Cholesterol Levels And Dementia Risk
An observational study is one that looks at large numbers of people over time and tries to find patterns and relationships between different factors . These studies can be very helpful for our understanding of things that change the risk of certain conditions, and they have been very helpful in finding things that may affect the risk of developing dementia.
Observational studies analysing a link between high cholesterol levels and development of dementia have mixed findings. A review that looked at 25 of these studies suggests that higher cholesterol in mid-life is associated with an increased risk of developing the condition.
Her Husband Noticed Changes
Mrs. Watson* came to see me at her husbands urging to discuss concerns about her memory. Her husband was very much aware of the relationship between cardiovascular health and overall quality of life. Since his own heart attack at age 70, he had paid much more attention to diet and exercise than ever before. The results were apparent he was bright-eyed, energetic, and spoke to me in a very organized way.
Mrs. Watson, despite his encouragement, had been less attentive to her health. During the past year, her husband had grown more and more concerned about this. He saw that she was having greater trouble managing her responsibilities and relationships than would be expected for a 72-year-old woman. She was much slower in getting things done. Getting started, and acting in an organized way, was much more difficult. She often struggled to remember names and other important things.
Usually the details would come back to her once someone gave her a reminder. She continued to drive, but avoided the highways. She had become a more cautious driver, she said, and she mentioned that she had become increasingly dependent on her GPS even when driving somewhere familiar.
The explanation for her memory and other difficulties seemed clearer once we discussed her medical health. She was under the care of a cardiologist for her high blood pressure and high cholesterol. Her diabetes was treated by her primary care clinician, and she had been a heavy smoker from her 20s until her 60s.
Effect Of Statins On Cognitive Decline And Dementia In Older Adults
- Zhou Z, Ryan J, Ernst ME, et al., on behalf of the ASPREE Investigator Group.
- Citation:
- Mollie McDermott, MD, MS
Quick Takes
- In this large, prospective cohort study, statin use was not associated with incident dementia, mild cognitive impairment, or cognitive decline.
- No differences were found in any of the primary outcomes between users of hydrophilic versus lipophilic statins.
- These results are encouraging, but a randomized trial with dementia and cognitive decline as prespecified outcomes will be required to prove that statins do not worsen cognitive outcomes.
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End Of Life And Legal Issues
If you have been diagnosed with dementia, you might want to make arrangements for your care that take into account the decline in your mental abilities.
This may include making sure that your wishes are upheld if you’re not able to make decisions for yourself.
You may want to consider:
- creating an advance decision, which makes your treatment preferences known in case you’re unable to do this in the future
- having a “preferred place of care” plan, which outlines where you would like to receive treatment
- giving a relative lasting power of attorney, enabling them to make decisions about you if you’re unable to
Statin Medications May Prevent Dementia And Memory Loss With Longer Use While Not Posing Any Short
A review of dozens of studies on the use of statin medications to prevent heart attacks shows that the commonly prescribed drugs pose no threat to short-term memory, and that they may even protect against dementia when taken for more than one year. The Johns Hopkins researchers who conducted the systematic review say the results should offer more clarity and reassurance to patients and the doctors who prescribe the statin medications.
The question of whether statins can cause cognition problems has become a hot topic among cardiologists and their patients following changes on the drug labels ordered by the U.S. Food and Drug Administration in February 2012, warning about memory problems with short-term statin use.
However, in their extensive review, the Johns Hopkins researchers found that statins do not affect short-term memory or cognition. In contrast, they say that when the drugs are taken for more than one year, the risk of dementia is reduced by 29 percent. Their findings are published in an online article in the Mayo Clinic Proceedings posted on October 1, 2013.
“Our goal was to provide clarity on this issue based on the best available evidence,” according to Raoul Manalac, M.D., a co-primary author of the study. “We looked at high-quality, randomized controlled trials and prospective studies that included more than 23,000 men and women with no prior history of cognitive problems. The participants in those studies were followed for up to 25 years.”
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Epidemiology Of Lipids And Intracerebral Haemorrhage
The association between higher total and LDL cholesterol levels and increased IS risk is seen in most observational studies . Similarly, most observational data report an association between lower total and LDL cholesterol levels and increased ICH risk . A meta-analysis of 23 prospective studies involving 1,430,141 patients found an association between lower total cholesterol and increased rates of ICH doseresponse analysis revealed a relative risk of ICH per 1 mmol/l increment of total cholesterol of 0.85 . The nature of this association remains poorly understood. Of note, low levels of LDL cholesterol have been identified in patients with haematological cancers and liver disease , who have a higher risk of ICH.
Lipid Effects On Alzheimer’s Disease
Whilst both coronary heart disease and hypertension are independent risk factors for AD , the association between cholesterol and AD is less clear. There are conflicting epidemiological data some report an association between raised serum cholesterol levels and an increased risk of developing AD , whereas other studies have shown no effect or a negative association . These incongruous findings are likely to be due to differing study design, participant age at enrolment , timing of cholesterol measurement in terms of age and dementia onset and length of follow-up. APOE is an important protein involved in cerebral cholesterol transport and influences aggregation and clearance of amyloid- peptide . The amyloid cascade hypothesis suggests that an imbalance between production and clearance of amyloid- is the first step in AD pathogenesis, culminating in neuronal degeneration and dementia . This provides a theoretical link between cholesterol metabolism and pathogenesis of AD. Presence of the APOE 4 allele increases the risk of AD by 3 and 15 times in heterozygotes and homozygotes respectively . The 4 allele is associated with a higher risk of atherosclerosis and higher plasma levels of total and LDL cholesterol . In addition, several other genes involved in cholesterol metabolism have been associated with AD including adenosine triphosphate -binding cassette subfamily A member 7 , clusterin and sortilin-related receptor .
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Statins And Reversible Cognitive Impairment Evidence For
Statins have been linked to short-term reversible cognitive impairment since early safety and tolerability testing . During a phase I clinical trial of atorvastatin, escalating doses showed a dose-dependent adverse reaction of mild, transient, restlessness, euphoria, and mental confusion . However, cognitive impairment was not reported significantly enough in the in phase II and III statin clinical trials to be recognized as a side effect . Post-marketing surveillance can uncover side effects not identified in clinical trials and post-marketing surveillance of statins has revealed numerous case reports that characterize a transient and reversible cognitive loss. A review of 60 case reports described the main symptom of short-term memory loss that occurred a few months after the start of statin therapy or after an increase in dosage. Several case reports observed resolution of cognitive impairment upon discontinuation of the statin and recurrence of cognitive impairment upon rechallenging of the statin .
Voluntary reporting to AERs captures only an estimated 1 to 10% of true events. By extrapolation from their data the authors estimated a true amount of 3000 to 30,000 occurrences of cognitive impairment associated with atorvastatin and simvastatin a year . Since there are 32 million Americans on statins the risk of cognitive impairment can be extrapolated to be between 0.11% for the entire population taking a statin.
The Causes Of Vascular Dementia
Vascular dementia is caused by damage to brain cells deprived of blood flow and life-sustaining oxygen and nutrients due to reduced circulation or blockage of the brains blood vessels. The subsequent brain damage results in cognition and behavior changes.
These days, we focus heavily on the importance of Alzheimers disease, and that makes sense because Alzheimers is the most common form of dementia. Vascular dementia, though, is thought by some authorities to be the second most frequent dementia. To make matters worse, vascular dementia often accompanies Alzheimers disease. Vascular dementia is a destination that can be reached by more than one path.
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Statin Drugs Do Not Prevent Dementia
By Will Boggs, MD, Reuters Health
3 Min Read
Bottles of statin medications for the treatment of high cholesterol. Left to right, Lipitor , Pravachol , and Zocor . REUTERS/Newscom
NEW YORK – Statin drugs, a commonly prescribed class of lipid-lowering drugs that include Lipitor, Zocor and Crestor, do not prevent Alzheimers disease or dementia, according to a report in the Cochrane Database of Systematic Reviews.
In late life there is good evidence that statins given to people at vascular risk have no effect in preventing Alzheimers disease or dementia, Dr. Bernadette McGuinness from Queens University Belfast, Belfast, UK told Reuters Health. Statins cannot be recommended for this purpose therefore.
In an earlier review, two clinical reports had described an association between statin therapy and a reduction in the rates of Alzheimer disease by as much as 70 percent, McGuinness and colleagues explain, but there had been no randomized clinical trials performed at that point.
The investigators identified two published trials that included 26,340 participants. One compared simvastatin 40 milligrams with placebo, and the other compared pravastatin 40 milligrams with placebo.
There were no significant differences between any of the treatment groups in the percentage of participants classified as cognitively impaired, the researchers note.
Data Extraction And Quality Assessment
Data from the included studies were extracted independently by two authors. Data on sample size, method used for the outcomes definition, estimates of the association of interest, were extracted using a standardized electronic form. Additionally, we collected data about study design and cohort baseline characteristics .
All included studies were also independently evaluated by two co-authors to assess the risk of several bias. Screening was performed for five main bias categories . An overall, synthetic grade was produced for each study. The methodological quality of the included studies was evaluated based on the items of modified Newcastle-Ottawa Scale, comprising patient selection, study group comparability and outcome assessment. The observational studies scored 0 to 9. Divergent opinions were discussed among authors and a consensus was reached.
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Dangers Of Statin Drugs: What You Havent Been Told About Popular Cholesterol
Hypercholesterolemia is the health issue of the 21st century. It is actually an invented disease, a problem that emerged when health professionals learned how to measure cholesterol levels in the blood. High cholesterol exhibits no outward signsunlike other conditions of the blood, such as diabetes or anemia, diseases that manifest telltale symptoms like thirst or weaknesshypercholesterolemia requires the services of a physician to detect its presence. Many people who feel perfectly healthy suffer from high cholesterolin fact, feeling good is actually a symptom of high cholesterol!
Doctors who treat this new disease must first convince their patients that they are sick and need to take one or more expensive drugs for the rest of their lives, drugs that require regular checkups and blood tests. But such doctors do not work in a vacuumtheir efforts to convert healthy people into patients are bolstered by the full weight of the US government, the media and the medical establishment, agencies that have worked in concert to disseminate the cholesterol dogma and convince the population that high cholesterol is the forerunner of heart disease and possibly other diseases as well.
The drugs that doctors use to treat the new disease are called statinssold under a variety of names including Lipitor , Zocor , Mevacor and Pravachol .
Aspree Neurocognition Analysis Largely Neutral For Most People
byNicole Lou, Staff Writer, MedPage Today June 21, 2021
Statin users provided reassuring longer-term data on cognition in ASPREE, but even that large study could not exclude statin-related dementia in some older people.
People who entered the ASPREE trial on baseline statin therapy were not at a significantly elevated risk of incident dementia, mild cognitive impairment, or changes in domain-specific cognition over a median 4.7 years of follow-up, according to Zhen Zhou, PhD, of Menzies Institute for Medical Research, University of Tasmania in Hobart, Australia, and colleagues.
Yet statin users had lower baseline cognition function compared with non-users, and baseline neurocognitive ability turned out to be an effect modifier for the associations between statins and dementia and statins and memory change .
The increased dementia risk with statin use at lower baseline cognition was attributable mainly to the increased risk for Alzheimer’s disease , Zhou and colleagues reported in the Journal of the American College of Cardiology.
“It is possible that the increased dementia risk with statin use seen in the lowest cognition quartile reflected reverse causality or an indication bias whereby participants with lower cognition have been prescribed statins in the hope of preventing deterioration in the vascular component of dementia,” the authors suggested.
Statins are an established therapy for primary and secondary cardiovascular prevention.
Disclosures
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Help And Advice For Carers
If you care for someone with dementia, you may find it helpful to read more about:
Carer’s breaks and respite care this can allow you to take breaks from caring
Benefits for carers such as allowances and tax credits that may be available
Page last reviewed: 05 March 2020 Next review due: 05 March 2023
Intracerebral Haemorrhage And Vascular Dementia
Although ICH accounts for only 15% of strokes, it is associated with high rates of stroke-related death and disability . Re-bleeding, IS and cognitive impairment and dementiaall frequent events following ICHare endpoints that may be mediated by underlying SVD, which is probably the aetiology responsible for these secondary clinical outcomes and ICH . Indeed, compared with general elderly controls those with ICH have an increased frequency of both neuroimaging and genetic markers of SVD .
Biffi et al. report a high incidence of dementia , which could be an overestimation, perhaps through the use of TICS-m rather than in-person assessment, although the concordance between telephone and in-person assessments was high. Despite this, it is clear that cognitive impairment or dementia following ICH is under-recognized. In summary, ICH characteristics were associated with early and not late dementia after ICH, and markers associated with both SVD and late-onset AD were associated with delayed onset dementia . Further studies are required to elucidate the contribution of AD to cognitive impairment following ICH. Although this cohort provides evidence of separate risk factors for early and late dementia after ICH, these results need to be verified. An important question to address in those with delayed dementia following ICH is whether cognitive impairment is secondary to the ICH, or are the bleed and cognitive impairment both sequelae of the same underlying disease process ?
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Were The Included Studies Sufficiently Valid For The Question Asked
Yes, with caveats. Two large studies were included the Heart Protection Study , and PROSPER , where the interventions were simvastatin 40 mg and pravastatin 40 mg respectively. However, only the Heart Protection Study provided data on the incidence of dementia. Although the risk was low in all assessed domains, the incidence rate of dementia was very low.
Hypercholesterolaemia And Vascular Dementia
Correspondence:
Jason P. Appleton, Polly Scutt, Nikola Sprigg, Philip M. Bath Hypercholesterolaemia and vascular dementia. Clin Sci 15 July 2017 131 : 15611578. doi:
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Statins May Prevent Dementia Memory Loss Study Finds
A review of dozens of studies on the use of statin medications to prevent heart attacks shows that the commonly prescribed drugs pose no threat to short-term memory and that they may even protect against dementia when taken for more than one year.
The Johns Hopkins researchers who conducted the systematic review say the results should offer more clarity and reassurance to patients and the doctors who prescribe the statin medications.
The question of whether statins can cause cognition problems has become a hot topic among cardiologists and their patients following changes on the drug labels ordered by the Food and Drug Administration in February 2012, warning about memory problems with short-term statin use.
In their extensive review, however, the Johns Hopkins researchers found that statins do not affect short-term memory or cognition. In contrast, they say that when the drugs are taken for more than one year, the risk of dementia is reduced by 29 percent. Their findings are published in an online article in the Mayo Clinic Proceedings posted Oct. 1.
“Our goal was to provide clarity on this issue based on the best available evidence,” says Raoul Manalac, a co-primary author of the study. “We looked at high-quality, randomized controlled trials and prospective studies that included more than 23,000 men and women with no prior history of cognitive problems. The participants in those studies were followed for up to 25 years.”