Citicoline, choline bitartrate, phosphatidylcholine (lecithin), and choline alfoscerate have been researched for dementia.

Citicoline is a natural substance involved in the production of phosphatidylcholine, an important brain chemical.  It is not available by prescription but is available over-the-counter as a health supplement.  It has been found in double-blind studies to be of mild benefit for mild cognitive impairment, dementia, after strokes, after head trauma, for Parkinson's Disease, and for glaucoma.  While it is not cheap at $81/month for the high dose 2000 mg/d level found to work best, its cost is still less than most patented medicines.  It also reported has few side-effects.  It's research is entirely by mainline established medicine and not the alternative medicine community.  It is used in a number of European countries.

Choline alfoscerate Helped Alzheimers: A DB PC study of 261 patients for 180 days half given choline alfoscerate 400 mg t.i.d. found clear beneficial effects on the ADAS-cog scale. Choline alfoscerate is a precursor of acetylcholine. Mexico City. 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. De Jesus Moreno Moreno M. Clin Ther. 2003 Jan;25(1):178-93

Choline Didn't Help Exercise: In a DB PC crossover study of 13 healthy men given 50 mg/kg, supplemental choline did not affect physical or cognitive performance after exhaustive physical activity. Choline ingestion does not modify physical or cognitive performance. Deuster PA, Singh A, Coll R, Hyde DE, Becker WJ. Mil Med. 2002 Dec;167(12):1020-5

Choline in Rat Pregnancy Increases Hippocampus Cell Size: In a Duke University study, pregnant rats were given 4 times per body weight the normal recommended human intake of choline for six days in the last trimester of the 21 day rat pregnancy. The rats born had 25% large hippocampus cells with more dendrites and fewer memory problems.  Unfortunately, the research Scott Swartzwelder made wild claims stating that his findings were "potentially huge," encouraged pregnant mothers to eat more liver and eggs during pregnancy, and claimed that choline during pregnancy might make human smarter throughout life and put off Alzheimer's disease. In 2003, the US Institute of Medicine did add choline to the list of essential nutrients, particularly for pregnant women. However, one little rat experiment doesn't deserve such wild claims which are sure to fuel a surge in choline consumption along with possibly unhealthy food consumption. Swartzwelder actively encourage men to eat more eggs in speaking to the media.

Choline Review: Choline is important for normal membrane function, acetylcholine synthesis and methyl group metabolism; the choline requirement for humans is 550 mg/d. Betaine, a choline derivative, is important because of its role in the donation of methyl groups to homocysteine to form methionine. There are multiple choline compounds that contribute to total choline concentration (choline, glycerophosphocholine, phosphocholine, phosphatidylcholine and sphingomyelin). The choline concentration of 145 common foods using liquid chromatography-mass spectrometry. found foods with the highest total choline concentration (mg/100 g) were: beef liver (418), chicken liver (290), eggs (251), wheat germ (152), bacon (125), dried soybeans (116) and pork (103). The foods with the highest betaine concentration (mg/100 g) were: wheat bran (1339), wheat germ (1241), spinach (645), pretzels (237), shrimp (218) and wheat bread (201). A number of epidemiologic studies have examined the relationship between dietary folic acid and cancer or heart disease. It may be helpful to also consider choline intake as a confounding factor because folate and choline methyl donation can be interchangeable. Concentrations of choline-containing compounds and betaine in common foods. Zeisel SH, Mar MH, Howe JC, Holden JM. J Nutr. 2003 May;133(5):1302-7

Citicoline or CDP Choline: A reportedly best selling herbal supplement from Jarrow costs 35 cents per 250 mg capsule. Jarrow says it is a naturally occurring, water soluble biological compound that is an essential intermediate for the synthesis of phosphatidylcholine, a major constituent for the grey matter of brain tissue (30%).  CDP choline is metabolized to yield the free nucleotide cytidine and choline.  Scientific research demonstrates that CDP Choline consumption promotes brain metabolism by enhancing the synthesis of acetylcholine, restoring phospholipid content in the brain and regulation of neuronal membrane excitability and osmolarity (by its effect on the ATP-dependent sodium and potassium pumps).

CDP Choline Didn't Help Vascular Dementia: A Brown University study of just 30 patients with vascular dementia treated in a DB PC study using citicoline 500 mg b.i.d. or placebo found no benefit over a one year period of time. Long-term citicoline (cytidine diphosphate choline) use in patients with vascular dementia: neuroimaging and neuropsychological outcomes. Cohen RA, Browndyke JN, et al. Cerebrovasc Dis. 2003;16(3):199-204

CDP Choline Increases Phosphodiesters and Learning Test Performance: A Harvard study with normal older adults found that oral citicoline can increase phosphatidylcholine synthesis in the brains of older subjects by measuring levels of phosphorus-containing metabolites using proton-decoupled phosphorus magnetic resonance spectroscopy ((31)P-MRS) before and after citicoline 500 mg/d for 6 weeks treatment. There was a 7.3% increase from baseline levels in brain phosphodiesters ( P=0.008), including an 11.6% increase in glycerophosphoethanolamine ( P=0.002) and a 5.1% increase in glycerophosphocholine ( P=0.137). A second 6-week of citicholine did not show significant additional increases. There was a correlation between improvement on the California Verbal Learning Test and increase in phosphodiesters. Thus, citicholine did reverse age-related decreases in brain phosphatidylcholine. Chronic citicoline increases phosphodiesters in the brains of healthy older subjects: an in vivo phosphorus magnetic resonance spectroscopy study. Babb SM, Wald LL, Cohen BM, Villafuerte RA, Gruber SA, Yurgelun-Todd DA, Renshaw PF. Psychopharmacology (Berl). 2002 May;161(3):248-54. 

Citicoline May Help Cognitive Impairment Some: A meta-analysis of seven studies giving citicoline to elderly patients suffering cognitive impairment found there is no significant evidence of a beneficial effect of CDP-choline on attention, but modest beneficial effects of CDP-choline on memory function and behavior. For the outcome of clinical global impression, the odds ratio for improvement in the subjects treated with CDP-choline as opposed to the subjects treated with placebo is 8.89 [5.19 to 15.22]. The drug is well tolerated. University of Rome, Cytidinediphosphocholine (CDP choline) for cognitive and behavioral disturbances associated with chronic cerebral disorders in the elderly. Fioravanti M, Yanagi M. Cochrane Database Syst Rev. 2000;(4):CD000269; One study used 1000mg/d for 12 weeks in a DB PC study of just 30 Alzheimer's patients. Exp Clin Pharmacol. 1999 Nov;21(9):633-44; An MIT study of 32 50-85 yos with relatively inefficient memories in a DB PC crossover 2 months study using 2000 mg/d and a 3 month study of 95 elderly using 1000 mg/d found the higher dose helped delayed recall and that only people with inefficient memories benefited. Arch Neurol. 1996 May;53(5):441-8

Citicoline Said to be of Some Benefit After Stroke: A meta-analysis of four studies giving oral citicoline 500, 1000, or 2000 mg/d started within 24 hours of stroke onset to 1372 stroke patients in double-blind studies reports that after three months 25% recovered vs. 20% with placebo.  In at least one study, the citicoline was continued for six weeks (Neurology. 2001 Nov 13;57(9):1595-602).  Only one of the four studies reported finding significant results, but the meta-analysis was able to report significant benefit by pooling the data which makes small benefits more likely to be statistically significant.  The best effect was with the 2000 mg dosage where 28% citicoline patients had recovered by three months. University Hospital, Girona, Spain. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Davalos A, Castillo J, et al. Stroke 2002 Dec;33(12):2850-7

Citicoline Said to Help Glaucoma and Amblopia in DBs: A Polish DB study is reported, but the abstract gives no details other than that citicoline helped. Pharmacodynamics of citicoline relevant to the treatment of glaucoma. Grieb P, Rejdak R. J Neurosci Res. 2002 Jan 15;67(2):143-8; An Italy study of 50 amblyopia patients treated with an open design and 10 with a DB design reports that citicoline helped over a 6 month period of time. Graefes Arch Clin Exp Ophthalmol 1995 May;233(5):307

Citicoline Helped Closed Head Injury: A Univ of Texas DB PC 1 month study of 14 patients with mild-moderate closed head injuries reported that citicoline helped reduce post-concussional symptoms, primarily recognition memory. Treatment of postconcussional symptoms with CDP-choline. Levin HS. J Neurol Sci 1991 Jul;103 Suppl:S39-42;

Citicoline Didn't Help Tardive Dyskinesia or ECT Memory Loss in DBs: Citicoline didn't help tardive dyskinesia in a very small DB study. Compr Psychiatry. 1989 Jan-Feb;30(1):1-4; It didn't help the confusion or memory loss after ECT. The value of cytidine-5-diphosphate-choline in the prevention of impairment of memory function after electric convulsive therapy. A double-blind study. Ayuso-Gutierrez JL, Saiz-Ruiz J. Prog Neuropsychopharmacol Biol Psychiatry 1982;6(3):243

Citicoline Helped Severe Head Injury in DB: A French study of 60 patients who were comatose in DB PC design found that citicoline reduced the duration of the coma. A precursor of phospholipids in the treatment of severe traumatic comas. Cohadon F, Richer E, Poletto B.

Citicoline Helped Parkinson's in DB: A DB PC study using citicoline as an add-on to levo-dopa found a 23% decrease in bradykinesia and a 33% decrease in rigidity with a small effect on tremor. New strategies in the management of Parkinson's disease: a biological approach using a phospholipid precursor (CDP-choline). Agnoli A, Ruggieri S, Denaro A, Bruno G. Neuropsychobiology. 1982;8(6):289-96. Neurochirurgie. 1982;28(4):287-90