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Research · Supplements

Alpha-GPC and choline supplements

Pooled trials in dementia and mild cognitive impairment report better cognitive scores with citicoline, from studies rated poor quality. A 2,298-patient stroke trial and a 1,213-patient brain injury trial of citicoline found no difference from placebo. Alpha-GPC strength trials are small and manufacturer-funded. A Korean cohort linked alpha-GPC prescriptions to more strokes.

Add to Bio HackChecked 2026-11-09
Status
Sold as dietary supplements in the US. Citicoline is approved as a drug for stroke in some countries and for traumatic brain injury in 59 countries. Choline alfoscerate is a prescription drug in South Korea.
Also called
alpha-GPC, A-GPC, L-alpha-glycerylphosphorylcholine, choline alfoscerate, choline alphoscerate, glycerophosphocholine, citicoline, CDP-choline, cytidine diphosphocholine, Cognizin, choline bitartrate
Taken for
memory, focus, brain health, dementia, stroke recovery, brain injury, power output, strength, pre-workout

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help2

Reported risks2

What people take it for, and what was found

Shown to help2

Limited

Cognition in dementia and mild cognitive impairment

Limited evidence: citicoline and choline alfoscerate improved cognitive scores in people with dementia or mild cognitive impairment, in studies of poor quality with risk of bias.

The numbers and sources
Effect
Across 6 pooled studies, citicoline improved cognitive status with SMDs of 0.56 (95% CI 0.37 to 0.75) to 1.57 (95% CI 0.77 to 2.37) depending on the sensitivity analysis [1]. In 261 patients with mild to moderate Alzheimer's disease, choline alfoscerate 400 mg three times a day for 180 days lowered ADAS-Cog by 3.20 points from baseline while placebo rose by 2.90 points [2]. In 3 head-to-head trials (358 participants), choline alfoscerate scored better than citicoline on a geriatric clinical scale (WMD -3.92, 95% CI -7.41 to -0.42), with no difference in memory or word fluency [3].
Population
Mild cognitive impairment, Alzheimer's disease and post-stroke dementia [1]; Alzheimer's disease, aged 60 to 80 [2]; dementia disorders [3].
Sources
[1], [2], [3]
Caveats
Study quality in [1] was poor, with significant risk of bias in favor of the intervention. The head-to-head review compares two choline compounds and has no placebo arm [3].
Limited

Memory and attention in healthy adults

Small trials found citicoline raised a memory score in older adults with memory impairment, and alpha-GPC raised one attention score in young men.

The numbers and sources
Effect
In 100 adults aged 50 to 85 with age-associated memory impairment, citicoline 500 mg a day for 12 weeks raised a composite memory score by 3.78 versus 0.72 on placebo, a secondary outcome [7]. In 20 resistance-trained men, single doses of 315 mg and 630 mg alpha-GPC raised Stroop scores over placebo (13.0 versus 5.2 at the higher dose). Flanker and N-back tests did not differ [8].
Population
Healthy older adults [7]; young men [8].
Sources
[7], [8]
Caveats
The memory gains in [7] were secondary outcomes, using a branded product (Cognizin). The alpha-GPC trial was funded by the ingredient maker and retrospectively registered [8].

Mixed results2

Moderate

Recovery after ischemic stroke (citicoline)

Mixed results: pooled trials found citicoline raised the odds of independence after stroke, but the largest trial, 2,298 patients, found no difference in recovery.

The numbers and sources
Effect
A meta-analysis of 10 double-blind trials found higher odds of independence with citicoline (OR 1.56, 95% CI 1.12 to 2.16, random effects). In patients also treated with rtPA the benefit was described as limited [4]. The largest trial, ICTUS, randomized 2,298 patients and was stopped for futility. Global recovery at 90 days did not differ (OR 1.03, 95% CI 0.86 to 1.25) [5].
Population
Patients with acute ischemic stroke treated within 14 days [4]; moderate to severe stroke treated within 24 hours, 1,000 mg every 12 hours for 6 weeks [5].
Sources
[4], [5]
Caveats
The pooled analysis and the largest trial disagree. ICTUS was funded by Ferrer Grupo, which makes citicoline [5]. Several authors appear on both papers.
LimitedStudied in men

Strength and power

Small trials found mixed effects on strength and power in young men, with one gain in lower body pull force. All were funded by alpha-GPC makers.

The numbers and sources
Effect
In 13 college-aged men, 600 mg a day for 6 days raised mid-thigh pull peak force by 98.8 N versus a 39.0 N fall on placebo. Upper body force did not differ significantly [9]. In 48 men over 7 days, 250 mg or 500 mg a day did not change isometric strength or psychomotor vigilance. Countermovement jump velocity and power differed between groups, with the largest change at 250 mg [10]. Jumps, bench throws and growth hormone did not differ after single doses [8].
Population
Young men [8][9][10].
Sources
[8], [9], [10]
Caveats
All three trials were funded by alpha-GPC manufacturers (Chemi Nutra [9][10], NNB Nutrition [8]). Samples were small and outcomes were mixed.

Not shown to help1

Limited

Recovery after traumatic brain injury (citicoline)

One large trial found citicoline did not change recovery at 90 or 180 days in 1,213 people with traumatic brain injury.

The numbers and sources
Effect
In 1,213 patients, 2,000 mg a day for 90 days did not change functional and cognitive status at 90 days (global OR 0.98, 95% CI 0.83 to 1.15) or 180 days (OR 0.87, 95% CI 0.72 to 1.04). Favorable improvement on the Glasgow Outcome Scale was 35.4% versus 35.6% [6].
Population
Complicated mild, moderate and severe brain injury at 8 US trauma centers [6].
Sources
[6]
Caveats
One large NIH-funded trial.

Doses studied

Alzheimer's trials used choline alfoscerate 400 mg three times a day for 180 days [2]. Stroke trials used citicoline 1,000 mg every 12 hours [5], and the brain injury trial 2,000 mg a day for 90 days [6]. Memory trials used citicoline 500 mg a day [7] and single alpha-GPC doses of 315 or 630 mg [8]. Strength trials used alpha-GPC 250 to 600 mg a day for 6 to 7 days [9][10].

Risks

Reported risks2

LimitedHow often is not known

Stroke in a national cohort (alpha-GPC)

Linked to about 43% more strokes over 10 years in South Koreans aged 50 and over prescribed alpha-GPC, with risk rising with longer use.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Among 12,008,977 South Koreans aged 50 and over, the 108,877 prescribed alpha-GPC had more strokes over 10 years after matching (total stroke aHR 1.43, 95% CI 1.41 to 1.46; ischemic aHR 1.34; hemorrhagic aHR 1.37). Risk rose with longer prescription duration [11].
Population
Adults 50 and over without prior stroke or Alzheimer's disease, followed 2009 to 2018 [11].
Sources
[11]
Caveats
Observational. People prescribed alpha-GPC may differ from non-users in ways matching did not capture. No randomized trial has tested this.
LimitedStudied in menHow often is not known

Thyroid-stimulating hormone (alpha-GPC)

One short trial found lower TSH after 7 days on 500 mg alpha-GPC in 48 young men. Thyroid hormones were not reported.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
After 7 days, serum TSH was significantly lower in the 500 mg alpha-GPC group than in the other groups [10].
Population
48 young men [10].
Sources
[10]
Caveats
One short trial. Thyroid hormones themselves were not reported in the abstract.

Checked, no increase found1

Moderate

Adverse events in large citicoline trials

Adverse events were about as common on citicoline as on placebo in 2,298 stroke patients.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 2,298 stroke patients, safety variables and adverse event rates did not differ significantly between citicoline and placebo [5]. In head-to-head dementia trials, dropout was 9.4% on choline alfoscerate and 6.7% on citicoline (OR 1.44, 95% CI 0.66 to 3.13) [3].
Population
Hospitalized stroke patients [5]; dementia patients [3].
Sources
[3], [5]
Caveats
Patients with acute stroke are not the population taking supplements for focus.

Claims tested and not found

  1. That citicoline improves recovery after stroke. The largest trial was stopped for futility, with global recovery OR 1.03 (95% CI 0.86 to 1.25) [5].
  2. That citicoline improves recovery after brain injury. Functional and cognitive status did not differ from placebo at 90 or 180 days [6].
  3. That alpha-GPC increases strength. Isometric strength did not change at 250 or 500 mg a day for 7 days [10].

Sources

  1. Bonvicini M, Travaglini S, Lelli D, et al. Is Citicoline Effective in Preventing and Slowing Down Dementia? A Systematic Review and a Meta-Analysis. Nutrients. 2023. https://doi.org/10.3390/nu15020386
  2. De Jesus Moreno Moreno M. Cognitive improvement in mild to moderate Alzheimer's dementia after treatment with the acetylcholine precursor choline alfoscerate: A multicenter, double-blind, randomized, placebo-controlled trial. Clinical Therapeutics. 2003. https://doi.org/10.1016/s0149-2918(03)90023-3
  3. Sagaro GG, Amenta F. Comparison of the effects of choline alphoscerate and citicoline in patients with dementia disorders: a systematic review and meta-analysis. Frontiers in Neurology. 2025. https://doi.org/10.3389/fneur.2025.1649661
  4. Secades JJ, Alvarez-Sabín J, Castillo J, et al. Citicoline for Acute Ischemic Stroke: A Systematic Review and Formal Meta-analysis of Randomized, Double-Blind, and Placebo-Controlled Trials. Journal of Stroke and Cerebrovascular Diseases. 2016. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.010
  5. Dávalos A, Alvarez-Sabín J, Castillo J, et al. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). The Lancet. 2012. https://doi.org/10.1016/S0140-6736(12)60813-7
  6. Zafonte RD, Bagiella E, Ansel BM, et al. Effect of Citicoline on Functional and Cognitive Status Among Patients With Traumatic Brain Injury. JAMA. 2012. https://doi.org/10.1001/jama.2012.13256
  7. Nakazaki E, Mah E, Sanoshy K, et al. Citicoline and Memory Function in Healthy Older Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. The Journal of Nutrition. 2021. https://doi.org/10.1093/jn/nxab119
  8. Kerksick CM. Acute Alpha-Glycerylphosphorylcholine Supplementation Enhances Cognitive Performance in Healthy Men. Nutrients. 2024. https://doi.org/10.3390/nu16234240
  9. Bellar D, LeBlanc NR, Campbell B. The effect of 6 days of alpha glycerylphosphorylcholine on isometric strength. Journal of the International Society of Sports Nutrition. 2015. https://doi.org/10.1186/s12970-015-0103-x
  10. Marcus L, Soileau J, Judge LW, et al. Evaluation of the effects of two doses of alpha glycerylphosphorylcholine on physical and psychomotor performance. Journal of the International Society of Sports Nutrition. 2017. https://doi.org/10.1186/s12970-017-0196-5
  11. Lee G, Choi S, Chang J, et al. Association of L-α Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years. JAMA Network Open. 2021. https://doi.org/10.1001/jamanetworkopen.2021.36008

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