Acetyl-L-Carnitine in dementia and other cognitive disorders: A critical update

Manuela Pennisi, Giuseppe Lanza, Mariagiovanna Cantone, Emanuele D’amico, Francesco Fisicaro, Valentina Puglisi, Luisa Vinciguerra, Rita Bella, Enzo Vicari, Giulia Malaguarnera

Research output: Contribution to journalReview articlepeer-review


Several studies explored the effects of acetyl-L-carnitine (ALC) in dementia, suggesting a role in slowing down cognitive decline. Nevertheless, in 2003 a systematic review concluded there was insufficient evidence to recommend a clinical use, although a meta-analysis in the same year showed a significant advantage for ALC for clinical scales and psychometric tests. Since then, other studies have been published; however, a critical review is still lacking. We provide an update of the studies on ALC in primary and secondary dementia, highlighting the current limitations and translational implications. Overall, the role of ALC in dementia is still under debate. The underlying mechanisms may include restoring of cell membranes and synaptic functioning, enhancing cholinergic activity, promoting mitochondrial energy metabolism, protecting against toxins, and exerting neurotrophic effects. The effects of ALC on the gut–liver–brain axis seem to identify the category of patients in which the new insights contribute most to the mechanisms of action of ALC, likely being the liver metabolism and the improvement of hepatic detoxifying mechanisms the primary targets. In this framework, our research group has dealt with this topic, focusing on the ALC-related cross-talk mechanisms. Further studies with homogeneous sample and longitudinal assessment are needed before a systematic clinical application.

Original languageEnglish
Article number1389
Issue number5
Publication statusPublished - May 2020


  • Acetyl-L-carnitine
  • Biochemistry
  • Brain axis
  • Dementia
  • Gut
  • Hepatic encephalopathy
  • Liver
  • Memory loss
  • Mild cognitive impairment
  • Neurodegeneration
  • Neuroplasticity

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


Dive into the research topics of 'Acetyl-L-Carnitine in dementia and other cognitive disorders: A critical update'. Together they form a unique fingerprint.

Cite this