Comprehensive metabolic correction in cognitive impairment: theoretical background for using citicoline and Bacopa monnieri combination


  • T.M. Slobodin Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine



cognitive impairment, network-based approach, Bacopa monnieri, citicoline, combination


In the past few decades, genetic and biochemical researches have revealed an extensive network of molecular and metabolic pathways involved in pathogenesis of cognitive decline, suggesting that a multi-target, network-based therapeutic approach, rather than a single target-based approach, may be potentially more effective for the treatment. This review summarizes the current evidence base of multiple neuromolecular mechanisms of cognitive enhancing action of Bacopa monnieri, a medicinal Ayurvedic herb, and its possible beneficial interactions with other well-known neuroprotective agent citicoline. Current experimental evidence suggests that Bacopa monnieri acts via the following mechanisms: antioxidant neuroprotection, increased cerebral blood flow, β-amyloid reduction, acetylcholinesterase inhibition and/or choline acetyltransferase activation, and modulation of other neurotransmitter systems (norepinephrine, 5-hydroxytryptamine, dopamine). Several randomized, double-blind, placebo-controlled trials have substantiated procognitive action of Bacopa monnieri in humans. Nootropic properties of Bacopa monnieri, at least partly, interfere with neuroprotective mechanisms of citicoline, creating potential additive effect in the correction of cognitive impairment of different (degenerative, vascular or both) origin.


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