoline or alpha-GPC products was read, so contents and purity are unknown.

Product quality testing. A 2022 laboratory paper describes a way to measure an impurity (beta-GPC) in commercial alpha-GPC. The abstract does not report levels found in products. ²⁰

Illegal disease claims. The FDA warning letter shows that products sold as alpha-GPC and CDP-choline capsules have been marketed with unapproved disease claims. ²²

Body	Action	Date
US Food and Drug Administration (Center for Food Safety and Applied Nutrition), warning letter to Pure Nootropics, LLC (United States)	Said the seller's alpha-GPC and CDP-choline capsules and other products were unapproved new drugs because the website claimed they could treat or prevent disease, such as cognitive decline and Alzheimer's disease. The letter is about one seller's claims, not a ruling on the compounds themselves. source	2019-02-05
National Institute on Aging (US National Institutes of Health) (United States)	Advises checking with a doctor before trying pills or supplements that promise to prevent Alzheimer's, which might be unsafe or a waste of money. source
Cochrane review abstract (2005) and a 2023 review abstract (Several European countries (as described); approval differs between countries)	Describe citicoline as a frequently prescribed medicine for cognitive impairment in several European countries, and alpha-GPC as a medicine or nutraceutical with a 1985 marketing authorization and differing approval status between countries. source	2005 and 2023

When to get medical help

Sudden face drooping, arm or leg weakness, trouble speaking, sudden confusion, loss of vision or a sudden severe headache: call emergency services at once. These can be signs of a stroke.
Rash, swelling of the face or throat, or trouble breathing after taking a supplement: get urgent medical help.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What are citicoline and alpha-GPC?

Two different choline-containing compounds sold for memory and focus. Citicoline (CDP-choline) is made by the body, and alpha-GPC (choline alfoscerate) is a choline phospholipid. Neither is the essential nutrient choline.

^{6 17}

Do they help memory in older people with memory problems?

A Cochrane review found some benefit for memory and behaviour with citicoline but none for attention. Alpha-GPC added to donepezil was linked to small gains in thinking. Studies were small, short and often poor quality.

^{6 17 1}

Do they help memory in healthy people?

One trial in 100 healthy adults aged 50 to 85 found larger memory-test gains with citicoline, but its authors are linked to the product maker. Single doses of alpha-GPC raised one attention test score in 20 men. Evidence is thin.

^{14 8}

Is alpha-GPC better than citicoline?

A 2025 analysis of three trials in dementia found one rating scale favoured alpha-GPC, while memory and word-fluency tests did not differ. It compares the two with each other, so it cannot show either works better than no treatment.

¹⁸

Does citicoline help recovery after a stroke?

No. The ICTUS trial of 2,298 patients found recovery similar to placebo and stopped early. A Cochrane review of 10 trials found little or no difference in death or disability.

^{5 13}

Does citicoline help glaucoma?

A 2023 review of 10 studies found no significant difference in eye pressure, visual field or other measures. It is not a replacement for prescribed eye treatment.

¹⁵

Does citicoline help Parkinson's disease?

A 2021 review of seven small studies reported better movement symptoms and a lower need for levodopa, but the studies were varied. Only a doctor should change Parkinson's medicines.

¹⁶

Is alpha-GPC linked to stroke?

In about 12 million Korean adults, people prescribed alpha-GPC had more strokes over 10 years (total stroke aHR 1.46). This shows an association, not that alpha-GPC caused strokes. A mouse study found it worsened artery plaque.

^{11 21}

What are the side effects?

Side effects of citicoline are poorly reported. The big stroke trial found no significant difference in adverse events from placebo, but Cochrane says the safety profile remains unknown. Alpha-GPC has the stroke signal above.

^{5 13 11}

Do they interact with medicines?

A review says citicoline allowed levodopa to be reduced in Parkinson's patients. Alpha-GPC has been studied added to donepezil, but side effects were not reported in the abstracts. No interaction study with blood thinners was found. Ask a doctor or pharmacist.

^{16 12}

Are they safe in pregnancy, breastfeeding or for children?

No pregnancy or breastfeeding data were found in the sources read. A 2026 review included children with ADHD but did not report safety in its abstract. Ask a doctor before use.

¹⁰

Are they foods or medicines?

They are sold as supplements, and in some countries as prescription medicines. The FDA told one seller in 2019 that its alpha-GPC and CDP-choline capsules were unapproved drugs because of disease claims. Choline, the essential nutrient, is in food.

^{6 17 22}

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against the sources listed.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-26
Last substantive update: 2026-10-26
How we research: We started from our existing summary and re-read PubMed abstracts for the reviews and trials, an FDA warning letter and a National Institute on Aging page. Only abstracts were read for studies. The NIH Office of Dietary Supplements page was blocked and is marked unread.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. Several cited trials are industry-linked, and we say so where the abstract shows it.

Sources 24

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Bonvicini M, Travaglini S, Lelli D, Antonelli Incalzi R, Pedone C. Is Citicoline Effective in Preventing and Slowing Down Dementia?-A Systematic Review and a Meta-Analysis.. Nutrients. 2023. PMID 36678257. DOI 10.3390/nu15020386. (abstract)
Bruce SE, Werner KB, Preston BF, Baker LM. Improvements in concentration, working memory and sustained attention following consumption of a natural citicoline-caffeine beverage.. Int J Food Sci Nutr. 2014. PMID 25046515. DOI 10.3109/09637486.2014.940286. (abstract)
Chen S, Ohkubo T, Yanaka N, Aisyah R. A Friend or Foe: Understanding the Physiological Significance, Therapeutic Uses, and Potential Risks of Glycerophosphocholine-A Narrative Review.. Nutrients. 2026. PMID 42196986. DOI 10.3390/nu18101526. (abstract)
Duong KL, Jung H, Lee HK, Moon YJ, Lee SK, Yang BR, Yun HY, Chae JW. Effect of choline alfoscerate in older adult patients with dementia: an observational study from the claims data of national health insurance.. BMC Geriatr. 2024. PMID 39548376. DOI 10.1186/s12877-024-05531-y. (abstract)
Dávalos A, Alvarez-Sabín J, Castillo J, Díez-Tejedor E, Ferro J, Martínez-Vila E, Serena J, Segura T, Cruz VT, Masjuan J, Cobo E, Secades JJ. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial).. Lancet. 2012. PMID 22691567. DOI 10.1016/S0140-6736(12)60813-7. (abstract)
Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly.. Cochrane Database Syst Rev. 2005. PMID 15846601. DOI 10.1002/14651858.CD000269.pub3. (abstract)
Kansakar U, Trimarco V, Mone P, Varzideh F, Lombardi A, Santulli G. Choline supplements: An update.. Front Endocrinol (Lausanne). 2023. PMID 36950691. DOI 10.3389/fendo.2023.1148166. (abstract)
Kerksick CM. Acute Alpha-Glycerylphosphorylcholine Supplementation Enhances Cognitive Performance in Healthy Men.. Nutrients. 2024. PMID 39683633. DOI 10.3390/nu16234240. (abstract)
Kim J, Song Y, Lee SJ, Lee JE, Chung MY, Kim IH, Kim BH. Enzymatic preparation of food-grade l-α-glycerylphosphorylcholine from soy phosphatidylcholine or fractionated soy lecithin.. Biotechnol Prog. 2020. PMID 31513729. DOI 10.1002/btpr.2910. (abstract)
Kucuksahin NG, Kaya TT, Halac E, Sut E, Ciray RO. The Impact of Citicoline/Phosphatidylserine Supplementation on Cognitive Performance and Executive Functions in Mental Disorders: A Systematic Review of Controlled Trials.. Hum Psychopharmacol. 2026. PMID 42538853. DOI 10.1002/hup.70058. (abstract)
Lee G, Choi S, Chang J, Choi D, Son JS, Kim K, Kim SM, Jeong S, Park SM. Association of L-α Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years.. JAMA Netw Open. 2021. PMID 34817582. DOI 10.1001/jamanetworkopen.2021.36008. (abstract)
Lee W, Kim M. Comparative study of choline alfoscerate as a combination therapy with donepezil: A mixed double-blind randomized controlled and open-label observation trial.. Medicine (Baltimore). 2024. PMID 38875437. DOI 10.1097/MD.0000000000038067. (abstract)
Martí-Carvajal AJ, Valli C, Martí-Amarista CE, Solà I, Martí-Fàbregas J, Bonfill Cosp X. Citicoline for treating people with acute ischemic stroke.. Cochrane Database Syst Rev. 2020. PMID 32860632. DOI 10.1002/14651858.CD013066.pub2. (abstract)
Nakazaki E, Mah E, Sanoshy K, Citrolo D, Watanabe F. Citicoline and Memory Function in Healthy Older Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.. J Nutr. 2021. PMID 33978188. DOI 10.1093/jn/nxab119. (abstract)
Prinz J, Prokosch V, Liu H, Walter P, Fuest M, Migliorini F. Efficacy of citicoline as a supplement in glaucoma patients: A systematic review.. PLoS One. 2023. PMID 37768938. DOI 10.1371/journal.pone.0291836. (abstract)
Que DS, Jamora RDG. Citicoline as Adjuvant Therapy in Parkinson's Disease: A Systematic Review.. Clin Ther. 2021. PMID 33279231. DOI 10.1016/j.clinthera.2020.11.009. (abstract)
Sagaro GG, Traini E, Amenta F. Activity of Choline Alphoscerate on Adult-Onset Cognitive Dysfunctions: A Systematic Review and Meta-Analysis.. J Alzheimers Dis. 2023. PMID 36683513. DOI 10.3233/JAD-221189. (abstract)
Sagaro GG, Amenta F. Comparison of the effects of choline alphoscerate and citicoline in patients with dementia disorders: a systematic review and meta-analysis.. Front Neurol. 2025. PMID 41426989. DOI 10.3389/fneur.2025.1649661. (abstract)
Sohn M, Park YH, Lim S. Effects of choline alfoscerate on cognitive function and quality of life in type 2 diabetes: A double-blind, randomized, placebo-controlled trial.. Diabetes Obes Metab. 2025. PMID 39703111. DOI 10.1111/dom.16131. (abstract)
Sun L, Fan Y, Wang Q, Xiang L, Han H, Chen D. Validated quantitative (31)P NMR spectroscopy for positional isomeric impurity determination in L-α-glycerylphosphorylcholine (L-α-GPC).. J Pharm Biomed Anal. 2022. PMID 36179504. DOI 10.1016/j.jpba.2022.115067. (abstract)
Wang Z, Hazen J, Jia X, Org E, Zhao Y, Osborn LJ, Nimer N, Buffa J, Culley MK, Krajcik D, van den Born BH, Zwinderman K, Levison BS, Nieuwdorp M, Lusis AJ, DiDonato JA, Hazen SL. The Nutritional Supplement L-Alpha Glycerylphosphorylcholine Promotes Atherosclerosis.. Int J Mol Sci. 2021. PMID 34948275. DOI 10.3390/ijms222413477. (abstract)
. US Food and Drug Administration, Warning Letter to Pure Nootropics, LLC (dated 2019-02-05). . . (full-text)
. National Institute on Aging: Preventing Alzheimer's Disease: What Do We Know?. . . (full-text)
. NIH Office of Dietary Supplements: Choline fact sheet for health professionals. . . (not-read)

Where to buy

Check the label first. Whatever you buy, look for these:

The amount of the active ingredient per serving, not just the front-label claim
A third-party testing mark (USP, NSF or ConsumerLab)
Other ingredients and allergens
Ask a pharmacist about interactions with your medicines

Talk to a pharmacist or doctor before you start any supplement, especially if you take medicines. See the Safety tab for interactions.

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Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.