The top four statin-type cholesterol-lowering medications are atorvastatin, simvastatin, pravastatin and rosuvastatin. Our back of the envelope calculations suggest that over 210 million prescriptions were dispensed to over 42 million Americans last year. Can statins affect memory? Most health professionals say no, despite a warning in the official prescribing information.
A new study in the Journal of the American College of Cardiology (June 29, 2021) says there’s nothing to worry about regarding the question of whether statins affect memory. But the data are a little more confusing than that simple conclusion.
The ASPREE Trial: Did Statins Affect Memory?
The ASPREE trial stands for ASPirin in Reducing Events in the Elderly. Over 19,000 older people with no pre-existing cardiovascular disease or dementia participated in this trial between 2010 and 2014. About a third of the participants had been taking statins when the aspirin study began.
All of them took tests to measure cognitive function at the beginning of the study and a few years later. The trial ran nearly five years. The study in the Journal of the American College of Cardiology analyzed the results to determine whether statin use was associated with cognitive decline.
Did Statins Affect Memory?
Although the investigators concluded that there was no link between statin use and dementia, their results are not entirely clear. People who were on statins at the start of the study, however, were about 33% more likely to be diagnosed with probable Alzheimer’s disease.
The association between statins and the development of Alzheimer disease was at the edge of statistical significance, at .05. According to the researchers, people who came into the trial on statins had lower test results when the study started. Moreover, people with lower cognitive scores at the outset were more likely to develop dementia during the study.
The accompanying editorial in the Journal of the American College of Cardiology (June 29, 2021) is titled “Statins and Your Memory: ‘Forget’ About It?” The authors state that although the risk for serious statin side effects is low:
“…statins have been associated with several other side effects, including liver function abnormalities, diabetes, muscular pain and weakness, and changes in memory.”
The authors note that:
“Lingering questions such as the one raised by this analysis regarding potential adverse effects of statins in patients with mildly impaired cognition can be answered only in randomized controlled trials in the appropriate age group and population and with appropriate testing and adequate follow-up.”
The editorial concludes that statins in older patients are unlikely to have a “major impact on cognition.”
I hope you find that more reassuring than I did. Statins have been on the market for more than 33 years. Don’t you find it a bit shocking that we still do not appear to have a firm answer to the question of whether statins affect memory.
Readers Continue To Ask About Statins and Memory:
Q. I read somewhere about a statin that is not fat-soluble and doesn’t cross the blood-brain barrier. Unfortunately, I forgot the name. I am currently taking simvastatin and have noticed a decline in my memory. Can you help me?
Could Statins Affect Memory?
A. Physicians have been debating the relationship between statins and cognitive function for decades. The FDA requires this statement for simvastatin:
“There have been rare postmarketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. These cognitive issues have been reported for all statins.”
How Do Clinical Trials Answer the Question: Do Statins Affect Memory?
Clinical trials have not demonstrated memory impairment due to statins (Journal of General Internal Medicine, March, 2015). The authors conclude:
“Statin therapy was not associated with cognitive impairment in RCTs [randomized controlled trials]. These results raise questions regarding the continued merit of the FDA warning about potential adverse effects of statins on cognition.”
A Contrary Perspective:
Despite this, published case reports link cognitive and psychiatric problems to statins (Pharmacotherapy, July, 2009; Drug Safety Case Reports, Dec., 2016; World Journal of Diabetes, June 15, 2017).
The authors of the last article on diabetes and statins introduce their research this way:
“Whether statins negatively affect cognitive function remains under dispute. Goldstein and Mascitelli (2014) propose that statins may negatively affect the brain and cognitive health, potentially via impaired myelination. Additionally, cell culture and animal studies show that statins exert neurotoxic effects. Four recent meta-analyses/reviews, however, found no significant relationship between statin use and cognitive impairment.”
Here is what they discovered in their research:
“This study analyzed correlations between statin use and cognitive impairment in a sub-group of participants with T1D [childhood-onset type 1 diabetes] from the on-going, observational Pittsburgh Epidemiology of Diabetes Complications Study. These now middle-aged adults were diagnosed with T1D prior to age 18 years, and have reported medication use biennially since the parent study baseline in 1986. Among the 108 participants with a cognitive assessment in 2010-2013, using statins more than tripled the odds of having cognitive impairment discernible by middle age. As duration of statin use increased (never, 1-6 years, 7-12 years), an increasing percentage of participants met the study definition of cognitive impairment (14%, 32% and 47%, respectively), independent of age or education.”
The authors noted that their results contradict the results of one other study that did not report such an association. They did find that statin use was linked to “poor performance of memory tasks.”
Canaries in the Coal Mine?
In a sense, people living with type 1 diabetes (T1D) since childhood are like canaries in the coal mines. They are more vulnerable to complications of this metabolic disorder. If statins affect memory, people with T1D may be more likely to experience such symptoms earlier in life than other individuals.
The authors’ conclusions from their relatively small study:
“Statin use was associated with cognitive impairment, particularly affecting memory, in these middle-aged adults with childhood-onset T1D, whom at this age, should not yet manifest age-related memory deficits.”
Statins and Memory Problems: An Old Question
We published this question in our March 12, 2001 syndicated newspaper column. The physician who contacted us was Duane Graveline:
Q. I am a retired family doctor and former astronaut (www.spacedoc.net). 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 did not seem to be aware of similar problems. Believing it must have been a simple coincidence, I decided a year later to restart Lipitor. Six weeks later I was brought to the ER with a twelve-hour episode of total global amnesia. I am more convinced than ever of a Lipitor relationship.
Do you have any information on other people who may have had such an experience? I have my astronaut physical again in a few weeks and would like to tell the doctors about this if you have any data. This drug is in common use at JSC and for all I know other astronauts may be on it as part of their enthusiasm for preventive medicine.
Our Response to Dr. Graveline:
A. Total global amnesia seems to be rare, but one person told us that Lipitor resulted in “big ugly holes burned through my memory.” According to Beatrice Golomb, M.D., Ph.D., Principal Investigator of the Statin Study at the University of California, San Diego:
“We have received dozens of reports from people citing significant memory problems with Lipitor that seem to resolve with discontinuation. Some are from older people who have gone from very bright and verbal to not recalling the names of their children or grandchildren, in short order; and others are from younger people who have rather abruptly developed memory problems. Several have gone so far as to get work-ups for early Alzheimer’s in their 40s or early 50s, only to find that the problems resolved when they discontinued statin drugs.”
Over the last three decades we have received hundreds of reports from readers of our newspaper column and visitors to this website. Here is just one of many articles:
The People’s Pharmacy Perspective:
The controversial question: Do Statins Affect Memory? remains unresolved to this day. We cannot disagree with researchers and physicians who say that it did not show up in the randomized controlled trials carried out by drug companies. That said, there may be susceptible individuals out there who are especially sensitive to statin side effects. We suspect that people who develop severe muscle pain and weakness when taking statins might also be vulnerable to cognitive complications.
Until this controversy is resolved, some experts recommend switching to a less fat-soluble statin, such as pravastatin or rosuvastatin (Canadian Pharmacists Journal, May, 2015). You can learn more about other ways to lower cholesterol in our Guide to Cholesterol Control and Heart Health. This online resource can be found in the Health eGuides section of this website.
No one should ever stop any prescription medication without careful conversations with the prescribing physician. Most people do not appear to experience noticeable cognitive decline or memory problems while taking standard doses of statins. Others, however, may be affected in subtle or profound ways.
We would love to learn about your statin experience. Have you noticed any statin side effects? Share your statin story (positive or negative) in the comment section below.