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Verbal and Visual Memory Improve After Choline Supplementation in Long-Term Total Parenteral Nutrition: A Pilot StudyDivision of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, a-buchman{at}nwu.edu
Department of Medicine, Northwestern University, Chicago, Illinois
Huntsman Cancer Institute, University of Utah, Salt Lake City
Department of Pharmacology, UCLA School of Medicine, Los Angeles
Department of Medicine, Northwestern University, Chicago, Illinois
Department of Pharmacology, UCLA School of Medicine, Los Angeles
Department of Neuropsychiatry, University of South Carolina School of Medicine, Columbia Background: Previous investigations have demonstrated that choline deficiency, manifested in low plasma-free choline concentration and hepatic injury, may develop in patients who require long-term total parenteral nutrition (TPN). Preliminary studies have suggested lecithin or choline supplementation might lead to improved visual memory in the elderly and reverse abnormal neuropsychological development in children. We sought to determine if choline-supplemented TPN would lead to improvement in neuropsychological test scores in a group of adult, choline-deficient outpatients receiving TPN. Methods: Eleven subjects (8 males, 3 females) who received nightly TPN for more than 80% of their nutritional needs for at least 12 weeks before entry in the study were enrolled. Exclusion criteria included active drug abuse, mental retardation, cerebral vascular accident, head trauma, hemodialysis or peritoneal dialysis, (prothrombin time [PT] >2x control), or acquired immune deficiency syndrome (AIDS). Patients were randomly assigned to receive their usual TPN regimen (n = 6, aged 34.0 ± 12.6 years) over a 12-hour nightly infusion or their usual TPN regimen plus choline chloride (2 g) (n = 5, aged 37.3 ± 7.3 years). The following neuropsychological tests were administered at baseline and after 24 weeks of choline supplementation (or placebo): Weschler Adult Intelligence Scale-Revised (WAIS-R, intellectual functioning), Weschler Memory Scale-Revised (WMS-R, two 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). Scores were reported in terms of standard scores including z scores and percentile ranks. Mean absolute changes in raw scores were compared between groups using the Wilcoxon rank sum test, where p values < .05 constituted statistical significance. Results: Significant improvements were found in the delayed visual recall of the WMS-R (7.0 ± 2.7 vs -.33 ± 5.7, p = .028), and borderline improvements in the List B subset of the CVLT (1.0 ± 0.8 vs -2.0 ± 2.4, p = .06) and the Trails A test (-3.8 ± 8.1 vs 3.7 ± 4.5 seconds, p = .067). No other statistically significant changes were seen. Conclusions: This pilot study indicates both verbal and visual memory may be impaired in patients who require long-term TPN and both may be improved with choline supplementation. (Journal of Parenteral and Enteral Nutrition 25:30-35, 2001)
Journal of Parenteral and Enteral Nutrition, Vol. 25, No. 1,
30-35 (2001) This article has been cited by other articles:
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