Concussions are considered mild forms of a traumatic brain injury (TBI) that occur after some sort of trauma to the brain. The concept of the concussion alludes many clinicians, largely due to the highly variable nature of concussion symptoms, some of which are quite mild and lack clear objective biomarkers. The importance of timely and holistic treatment is imperative to reducing risk for future sequelae such as Alzheimer’s disease, frontotemporal dementia, and chronic traumatic encephalopathies.1 Further, it is reported that approximately 15% of people who experience a concussion, go on to experience symptoms months or even years after their injury,
Cognitive function encompasses many domains such as attention, memory, reasoning, and language. Our brains continually change throughout our lives. Unfortunately, as we age our cognitive function declines. We may become more forgetful, or easily distracted, or struggle to concentrate on tasks as easily as we used to. This is all part of the aging process and these changes are completely normal, albeit they can cause frustration!
The normal aging process is different from dementia, which refers to a group of conditions, which cause significant impairments in memory, intellectual function, spatial awareness, language, and behaviour. Unlike the normal aging process, a person’s independence in daily activities becomes severely affected. There are a number of causes of dementia, the most common being Alzheimer’s disease (AD). Unfortunately, it is not possible to reverse the cognitive function decline caused by dementia. However, there is evidence that lifestyle modifications/natural supplements can slow down the cognitive decline process in people with mild cognitive impairment (MCI). MCI means that cognitive symptoms are more pronounced than is expected for someone your age, but is not severe enough to be classified as dementia. Another way to think of it is a spectrum with normal aging and dementia on either end and MCI sitting in the middle.
Here at AOR, we are determined to help our customers with all of their health needs, and we believe in adopting a holistic approach to health. In this blog, we will discuss the role of ALCAR in supporting cognitive function.
What is ALCAR?
L-carnitine is an amino acid that plays a central role in the breakdown of long-chain fatty acids and their transport into the mitochondria for oxidation and use in the production of cellular energy. This makes L-carnitine essential to maintaining healthy metabolism, which is critical for avoiding many age and lifestyle-associated disorders like metabolic syndrome, cardiovascular disease, and cognitive decline. L-carnitine is generally obtained from red meats and as a result, many vegetarians and vegans are deficient in L-carnitine. Unfortunately, L-carnitine is incapable of crossing the blood-brain barrier, and as a result, it is not possible to derive the metabolic benefits of L-carnitine in the brain through L-carnitine supplementation.
ALCAR is N-acetyl levocarnitine, an acetylized ester of the amino acid L-carnitine. This ester is capable of crossing the blood-brain barrier and neural cell membranes more readily than conventional L-carnitine. It has been suggested that ALCAR is a more bioavailable form of L-carnitine, and has cognitive benefits associated with it that are not attributed to regular L-carnitine.
One of the earliest clinical trial reporting the efficacy of ALCAR was from a study conducted in 1990 (Passeri et al.). Patients >65 years and suffering from mild cognitive impairments were randomised to receive either ALCAR (2g/day) or placebo for a three month period. The study highlighted that ALCAR treated patients showed significant improvement in memory tests, on behavior scales, and verbal fluency tests in comparison to placebo-controlled patient.
Subsequent clinical trials and meta-analyses have supported these initial results. In a 2007 double blind, placebo-controlled six-month study was conducted on elderly subjects in their 70s complaining of fatigue and having chronic fatigue symptoms. ALCAR, administered at 2 g twice daily, was found to significantly improve physical fatigue, muscle pain, post-exercise fatigue, mental fatigue, the severity of the fatigue, sleep disorders, cognitive functions (measured by mini mental state examination), chronic fatigue symptoms such as headache, sore throat, painful lymph nodes and joints, and overall functional status (Malaguarnera et al., 2007).
The positive effects of ALCAR have also been reported in patients with mild AD (Remington et al., 2015). In a double blind, placebo controlled RCT of 106 individuals with AD, ALCAR (in combination with other natural products such as folate, N-acetyl cysteine and Vitamin B12), was found to significantly improve the cognitive performance and behavioral difficulties of these patients over a period of six months. This natural formulation was also tested in a cohort of care home patients without dementia and was found to improve a range of cognitive measures over a six-month period. The authors strongly advocated the use of natural supplements in the care of the elderly (Chan et al., 2010).
Beyond its cognitive effects, ALCAR has also been noted to improve depression and effective in the treatment of hepatic encephalopathy, a complication of liver cirrhosis.
Whilst further clinical trials are needed to further assess the role of ALCAR, these findings are promising for the management of patients with mild cognitive function impairments.
Chan et al. A vitamin/nutraceutical formulation improves memory and cognitive performance in community-dwelling adults without dementia. J Nutr Health Aging. 2010;14(3):224-30.
Passeri et al. Acetyl-L-carnitine in the treatment of mildly demented elderly patients. Int J Clin Pharmacol Res. 1990;10(1-2):75-79.
Malaguarnera et al. Acetyl L-carnitine (ALC) treatment in elderly patients with fatigue. Arch Gerontol Geriatr. 2007;46(2):181-90.
Remington et al. A phase II randomised clinical trial of a nutritional formulation for cognition and mood in Alzheimer’s Disease. J Alzheimers Dis. 2015;45(2):395-405.