It is produced by the body as an intermediate product of phosphatidylcholine and sphingomyelin biosynthesis ( 11, 12). Citicoline is a naturally occurring mononucleotide comprised of cytosine, ribose, pyrophosphate, and choline. Compared with choline moiety obtained through other dietary sources such as phosphatidylcholine, choline in citicoline has been suggested to be less prone to conversion to trimethylamine (TMA) and trimethylamine N-oxide (TMAO), which have been implicated in the pathogenesis of cardiovascular disease ( 10). One method to increase dietary choline is through supplementation with citicoline (CDP-choline or cytidine-5′-diphosphate choline), choline salts, such as choline chloride and choline bitartrate, glycerophosphocholine, as well as phosphatidylcholine. Not surprisingly, higher dietary choline is associated with better cognitive performance in elderly individuals ( 8, 9). Brain choline uptake is decreased in older adults ( 7) and the lower supply of extracellular choline may contribute to aging-related cognitive decline. For example, choline metabolites acetylcholine and phosphatidylcholine, respectively, contribute to proper signaling functions for normal cholinergic neurotransmission and the structural integrity of cell membranes ( 6). Choline is essential for several biological functions of cells. Additionally, individual nutrients such as B vitamins, antioxidant polyphenols, selenium, vitamin D, medium-chain triglycerides, and long-chain omega-3 fatty acids have been investigated for their potential cognitive-enhancing properties ( 5).Īn important nutrient that is known to affect brain development and aging is choline. Some evidence points to specific dietary patterns (e.g., ketogenic or Mediterranean diets) as having strong potential to combat age-related cognitive decline ( 4). There is extensive evidence on how nutrients and bioactive compounds may impact on cognitive decline due to aging ( 3). No effective pharmaceutical treatments for age-related cognitive decline are available, emphasizing the importance of prevention strategies against cognitive decline. Although age is the most important predictor of cognitive decline, this process is a complex interplay of many contributing factors including demographic, genetic, socioeconomic, environmental, and nutritional parameters ( 2). An expected challenge of an aging population is the increased rates of health issues associated with aging, such as age-related cognitive decline. Projections of the World Population Prospects by the United Nations suggest that 1 in 6 people (16%) in the world will be aged over 65 y by 2050 ( 1).
The world's population is aging with almost every country experiencing a growth in the number and proportion of older persons.