Citicoline (CDP-Choline) for Visual Pathway Support and Cognitive Aging

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IntroductionCiticoline, also known as CDP-choline, is a naturally occurring compound that supports nerve cell function. It serves as a key precursor for phospholipids — essential components of cell membranes — and boosts levels of important neurotransmitters in the brain. In the visual system, citicoline has drawn attention as a possible neuroprotective agent for retinal ganglion cells (RGCs) affected by glaucoma and other optic neuropathies () (). Likewise, in the aging brain, citicoline’s membrane-repair and neurochemical effects have been investigated for preserving memory and cognition with age () (). This article reviews clinical and experimental evidence that citicoline can improve RGC function (often measured by visual fields and electrophysiologic tests) and explores how its cellular mechanisms (membrane repair and dopaminergic modulation) may also benefit age-related cognitive decline. We also consider practical issues of dosing, safety, adherence, and how long any benefits last once treatment stops.How Citicoline Works in Nerve CellsCiticoline (cytidine-5′-diphosphocholine) is metabolized into cytidine and choline in the body. Choline feeds into the synthesis of phosphatidylcholine, a major membrane lipid, and of the neurotransmitter acetylcholine (). By supplying these building blocks, citicoline helps repair and maintain cell membranes. It can prevent loss of cardiolipin (a key membrane lipid in mitochondria) and accelerate membrane phospholipid resynthesis () (). These actions support overall cell integrity and energy production, which are crucial for high-energy neurons like RGCs and aging brain cells.Citicoline also boosts neurotransmission. It provides choline for acetylcholine, raising levels in the hippocampus and cortex. It has been shown to increase dopamine levels by enhancing tyrosine hydroxylase (the enzyme that makes dopamine) and by slowing dopamine reuptake (). In animal models, retinal dopamine was specifically elevated after citicoline treatment (). Citicoline likewise raises noradrenaline and serotonin levels in various brain regions (). Because dopamine is especially important in the retina (for visual signal modulation) and in brain circuits for attention and memory, these effects may underlie improved neural function. Relatedly, citicoline may attenuate glutamate excitotoxicity by upregulating the EAAT2 glutamate transporter (), and it has been shown to reduce β-amyloid plaque formation in experimental models (). All these mechanisms – membrane repair, energy support, and modulation of neurotransmitters – contribute to citicoline’s broad neuroprotective profile () ().Citicoline in Glaucoma and RGC ProtectionGlaucoma is characterized by the loss of RGCs and their fibers, leading to progressive vision loss (peripheral visual field defects). Elevated eye pressure (IOP) is the main treatable factor, but many patients continue to show RGC degeneration despite good pressure control. Citicoline has been extensively studied as an adjunct therapy aimed at slowing RGC loss. Laboratory and Animal StudiesIn laboratory models of optic nerve injury or glaucoma, citicoline consistently showed neuroprotective effects on RGCs. For example, rabbit studies found that citicoline reduced retinal cell death and increased retinal dopamine levels (). In a model of optic nerve crush, citicoline not only preserved RGCs but upregulated the anti-apoptotic protein Bcl-2 (). Cultured retinal neurons exposed to toxic stress had ~50% less cell death whe