Can statins (HMG-CoA reductase inhibitors) cause confusion in older adults?

From the Guidelines

Yes, statins can cause confusion in older adults, as evidenced by the most recent and highest quality study available 1. This side effect, while not extremely common, is more likely to occur in elderly patients due to their increased sensitivity to medication effects and changes in how drugs are metabolized with age. Some key points to consider include:

• Statins like atorvastatin, rosuvastatin, simvastatin, and pravastatin have been associated with cognitive effects including confusion, memory problems, and brain fog in some patients.
• These symptoms typically develop gradually after starting statin therapy and may be more pronounced at higher doses.
• If an older adult experiences new or worsening confusion after starting a statin, they should not abruptly stop the medication but should promptly consult their healthcare provider.
• The mechanism behind statin-related cognitive effects isn't fully understood but may relate to cholesterol's important role in brain function and neuron communication, as suggested by 1.
• Healthcare providers often weigh these potential side effects against the significant cardiovascular benefits of statins, and may consider dose adjustments, switching to a different statin, or alternative cholesterol-lowering approaches if cognitive symptoms occur, as noted in 1 and 1.
• It's also important to consider the patient's overall health, comorbidities, and potential interactions with other medications, as highlighted in 1. Overall, while statins can cause confusion in older adults, the benefits of statin therapy often outweigh the risks, and healthcare providers should carefully monitor patients for any adverse effects and adjust treatment as needed, based on the most recent evidence available 1.

From the FDA Drug Label

There have been rare reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with the use of all statins. Cognitive impairment was generally nonserious, and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks) Rare postmarketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. Cognitive impairment was generally nonserious, and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks)

Statins and Confusion in Older Adults:

• Statins have been associated with rare reports of cognitive impairment, including confusion, in older adults.
• The cognitive impairment is generally nonserious and reversible upon statin discontinuation.
• The time to symptom onset and resolution can vary, but the median time to resolution is 3 weeks 2, 3.
• Key Points:
  • Statins may cause confusion in older adults.
  • The incidence is rare.
  • Cognitive impairment is generally reversible upon statin discontinuation.

From the Research

Statins and Cognitive Side Effects in Older Adults

• Statins, also known as HMG-CoA reductase inhibitors, are commonly prescribed to prevent atherosclerotic vascular disease (ASCVD) events in adults, including older adults 4.
• However, there is evidence to suggest that statins may cause cognitive side effects, including confusion, in some older adults 5, 6, 7.
• A review of the current literature found that statin use may lead to mild reversible cognitive decline, although long-term studies have shown inconclusive findings 8.
• Some studies have reported a possible association between statins and adverse effects on cognition, including cognitive decline and dementia 5, 6, 7.
• The mechanisms of statin-induced cognitive decline are not fully understood, but may include reduction of synthesis of coenzyme Q10, depletion of central nervous system myelin, and inhibition of cholesterol synthesis 5.

Prevalence and Risk Factors

• The prevalence of statin-induced cognitive decline is not well established, but it is thought to be a rare side effect 6, 7.
• Older adults may be at higher risk of statin-induced cognitive decline due to age-related changes in cognition and increased sensitivity to medication side effects 8, 5.
• Other risk factors for statin-induced cognitive decline may include high doses of statins, combination therapy with other medications, and underlying medical conditions such as diabetes and hypertension 5, 6.

Clinical Implications

• Clinicians should be aware of the potential for statin-induced cognitive decline in older adults and monitor patients for signs of cognitive impairment 6, 7.
• The decision to initiate statin therapy should be based on a patient's overall ASCVD risk and weighed against other clinical factors that influence the patient's life expectancy and quality of life 4.
• Future trials of statin therapy should include systematic assessment of cognition to better understand the relationship between statins and cognitive side effects 6, 7.