The reason I am writing this second part is twofold, one is that when I wrote the original post, it was very specific to my friend's condition which involved more than memory deficits that she wanted to try and improve, so not 100% specific for memory, but interest in this post is for the memory aspect of this supplement regimen. So in order to focus more specifically on memory improvement, I am changing this supplement regimen based on reader interest as well as potentially improving memory benefit and elapsed time to benefit as well as new research.
So in this new regimen, I still want to keep 5 supplements, but I want to decrease the time to test each supplement, rearrange the order, drop one supplement and add a new supplement.
Here is the revised regimen :
1. Vinpocetine @ 30 mg/day + Vitamin D @ 5000 IU/day up to 10,000 IU/day
2. Lithium Orotate 5 mg/day up to 20 mg/day if needed
3. Citicoline 500 mg/day up to 1,000mg/day
4. Melatonin 10 mg/night up to tolerance if needed
If another friend were to want to test this regimen, I would suggest the above order and I would suggest testing each number for 4 to 6 weeks before adding the next number to make sure that they will tolerate each number before adding the next. If they go with a 6 week test for each number, that is 24 weeks to test the full regimen and results should be apparent by 24 weeks or 6 months which is significantly quicker that the original regimen. If they only test each number for one month, it will take 4 months to test all numbers and some benefit should be noticeable by 4 months which again, is substantially quicker than the original regimen.
The reason I am dropping AMLA extract is because it was focused more toward other health issues that my friend was having and less toward memory improvement. The reason I am adding Citicoline is because the research has evolved since I wrote part 1 and I think Citicoline represents a meaningful advancement in memory enrichment that is worth incorporating in a good memory supplement regimen and an effective memory regimen should not be static and should adapt as the research in the field of memory expands. I am adapting this regimen to reflect the current science and to significantly improve potential response time to this regimen. The following new (August 2021), randomized, placebo controlled, double blind trial using Citicoline in trial participants for 12 weeks represents very good progress in the science of memory enrichment, though it has gotten no significant fanfare whatsoever.
>>>>>>> A warning regarding Citicoline in PwP <<<<<<<
Although this new study above suggests that Citicoline is likely useful in terms of memory improvement, Citicoline is also suggested to be useful in promotion of levodopa and in PwP, that means that the addition of Citicoline to your C/L regimen may result in too much dopamine, which can lead to issues such as seen when the C/L dose is too high and in fact some PwP have been able to decrease their C/L dose after adding Citicoline to their daily C/L regimen. For this reason, you should seek the advice and direction of your neurologist or movement disorder specialist before adding Citicoline to your PD regimen.
Although this regimen is more memory specific, it too should offer other health benefits over time. These supplements all have at least a very good safety profile at the doses used.
Art
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Citicoline can make your C/L meds more effective, so people with PD can have the extra benefit of lowering their C/L dose. This probably wouldn't happen on a dose of 500mg per day -- more likely at 750-1000mg per day. But do be aware, if you start to develop C/L side effects like dyskinesia, it means you can try (carefully and with your doctor's approval) gradually reducing your C/L dose. Per Dr. Laurie Mischley.
Yes, it would be higher dosing of Citicoline for PD alone. This should make it a very good memory regimen for anyone already using Citicoline for PD, but in terms of memory, the 500 mg dose meets the dose that was used effectively in the study.
I am a little familiar with it, Despe. I think it is very likely that it will work, and it appears he has streamlined his approach, but it is a little difficult in that it requires regular testing that will not likely be covered by most insurance, which would be an out of pocket expense and it requires a practitioner who is as well versed in the execution of his regimen as he is. Here is a link to expenses related to his treatment plan.
Actually, I need to rephrase, I asked if it was good for Lewy Body dementia. He said yes.
I decided to “treat myself” to a 4 day break from my strict diet and exercise. I feel awful. Cognitively, physically, I feel so much worse. I’m jumping back in to my diet inspired by Dr. Bredeson and Perlmutter.
HDT & HDM are fine. However, what about High Dose B6 ? Do you realize, folks, that this vitamin is virtually poured everywhere ? Melatonin 10 mg comes with 10 mg B6. Mg most of the time comes with B6. The same for B Complex, for obvious reasons, etc. At the end of the day, the body is swimming in a sea of B6...
That may be so....but as we age the gut microbiome that breaks down and absorbs these vitamins becomes less functional...so most of the nutrients you ingest just pass through to the porcelain throne.
Melatonin 10 mg with B-6 is the exception, not the rule. There are more melatonin at 10 mg without B-6 available than with B-6. The B-6 is used because it can potentially increase bioavailability of melatonin which has poor bioavailability estimated between 3% and 15%.
Assuming that you mistakenly got a melatonin bottle that had B-6 with the melatonin, it is 10 mg of B6 per capsule.
In the context of this thread, B6 is not really part of it.
Art
As always, you are a blessing to us. Is keeping the supplements at just 5 to encourage compliance?
For memory and cognition, I believe Taurine is good too?
Yes, it is about compliance since it could be the best remedy in the world, but if you don't take it regularly, what good will it be? I think combining vitamin D with Vinpocetine in #1 might be helpful in speeding the process up and most people tolerate vitamin D at the dosage used with only a few exceptions.
Yes, taurine is good and is on my substitution list of memory supplements in case one doesn't work out, there are plenty of options!
I believe that vitamin D plays a role in maintaining memory, preventing dementia and it is useful for many other health issues. I only combined it with Vinpocetine because I felt that most people can tolerate that dose range of 5000 IU to 10,000 IU and by combining with another supplement, reduced the total testing time of the regimen and potentially decreased the elapsed time to benefit. Imo, Vinpocetine stands on its own merits as far as memory enhancement. I linked to several studies regarding vitamin D and memory in Part 1.
Here are those three studies on vitamin D and dementia prevention :
I’m looking to buy the Vinpocetine. Amazon had all manner of random “brain pills” but no Vinpocetine. Vita cost has it from a brand called Source Naturals. I’ve never seen this company. Anyone have a recommended source? Not on the list but also ordering Broco Max from Jarrow since I’ve yet to grow my broccoli sprouts myself.
Yes, Amazon in their infinite wisdom decided to stop carrying NAC and Vinpocetine, which makes no sense for two supplements that actually do something useful. I'd rather give my business to Vitacost any day. The Source Naturals and Life Extension are both good products and they both have an additional 12% off with the code right below them :
Oh, I see I'm too late. Was going to suggest Piping Rock for Vinpocetine. I have been buying 30mg capsules from them at a very good price. They ship here to the UK and charge shipping, taxes and duty at source which means there are no hidden surprise costs when the items arrive.......and they still work out cheaper than most UK suppliers!
I have no memory, decision making or other cognitive issues. I am just trying because all PWP have reduced blood flow to the brain, and Vinpocetine + Gingko work synergistically to increase blood flow to the brain as well as exert neuroprotective effects, hence the tryout.
The reason that vinpocetine is at the number one spot is because it has quite a few studies and history to place it there, whereas very low dose lithium orotate (LO) does not have those studies, but it does have a lot of anecdotal evidence to support its use for the purpose and this is probably why your husbands neurologist is recommending it to him. If you do decide to test LO first, the vitamin D could remain in the number one spot with it and then vinpocetine could take the number 2 spot and the others remain the same. That's what I would do for myself.
Btw, what dose of LO is his neurologist recommending your husband take?
Regarding the Citicoline raising dopamine levels, that is a known positive effect of Citicoline and this has allowed some people to lower their C/L dose significantly. This C/L dose sparing effect of Citicoline may potentially allow for slower increases of C/L dosing through the years for the purpose of possibly extending the useable time that C/L will remain effective for the patient, but that is currently unknown.
>>> ' Take in concert, these results suggest that melatonin reduces AD-related deficits in mitophagy such that the drug should be considered as a therapeutic candidate for the treatment of AD. ' <<<
I had a conversation with my friend, about two months ago, who I originally wrote this thread about. In that conversation she mentioned to me that she was about to run out of her regular melatonin capsules of which she has been taking 2 capsules at 10 mg each per night for a total of 20 mg per night. She asked me to order more for her so I told her I was going to order her the type that dissolves in the mouth, for three reasons. One, I think it is better absorbed than the capsules she was taking, two, it may offer some protection to her teeth and gums and three, the particular product I was going to order for her had 12 mg instead of 10mg so this would increase her nightly dose by 4 mg to 24 mg/night.
She came by to visit yesterday after picking up her lab results at her doctor's office which she wanted to discuss with me and while we were talking, she told me that something unusual had happened in the past week or two, she noticed that she can now move around in bed much easier and can get in and out of bed with little effort compared to the previous 3 years. She is 79 years old now. She also told me that now she can get up from a seated position with little effort, whereas before, she said she actually had to think of how she was going to get out of bed or standup from a seated position and then with great effort, make the move to get up.
I asked her what she attributed this change to and she said the only thing she had changed in her regimen was the melatonin that she dissolves in her mouth every night before bed. She said she only wants me to order her that type from now on!
She told me that she is off all medications now and is only using the supplements that I have recommended to her. She further told me that her A1C was down, her triglycerides were significantly down, her LDL cholesterol was modestly down, her HDL was up and she was feeling pretty darn good and we both smiled at that last comment. She also told me that her dizziness is almost completely gone after I suggested that she try the Epley Maneuver a few times because her balance was really bad she would feel dizzy to the point of almost falling and would need to lay down frequently. Overall, she said she was quite happy with her latest results and she told me that her cholesterol results would likely have been better, but she was only taking her lecithin drink about 2 or three times a week. She also said that now that she sees how much the lecithin moved her numbers, she will start taking it faithfully. Lastly, she told me that she still keeps her walking cane in her car, but has not used it in many months.
It was a good visit and I am so happy to see my friend returning to the person she used to be!
To be clear, what she was attributing her recent ability to move around in bed with greater ease, improved ability to get in and out of bed and the ability to just standup from a seated position with much less effort, to her change of melatonin from capsules to fast dissolve tablets.
The brand is Carlyle and they describe them as "Fast Dissolve" 12 mg Melatonin Natural Berry Flavor.
Here is another study showing that Citicoline (Recognan) is useful in patient's who already have mild cognitive impairment. So this is further confirmation that Citicoline belongs as part of this memory improvement regimen. Here is a link to the abstract :
>>> 'After 2 weeks of treatment with Recognan, there was an improvement in concentration in 81.9%, memory in 50% (p=0.008), verbal imagination productivity in 68.2% (p=0.015), counting functions in 60% (p=0.015), visual-motor coordination and dynamic praxis - in 86.4% (p=0.003), increased speed and efficiency of mental work (p=0.001). After a 30-day course of treatment with Recognan, there was an improvement in memory in 58.3% of patients (p=0.007), an increase in concentration in 64%, an improvement in counting functions in 64.3% (p=0.011), verbal imagination productivity in 63.3%, visual-motor coordination and dynamic praxis in 86.4% (p=0.007), speed and efficiency of mental work (p=0.006), which indicates a complex positive effect of Recognan on higher mental functions in patients with mild cognitive impairment. ' <<<
This is the latest version of this simple and easy to follow memory protocol :
1. Vinpocetine @ 30 mg/day + Vitamin D @ 5000 IU/day up to 10,000 IU/day
2. Lithium Orotate 5 mg/day up to 20 mg/day if needed
3. Citicoline 500 mg/day up to 1000 mg/day if needed
4. Melatonin 10 mg/night up to tolerance if needed
Here is an important quote from the study review :
>>> ' Evidently, vinpocetine is a multi-action agent with a variety of pharmacological targets. Its multi-actions, including vasodilation, anti-oxidation, anti-inflammation, anti-thrombosis, and anti-remodeling, may act together to elicit synergistic therapeutic effects, thereby providing significant benefits to those multifactorial cerebrovascular and cardiovascular diseases. In addition, vinpocetine is effective for a wide range of pathological conditions. ' <<<
To update this thread regarding the melatonin component of this 5 supplement memory regimen, this 2021 systematic review and meta analysis of randomized controlled trials using melatonin in Alzheimer's disease patients at the mild to moderate stage showed significant improvement in the Mini Mental State Exam (MMSE) scoring in just 12 weeks of use. This adds further confirmation to the use of melatonin as an important element of this five supplement memory regimen.
Here is a relevant quote from this meta analysis of melatonin use in AD patients with notable p-value :
>>> ' Our meta-analysis suggested that patients with AD could eventually show benefits with regard to increased MMSE scores (p < 0.0001) after 12 weeks of melatonin therapy, while the ADAS-Cog scale remained unchanged. Furthermore, melatonin treatment may be more effective in mild than moderate AD (p < 0.0001). ' <<<
Citicoline is noted for improving cognitive decline in the elderly (65 years of age +) and this new study (May 2022) adds a bit more confirmation to the idea that Citicoline helps to enhance cognition even in young people :
>>> ' Acute NED consumption improved cognitive function and gaming performance in young adult gamers, providing evidence that NED produces nootropic effects that may translate to improved performance in cognitively demanding tasks. Further, NED-related improvements in gaming performance appear to be, at least partially, a function of improved psychomotor speed. ' <<<
I some times think it would be nice to think as quickly as a 16 year old again, but maybe I should raise my standard and think in terms of a 16 year old using NED as my model!
In any case, aside from the potential Citicoline has suggested for PwP, it definitely belongs in this memory regimen of 5 supplements.
This new meta analysis (January 2023) confirms that Citicoline is useful against memory/dementia/cognitive issues and adds further confirmation that Citicoline belongs in this five supplement memory regimen :
' Our results confirm the evidence on the positive effects of citicoline in a wide range of neurological conditions, such as dementia, neuropathic pain and nerve regeneration [39]. They are in line with and extend those of Piamonte et al. [37], which showed that citicoline in addition to standard treatment has beneficial effects on cognition in people with AD. '
A note of caution in the abstract - “The overall quality of the studies was poor. Discussion: Available data indicate that citicoline has positive effects on cognitive function. The general quality of the studies, however, is poor with significant risk of bias in favor of the intervention. Other: PubMed and the Cochrane Library.”
When it comes to supplement studies, they are sometimes not of the highest quality design and execution which I suspect often comes down to less robust funding availability for such studies, but that is what we have to work with in the context of supplement studies. It is my impression that the main choice as to whether we try a supplement for a specific purpose or not is whether the supplement has at least a better safety profile than a relative prescription medication for the same purpose and Citicoline does seem to have a good safety profile as do the other 4 supplements in the five supplement memory protocol when compared to prescription meds for cognitive issues.
Given the relatively limited abilities of the currently available drugs for cognitive issues, other options seem of major importance and even better if they have very good safety profiles as well.
Hi Art, that’s a fair point but maybe it should be even safer if there’s any doubt about efficacy, e.g. should we look for molecules with GRAS status? Otherwise the trade off (accepting doubts of efficacy in return for doing no harm)might be unbalanced.
Generally if I discuss a supplement at all, GRAS would be my minimum standard. Citicoline is GRAS. In the context of cognitive decline/dementia, Citicoline could be one consideration on the supplement side and on the prescription side, Aricept/Donepizil would be a typical dementia selection.
This is a list of potential side effects for Aricept :
So Citicoline has potential for side effects also, but it also has other potential health benefits such as amelioration of glaucoma. It also has the potential for causing heart problems via increased TMAO levels, at least in theory based on choline studies, but two of the other supplements are likely to ameliorate that potential via inhibition of TMAO. It also has potential to ameliorate damage from stroke.
So looking at Citicoline in relation to Aricept, it appears to offer some benefit in dementia with less potential for severe side effects. In conjunction with the other 4 supplements in that regimen, it may offer further benefit in terms of improved cognitive effects based on related studies linked to in the original post. The group of five supplements, also based on studies, is likely to offer other health benefits besides cognitive enhancement such as CVD prevention, which in PD, is a very important protective feature considering the increased risk for CVD in PwP.
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Switch in generic medication
8/30/22 Day 7 (1wk) - restart of TTFD (B1): 
