Choline, parenteral nutrition, and cognitive decline. (Literature Review & Commentary).(Brief Article)

Eleven patients who had received total parenteral nutrition (TPN) for more than 80% of their nutritional needs for at least 12 weeks were randomly assigned to receive their usual TPN regimen (n = 6; mean age, 34.0 years) or their usual TPN regimen plus 2 g/day of choline chloride (n = 5; mean age, 37.3 years). The following neuropsychological tests were administered at baseline and after 24 weeks: Weschler Adult Intelligence Scale-Revised (WMS-R, intellectual functioning), Weschler Memory Scale-Revised (WMS-R, 2 subtests, verbal and visual memory), Rey-Osterrieth Complex Figure Test (visuospatial functioning and perceptual organization), Controlled Oral Word Association Test (verbal fluency), Grooved Pegboard (manual dexterity and motor speed), California Verbal Learning Test (CVLT, rote verbal learning ability), and Trail Making Parts A & B (visual scanning, psychomotor speed and set shifting). Compared with the placebo group, significant improvements were seen in the choline group in the delayed visual recall of the WMS-R (p = 0.028), and borderline improvements were seen in the List B subset of the CVLT (p = .06) and the Trails A test (p = .067).

Comment: This study demonstrates that both verbal and visual memory may be impaired in patients receiving long-term parenteral nutrition, and that both of these deficits may be improved with choline supplementation. As a component of acetylcholine, choline plays an important role in normal brain function. Choline deficiency is uncommon, because it can be manufactured in the body and is present in many foods. However, patients receiving choline-free parenteral nutrition as their main source of nutrition are apparently not capable of manufacturing sufficient amounts of this compound. Because of the wide range of nutritional deficiencies that have been reported in patients fed intravenously, it would be more appropriate to change the term "total parenteral nutrition" to "sub-total parenteral nutrition."

Buchman AL, et al. Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study. J Parenter Enteral Nutr 2001;25:30-35.




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