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One nutritional supplement that has been studied extensively for the treatment of dementia is acetyl-L-carnitine, which is believed to be a precursor for the synthesis of acetylcholine. In one double-blind study, typical of other similar trials, half of 60 subjects with mild dementia were treated with 2 g per day of acetyl-L-carnitine and half received a placebo for three months. When subjects were assessed, using scales of behavior, memory, attention, and verbal fluency, there was significant improvement in the group receiving the acetyl-L-carnitine.33 Several other studies also suggest positive findings, indicating that acetyl-L-carnitine may be helpful in slowing the progression of Alzheimer's disease and in improving cognitive function in patients with this disorder.34,35

Enthusiasm for acetyl-L-carnitine may be tempered somewhat, however, by several yearlong trials showing less-promising results. In the first of these trials, with more than 350

patients completing treatment consisting of 3 g per day of acetyl-L-carnitine for one year, a trend was seen toward a slower progression of Alzheimer's disease symptoms. However, the trend was only seen in subjects who were under 65, while older subjects who were given acetyl-L-carnitine might actually have experienced a more rapid progression of their symptoms.36 In an additional study of several hundred subjects under 65 with onset of Alzheimer's disease, treatment with 3 g per day of acetyl-L-carnitine for one year, again, did not slow decline.37 While it is difficult to understand completely why some studies show positive results and others do not, it may be that, for early-onset cases of Alzheimer's dementia, a short-term treatment protocol might offer some slowing of the progressing dementia. If there is even some improvement clinically, such a course seemsjustified within the context of the progressing and debilitating dementia of Alzheimer's disease.

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