Statins Could Potentially Slow Deterioration of Cognitive Function for Those With Alzheimer Disease

Lipid-lowering statins have the potential to slow the deterioration of cognitive functions for individuals with Alzheimer disease (AD), according to results of an observational study published in Alzheimer Research and Therapy. Due to the observational nature of the study, the study authors said they cannot determine causal relationships between statins and cognitive decline and caution against the interpretations of the study.^1,2

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“[Individuals] with [AD] treated with statins had better cognitive development over time. However, the results of the study do not mean that we now have evidence that [those] with dementia should be treated with statins. But, on the other hand, we can't see any support for not doing so. So, if [someone] needs statins for high blood lipids, a dementia diagnosis should not stop the treatment," Sara Garcia-Ptacek, MD, PhD, docent of neuroscience and assistant professor at the Department of Neurobiology at the Care Sciences and Society at the Karolinska Institutet, said in a press release.¹

Investigators used a longitudinal cohort study design of individuals with AD or mixed dementia and statin usage for lowering lipids. Data were gathered from the Swedish registry for dementia, according to the study authors, which accounted for 78% of primary care centers and all memory clinics of Sweden.² Information on age, sex, living arrangements, date and care unit registration, type of dementia, and cognitive status at baseline and follow-up using mini-mental state examination (MMSE) scores were used.²

In the study, there were 15,586 individuals with AD or mixed dementia, with a mean diagnosis age of 79.5 years. Approximately 59.2% were women and the MMSE scores averaged 21 points at baseline. In the observation period, 10,867 individuals used statins, with the most prescribed being simvastatin at 52.8% and atorvastatin at 14.2%. There were 1.9% of users who used non-statin, but lipid-lowering medications, according to the investigators.²

The study authors reported that those who used statins, after taking an average of 1 defined daily dose of statins for a year, had an MMSE score of 0.21 more points, and there was a dose-response effect. After 3 years of an average 1 defined daily dose of statins, patients had 0.63 more points on MMSE scores, according to the results of the study.²

According to the study investigators, those taking simvastatin had a slower MMSE decline compared to those using rosuvastatin, and simvastatin was associated with a 1.01 increase in MMSE points after 3 years compared to atorvastatin. Younger aged individuals taking simvastatin had 0.80 more MMSE points compared to younger individuals taking atorvastatin after 3 years.²

There was no significant difference in MMSE decline for lipophilic statin compared to hydrophilic statins. Further, the use of fungal statins was not associated with a difference in MMSE decline compared to synthetic statins nor was there a difference between non-statin lipid lowering medication and statins.²

“The basic idea of this study was to pave the way for a more precise cohort study that could eventually lead to a clinical intervention study, which is what is needed to prove a causal link between statins and cognition,” Garcia-Ptacek said in the press release. "We believe that only certain patients with Alzheimer's dementia may benefit from statins and that previous clinical trials have been too small to show any significant differences. Our idea is to try to crystallize which patient groups benefit the most and why, before embarking on clinical trials.”¹

References

1. Finding that statins could slow dementia stimulates further research. News release. EurekAlert. December 19, 2023. Accessed December 20, 2023. https://www.eurekalert.org/news-releases/1029511
2. Petek B, Häbel H, Xu H, Villa-Lopez M, et al. Statins and cognitive decline in patients with Alzheimer's and mixed dementia: a longitudinal registry-based cohort study. Alzheimers Res Ther. 2023;15(1):220. doi:10.1186/s13195-023-01360-0