Are Statins Associated With Memory or Cognition Decline in Elderly?

Statins may not be associated with memory or cognition decline in elderly patients, according to a study published Nov. 18 in the Journal of the American College of Cardiology.

Katherine Samaras, MBBS, PhD, et al., examined changes in memory and global cognition regarding statin-use over a six-year observation period and two years of brain volume studies in 1,037 participants aged 70 to 90 years. Data were collected every two years on four occasions over the six-year period by psychologists and nurses. There were 395 statin never-users and 642 statin ever-users, which included ever-users at baseline and those who commenced taking statins during the study period. On average, participants had been on statins for nine years. To measure the primary endpoints of memory and global cognition, the researchers developed a comprehensive assessment of global cognition and memory. Five memory tests were employed to assess new learning and short- and long-term recall using verbal and visual memory tasks.

Results showed that statin ever-users and never-users were similar at baseline for both memory and global cognition and the researchers found no significant difference in rate of decline in either memory or global cognition. Participants who took statins continuously over the study period had significantly higher baseline performance in memory and global cognition compared to never-users and the rate of decline in memory and global cognition for this subgroup was similar over the six-year observation period. When researchers compared the 99 participants who started statins during the study period, they found statin initiation was associated with a lessening in the rate of decline of memory. Overall, no associations between statin use and cognition were found between baseline and the six years of observation.

The researchers did find a protective interaction between statin ever-use, cardiovascular disease and the six-year change in the total learning memory test score. Among patients with cardiovascular disease, statin ever-users displayed a slower rate of decline on this test compared to never-users. However, in patients without cardiovascular disease, there was a comparable rate of decline between statin ever-users and never-users. The study also found a protective interaction between statin ever-use and the rate of decline in long-delayed recall performance for patients carrying the APOE-4 genotype, the genotype with high risk of Alzheimer’s disease. In secondary analyses, male statin users did display a significantly faster logical memory decline compared to male never-users, but there was no significant difference between female statin users and never-users.

In an accompanying editorial, Costantino Iadecola, MD, and Neal S. Parikh, MD, MS, said, “These data support the view that worries about cognitive impairment should not limit statin use and raise the possibility that statins may favorably alter cognitive trajectories in a group of elders at high risk of Alzheimer’s disease.”

Clinical Topics: Dyslipidemia, Lipid Metabolism, Sleep Apnea

Keywords: Apolipoprotein E4, Memory, Cognition, Alzheimer Disease, Learning, Cardiovascular Diseases, Genotype, Brain

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