From the Guidelines
Statins should not be started or continued specifically to prevent or treat dementia, as the current evidence does not support a significant benefit in preventing dementia or cognitive decline. While some observational studies initially suggested statins might reduce dementia risk, more rigorous clinical trials, such as those cited in 1, have not confirmed this benefit. The most recent and highest quality study, 1, found that published data do not reveal an adverse effect of statins on cognition, and therefore, a concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia is not currently supported by evidence.
For patients already taking statins for cardiovascular disease prevention, continuing them is generally recommended regardless of cognitive status, as the benefits of statin therapy in reducing cardiovascular risk outweigh the potential harms. However, in patients with established dementia, decisions about statin therapy should be individualized based on cardiovascular risk, life expectancy, and goals of care. Some patients with advanced dementia may appropriately have statins discontinued as part of deprescribing efforts, as the potential benefits of statin therapy may be outweighed by the potential harms and the burden of polypharmacy.
Key considerations in making decisions about statin therapy in patients with dementia include:
- Cardiovascular risk: Patients with high cardiovascular risk may benefit from continued statin therapy, regardless of cognitive status.
- Life expectancy: Patients with limited life expectancy may not benefit from continued statin therapy, and the potential harms may outweigh the benefits.
- Goals of care: Patients with advanced dementia may have goals of care that prioritize comfort and quality of life over aggressive medical therapy.
- Potential harms: Statins can cause adverse effects, such as myalgias, liver enzyme elevations, and cognitive changes, which should be carefully considered in patients with dementia.
Overall, the decision to start or continue statin therapy in patients with dementia should be individualized and based on a careful consideration of the potential benefits and harms, as well as the patient's overall health status and goals of care, as supported by the evidence in 1.
From the Research
Dementia and Statin Use
- The relationship between statin use and dementia has been investigated in several studies, with mixed results 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that statins may have a small benefit in delaying progression in Alzheimer's dementia, although the evidence was insufficient to fully evaluate the efficacy of statins in people with dementia 2.
- Another study found that ongoing statin use was not associated with cognitive decline or dementia progression in mild-moderate Alzheimer's disease, and was also not associated with adverse events 3.
- A meta-analysis of observational studies found that statin therapy was significantly associated with a decreased risk of dementia, particularly Alzheimer's disease 4.
- However, other studies have found no association between statin use and the risk of incident dementia 5, or have reported conflicting results depending on the analysis method used 5.
Statin Use and Dementia Risk
- The use of statins has been associated with a lower risk of dementia in some studies, particularly in those with high vascular risk 2, 4.
- However, the evidence is not consistent, and some studies have found no association between statin use and dementia risk 5.
- The relationship between statin use and dementia risk may be influenced by factors such as the type of dementia, the duration of statin use, and the presence of other cardiovascular risk factors 3, 6.
Clinical Implications
- Clinicians should be aware of the potential benefits and harms of statin use in patients with dementia, and should consider the individual patient's risk factors and medical history when making prescribing decisions 2, 3.
- Further research is needed to fully understand the relationship between statin use and dementia, and to inform evidence-based prescribing decisions 2, 4.