Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: A pilot study

Background: Previous investigations have demonstrated that choline deficien cy, 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 supplementatio n might lead to improved visual memory in the elderly and reverse abnormal neuropsychological development in children. We sought to determine if choli ne-supplemented TPN would lead to improvement in neuropsychological test sc ores in a group of adult, choline-deficient outpatients receiving TPN. Meth ods: 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, men tal retardation, cerebral vascular accident, head trauma, hemodialysis or p eritoneal dialysis, (prothrombin time [PT] >2x control), or acquired immune deficiency syndrome (AIDS). Patients were randomly assigned to receive the ir usual TPN regimen (n = 6, aged 34.0 +/- 12.6 years) over a 12-hour night ly infusion or their usual TPN regimen plus choline chloride (2 g) (n = 5, aged 37.3 +/- 7.3 years). The following neuropsychological tests were admin istered at baseline and after 24 weeks of choline supplementation (or place bo): Weschler Adult Intelligence Scale-Revised (WAIS-R, intellectual functi oning), Weschler Memory Scale-Revised (WMS-R, two subtests, verbal and visu al memory), Rey-Osterrieth Complex Figure Test (visuospatial functioning an d perceptual organization), Controlled Oral Word Association Test (verbal f luency), Grooved Pegboard (manual dexterity and motor speed), California Ve rbal Learning Test (CVLT, rote verbal learning ability), and Trail Making P arts A & B (visual scanning, psychomotor speed and set shifting). Scores we re reported in terms of standard scores including z scores and percentile r anks. Mean absolute changes in raw scores were compared between groups usin g the Wilcoxon rank sum test, where p values < .05 constituted statistical significance. Results: Significant improvements were found in the delayed v isual recall of the WMS-R (7.0 +/- 2.7 vs -.33 +/- 5.7, p = .028), and bord erline 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. Conclusi ons: This pilot study indicates both verbal and visual memory may be impair ed in patients who require long-term TPN and both may be improved with chol ine supplementation.