Do people taking statins to control their cholesterol experience cognitive impairment as a side effect? Many think so. If they anticipate that statins wreak havoc on their memory, they may be reluctant to take such drugs. Needless to say, cardiologists often find this regrettable (JAMA Cardiology, June 26, 2019). Most doctors are convinced that “Statin treatment does not adversely affect cognitive function” (European Heart Journal, July 14, 2018). Despite this, patients continue to report cognitive and memory problems (Advances in Therapy, Oct. 2019).
Could Statins Wreak Havoc on Cognitive Capacity?
Australian scientists expressed concern that media reports and anecdotes discouraged people from taking statins (Trends in Cardiovascular Medicine, Aug. 2016). Consequently, they examined the results of an observational study to look for evidence of cognitive decline (Journal of the American College of Cardiology, online Nov, 18, 2019).
The Sydney Memory and Aging Study included more than 1,000 individuals who were between 70 and 90 at the start of the study. None of these people had dementia at the outset. The study organizers performed cognitive tests and physical examinations on the participants every two years.
In addition, about 500 of the volunteers agreed to have brain scans as part of the study. Roughly 400 underwent an additional scan two years later.
No Evidence That Statins Wreak Havoc on Memory:
Upon analyzing these data, the investigators did not find statistical differences in cognitive skills between those taking statins and those not on the drugs. Moreover, the two-year changes in brain volume were also indistinguishable between people on statins and others.
There was one important exception: People with heart disease seemed to do better if they were taking a statin. The long-term effects of heart disease are deleterious for the brain.
The investigators concluded:
“In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.”
The People’s Pharmacy Perspective:
We are pleased to learn that statin use was not associated with obvious cognitive decline in this cohort of Australian elders. However, we are not convinced that this study provides the final word on the question. A narrative review of research concluded that statins can, in some cases, cause cognitive impairment but in others they appear protective (Translational Neurodegeneration, Feb. 27, 2018). Randomized controlled trials do not provide evidence of either effect. The authors hypothesized that two independent mechanisms may account for the conflicting results.
Some years ago, headlines suggested that statins might actually prevent dementia:
Furthermore, a different group of Australian researchers reported on their review of studies and case reports (Expert Review of Clinical Pharmacology, April 27, 2019). They proposed mechanisms such as reduced Coenzyme Q1o synthesis and depletion of myelin on nerves to explain the results they found.
Consequently, they concluded that statins wreak havoc on memory and cognition, at least in some individuals:
“We conclude that statin-induced cognitive decline does exist, needs to be better recognized and requires more studies of prevention and treatment.”
Many of our readers have noticed memory problems associated with statins. We acknowledge that these reports are anecdotal, but we suspect that such experiences color people’s attitudes toward these drugs.
Mary Beth reported:
“My husband is only 57 and is having major memory problems. He was started on a statin in July 2017, and I first started noticing memory problems in August 2017. Now it is almost 2 years later, and he is having major memory problems. I just stopped his statin with the O.K. from his doctor 3 days ago.”
Winifred thinks a statin may be affecting her job performance:
“I have been on atorvastatin 6 wks now. My job entails acute attention to detail, as I assist individuals in completing applications for Medicare plans. These enrollments are also contracts, and must be accurate in all aspects. My work has always been exemplary. However, for the past month and a half, I have made several mistakes a week–mistakes of which I was unaware and did not catch on review of applications. I have felt increasingly incompetent and inadequate and have been considering quitting my job, attributing the issue to my aging brain. (I am 65.) It struck me today that this problem began occurring since I started taking atorvastatin.”
“In conversation with my husband, he acknowledged that he has noticed a difference in my functioning. Though he ‘could not put a finger on it,’ I have not been as sharp as he has always known me to be. He attributed it to getting older but noted the onset was relatively acute. How have I felt? Perhaps a little fuzzy and definitely not sharp! At this point, I am stopping this drug. I go to see my doctor tomorrow to let her know. I should also say that I am rather medication-sensitive, and my mother was acutely so.”
Our Conclusion:
We suspect that some people are far more susceptible to statin side effects than others. Many people get great benefit from these cholesterol-lowering drugs. Perhaps others, like Winifred, are more sensitive to the effects. This is not likely to show up in clinical trials or even in observational trials like the Sydney Memory and Aging Study. If both patients and doctors approached the potential value/harm equation of these medications without bias, those who benefit could do so. Conversely, those who find that statins wreak havoc on their minds or their muscles would be encouraged to discontinue early and reverse the damage.
