Serum Lipoprotein Levels, Statin Use, and Cognitive Function in Older Women

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Abstract
ABOUT 10% of people older than 65 years have cognitive impairment, ranging from mild deficits to dementia.1 However, few modifiable risk factors for cognitive impairment have been identified. Serum lipoprotein levels, especially among people with cardiovascular disease, may be a common and potentially modifiable risk factor for cognitive disorders. The findings of studies that have investigated the relationship between serum lipoprotein levels and risk of cognitive impairment are conflicting. Some cross-sectional studies2,3 suggest that high total cholesterol levels are associated with an increased risk of Alzheimer disease (AD), while others4 report that low total cholesterol levels are associated with the risk of developing AD. Cross-sectional studies of this question can be misleading because dementia may cause changes in lipoprotein levels by altering diet or metabolism. However, prospective studies have also had conflicting results. In one study5 of more than 1000 elderly persons, a higher baseline low-density lipoprotein (LDL) cholesterol level was associated with an increased risk of developing stroke-related dementia but not with a risk of developing AD. Two other prospective studies6,7 found no association between lipoprotein levels and risk of dementia, and a third study8 reported a statistically significant, but of unclear clinical significance, association between lower total cholesterol levels and higher rates of cognitive decline in older twins. To our knowledge, no studies have explored whether changes in lipoprotein levels are associated with cognitive function in elderly persons.