The relationship between statin-type cholesterol-lowering drugs and memory problems has been controversial for decades. When we first wrote about a link between drugs like atorvastatin (Lipitor), lovastatin (Mevacor), or simvastatin (Zocor) and forgetfulness or brain fog 22 years ago, we were told it was all in our heads. Some health professionals were outraged that we dared to discuss this issue at all. The idea that a statin-type heart drug could cause transient global amnesia was an abomination.
Transient Global Amnesia:
We first heard about a rare medical condition called TGA (transient global amnesia) in 2001 from a reader of this newspaper column. Duane Graveline, MD, MPH, wrote to us with a strange story:
“I am a retired family doctor and former astronaut. Two years ago at my annual astronaut physical at Johnson Space Center (JSC) I was started on Lipitor. Six weeks later I experienced my first episode of total global amnesia lasting six hours. They couldn’t find anything wrong with me so I suspected Lipitor and discontinued it.
“Other doctors and pharmacists were unaware of similar problems. Believing it must have been a coincidence, I restarted Lipitor a year later. After six weeks I landed in the ER with a twelve-hour episode of total global amnesia. I am more convinced than ever of a Lipitor relationship.”
Dr. Graveline’s Legacy:
Dr. Graveline died in 2016. He was convinced that his episodes of TGA and his subsequent degenerative neuromuscular condition were caused by statin-type cholesterol-lowering drugs. Over that time he wrote several books including Lipitor, Thief of Memory, and Statin Drug Side Effects.
After sharing Dr. Graveline’s story with readers we heard from many other people who had also suffered episodes of transient global amnesia. In honor of Dr. Graveline, we share some of those stories with you:
Readers Share Stories of Transient Global Amnesia:
TGA is a frightening complication:
Q. My doctor prescribed Lipitor when it was a hot drug for lowering cholesterol. I was 48 years old and on no other meds. My numbers dropped dramatically. I was on no other medication and my blood sugar count was normal. My kidney function was also good for my age.
Everything was great for several years. Then I developed type 2 diabetes, peripheral neuropathy, reduced kidney function and Transient Global Amnesia. The TGA episodes were more frightening than all the other side effects combined.
A. There are relatively few reports of TGA associated with statins in the medical literature. That said, the FDA requires this notification in the official prescribing information:
“There have been rare reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with the use of all statins.”
Transient Global Amnesia Can Strike At Any Age:
“I suffered from 10 hours of amnesia in 2009 when I was 63 years old. I had been on statins for ten years. I was hospitalized and thoroughly tested, including MRI, EEG and EKG. I was tested for stroke or other possible causes including blockage of carotid arteries.
“All of those tests were negative. My final diagnosis was that I had suffered TGA (Transient Global Amnesia). I came out of the amnesia feeling well. I went off statins and now control my cholesterol with other strategies. My cholesterol is not as low as it was on statins, but is in an acceptable range.”
William in Huntingdon, PA shared this scary situation:
“I, too, had amnesiac experiences on Lipitor: on one occasion I lost an entire day–bewildering. A second time I had a memory blackout: forgot my S.S.#, my telephone #, my bank card #, even my birthday date.
“I was a university professor for 30 years who remembered everything. I worried that I had had a minor stroke. I saw a neurologist for an Alzheimer’s test: I had no symptoms. Later, because I had leg and muscle pain on Lipitor, my family physician changed me to Pravachol. Both the muscle pain and the amnesiac experiences stopped!
“Physicians need to inform their patients on Lipitor–and probably some other statins–of this serious and upsetting side effect.”
We have had far fewer reports of memory problems associated with pravastatin than with atorvastatin. That may be because pravastatin (Pravachol) is prescribed less often than atorvastatin. It may also be that pravastatin doesn’t get into the brain as easily as some other statins such as simvastatin or atorvastatin.
Mel in Oregon wrote in October, 2008:
“My situation is similar to others in terms of cholesterol and TGA. I was taking 5 mg of Lipitor (half of a 10 mg pill) and had been for over a year. At a dinner business presentation, sitting and talking to people on one side and my wife on the other, I suddenly ‘woke up’ and realized I didn’t remember anything that had happened for the previous 40 minutes.
“According to my wife, I had continued to talk to her and the people on the other side until the meeting started. But after I woke up I kept repeating myself and she thought I might have had a small stroke. Doctors did ultra sound, CT Scan, EEG, stress tests and found no cause. The Neurologist wanted to blame it on migraines — I think because I had a lingering stiff neck and slight headache at the back of my head. But in my opinion it didn’t fit. I had never had migraines. I was 73 years old at that time.
“My Internal medicine doctor had me switch to 5 mg of Crestor so I didn’t have to split the 10 mg Lipitor pill. Six months later, while on the treadmill (after four days of taking 5 mg of left over Lipitor–I wanted to use it up before it expired and not waste it), I had a 10-minute memory loss.
“This time I ‘woke up’ much more confused than the first time and I could not think clearly. Less than an hour later at supper again my wife told me I was repeating myself. It was then that I first understood that I had had another TGA attack. Again I had the stiff neck and slight base of skull ache that started about an hour after the attack and lingered for several weeks. My doctor was not interested in even talking about it.”
Another reader related this experience:
“I prodded my doctor to start me on Lipitor. The drug dropped my LDL cholesterol well below 80 but my HDL stayed in the mid-thirties.
“After being on atorvastatin for a couple of months I woke up one morning and had no idea what day of the week it was or that the company picnic had been the day before. At work I could not make simple postings of dollar amounts from hard copy to electronic spreadsheet (I would forget the amounts).
“At a meeting I could not remember names or how to structure sentences. At home I kept asking my wife the same question as I could not remember her answer. She became so concerned she forced me to see a doctor. He thought I had a mini-stroke but ultrasound, brain scans and all other tests were normal. I mentioned Lipitor but the doctor dismissed it (“no way”). At the end of the evaluation I was diagnosed with TGA.
I went back to the Niaspan my doctor had originally prescribed. My liver tests are good. My HDL improved to 43 and my LDL is now 80. What is most surprising is that my memory has improved (not just returned to normal) and my performance at work is outstanding.”
Statins and General Memory Problems:
Transient Global Amnesia is a relatively rare condition. That’s why it stands out. Very few people spontaneously experience amnesia where they forget where they are, who they are married to or what they do for a living.
Here are just a few additional stories we have received:
Arlene shared this experience:
“I have tried many statins, but continue to have the same side affect, which is loss of memory. I also had what I can call amnesia episodes. My doctor wants me to continue trying different statins, but I’ve just about had it. I’m beginning to think he doesn’t believe me about the regular memory problems or the two amnesia episodes.
“I also had a muscular problem with one statin which he quickly asked me to stop taking. I don’t know what to do. Maybe I should change doctors, but they’re all pretty much into statins these days. Has anyone else had so many episodes with memory problems while taking statins?”
Linda is worried about her husband’s memory:
“My husband has been on the atorvastatin for over three years. He was always a very sharp individual with an excellent memory. Over the past two years he’s been having terrible bouts of severe depression and memory loss. He is always tired and at times cannot think of certain words. He’s mentioned this to his cardiologist but his doctor refuses to admit that it is from the atorvastatin. He is taking 80 mg of atorvastatin and his cholesterol levels are very low.”
Mike’s Cognitive Decline:
Perhaps the most powerful story we have ever received about statins and memory problems came from Michael, a retired professor of business law and computer science. He was diagnosed with probable Alzheimer’s disease that was progressing very rapidly. He went to his 50th college reunion with a sign around his neck that said, “I’m Mike. I have Alzheimer’s disease.”
At his youngest daughter’s wedding, he did not recognize people he had known for more than 20 years. His decline made it clear that he would need long-term nursing care very soon. But then he read about statins and memory problems. With his doctor’s knowledge, he discontinued the simvastatin he had been taking. Although it took many months, he gradually regained his memory and cognitive ability.
He wrote to us and reported that he was back to reading three newspapers a day and is as sharp as a tack. A complete neurological workup showed no signs of Alzheimer’s disease.
The FDA’s Stance on Statins and Memory:
Of course not all symptoms related to forgetfulness or memory loss can be attributed to statins. Many people develop cognitive decline regardless of medications. This can happen even when someone is taking no medications at all.
The FDA does require the makers of statin-type drugs to list memory loss, forgetfulness, amnesia, memory impairment and confusion as possible adverse reactions. It also adds this:
“The reports are generally nonserious, and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks).”
Don’t you love the word “generally”? It leaves a lot of uncertainty. As far as we can tell, the FDA has not required pharmaceutical manufacturers to do large, well-controlled, long-term studies to resolve the lack of clarity.
It has been our experience that many cardiologists hate mentioning statin side effects. Some have denied that statins cause muscle problems. Others insist that any mental side effects are imaginary. Without well-designed studies it is hard to refute these assertions.
What To Do?
The scientific literature is confusing when it comes to statins and transient global amnesia and other memory problems. We found one link in BMJ Case Reports (online, Feb. 26, 2009) titled:
We advise that people never stop taking a statin without first consulting the prescriber. Patients with heart disease may find that the benefits of statins outweigh any risks of such drugs. Others, though, may need to consider alternatives to statins if muscle pain, weakness or cognitive deficits are interfering with quality of life.
To learn more about statin side effects you may wish to consult our Guide to Cholesterol Control and Heart Health. It offers many non-drug strategies for lowering risks.