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Effects of Statins on Memory in the Elderly
Study Questions:
What is the association between statin use and changes in memory and global cognition, as well as brain structure, in the elderly?
Methods:
The authors used data from the Sidney Memory and Ageing Study, a longitudinal cohort of community-dwelling elderly (ages 70-90 years) Australians. Patients with cognitive impairment were excluded from these analyses. Data, including demographics, medication and medical history, neuropsychiatric assessments, and laboratory evaluation were performed every 2 years for 6 years. Statin use was characterized as ever versus never statin use; continuous statin use during the study period; and statin initiation during the study period. Memory was evaluated using standard neuropsychiatric metrics and assessment of global cognition included tests of memory as well as executive function, visuospatial ability, and processing speed. A subset of subjects had brain magnetic resonance imaging, at baseline and after 2 years, to evaluate for changes in brain structure. Mixed modeling was used to evaluate the association between statins and memory and global cognition, with adjustment for risk factors.
Results:
There were 1,037 subjects included in the analyses. The vast majority (98%) were Caucasian and the mean education was 11.8 years. Forty-five percent of patients had incomplete cognitive testing data. Statin users comprised most of the cohort (68% with continuous statin use), although 395 patients had never used a statin. The mean duration of statin use was 9.1 years. When compared with subjects who had not used statins, statin users had a higher prevalence of vascular risk factors, lower total cholesterol, high-density lipoprotein and low-density lipoprotein values, but higher triglycerides and fasting glucose values.
Statin users had higher baseline performance on tests of memory and global cognition when compared to subjects who did not use statins, but the rate of decline was not significantly different between to the two cohorts. Among statin users, there were no differences between those taking atorvastatin versus simvastatin versus pravastatin. In the 99 subjects who started a statin during the study period, the decline in memory associated with aging was attenuated. Statin use was also associated with a decrease in the rate of memory decline in patients with heart disease and the ApoE4 allele. Statin use was not associated with differences in brain volume measures.
Conclusions:
In a cohort of community-dwelling elderly Australians, statin use was not associated with changes in memory or global cognitive decline, or changes in brain structure.
Perspective:
Statin use is common and despite no evidence of a negative association between statins and memory or cognition in trials, patients frequently report an association between statins and worsening thinking. Elderly populations have not been well represented in statin trials, adding to the importance of this work. The results of the study are strengthened because the authors could adjust for covariates associated with cognitive decline and used detailed neuropsychiatric testing to evaluate memory and cognition. Limitations include the observational design of the study and frequent missing cognitive assessment data. The finding that statins are not associated with an accelerated rate of memory and cognitive decline in elderly patients is reassuring given an aging population, the societal implications of dementia, and frequency of statin use.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Noninvasive Imaging, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Magnetic Resonance Imaging, Sleep Apnea
Keywords: Aging, Apolipoprotein E4, Cholesterol, Cholesterol, LDL, Cholesterol, HDL, Cognition, Dementia, Dyslipidemias, Geriatrics, Glucose, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Magnetic Resonance Imaging, Memory, Pravastatin, Primary Prevention, Risk Factors, Simvastatin, Triglycerides, Vascular Diseases
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