While some doctors and researchers seem keen to downplay the potential hazards of statins, their use is linked with a range of unwanted effects including muscle weakness, muscle pain, liver damage and kidney damage. These are all well-recognised side-effects from this form of medication. However, there is also some thought that statins can affect brain function too, and in particular may impact on memory and basic brain function. If this is the case, then one might expect statins to be particularly problematic in individuals who have compromised brain functioning to begin with, such as those with Alzheimer’s disease.
A group of US-based researchers decided to test this idea in a group of elderly individuals suffering from Alzheimer’s disease (the most common form of dementia) . All of the individuals in this study were taking statins at the start of the study. The research involved taking these individuals off statins for 6 weeks, and then putting individuals back on their statin medication for another 6 weeks. During the study, individuals had their mental functioning assessed including with a tool known as the ‘mini mental state examination’ (MMSE). This test is designed to assess brain functions such as memory, the production and understanding of language, problem-solving and decision-making – what researchers and doctors often refer to as ‘cognition’.
This research revealed that withdrawal of statins led to a statistically significant improvement in cognition in the study subjects. Re-starting statin therapy led to cognition worsening again. The implication here is that for individuals with dementia, statin treatment might further compromise brain function and, along with it, quality of life and dependence of carers.
Just this week, I saw an elderly man in practice who came with a main diagnosis of Parkinson’s disease, and a past history of more than one ‘mini-strokes’ (known as transient ischaemic attacks). One of the medications which he takes is simvastatin. His daughter wondered whether this might be somehow compromising her father’s health, including his mental functioning. The only legitimate answer to her question is ‘yes’. But as I went on to explain, it is in my view highly unlikely that any problems here are likely to be entertained by her father’s regular doctor.
The problem is that most doctors will see sitting in front of them an elderly man with Parkinson’s disease and a history of mini-strokes, and imagine any compromise in his functioning will be related to these things, not a statin drug which was started several years ago. It might be, however, that the statin drug is genuinely compromising his functioning, and it’s certainly legitimate for this possibility to at least be entertained.
Of course precisely the same situation may arise for individuals suffering from Alzheimer’s disease, and it seems reasonable to wonder how many individuals might benefit from a trial without their statin medication. It certainly conceivable that many would benefit, as would perhaps other individuals on statins who find their energy levels and mental functioning is not what it should be.
Here’s to a healthy heart
Dr John Briffa
for The Cholesterol Truth
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1. Padala KP, et al. The Effect of HMG: CoA Reductase Inhibitors on Cognition in Patients With Alzheimer’s Dementia: A Prospective Withdrawal and Rechallenge Pilot Study. Am J Geriatr Pharmacother. 2012 Aug 22. [Epub ahead of print]