A common question we’ve encountered from members is whether the common class of drug used to treat high cholesterol - called “statins” - can cause memory problems in some people.

This article is an overview of the link between cholesterol, statins, and memory, and how to start a conversation with your own doctor to decide what is right for you.

For background on what cholesterol is and other roles in the body, read this medical minute.

Cholesterol Balance

Cholesterol is needed by our brain to:

• form brain cells (as part of cell membrane formation),

• send proper signals (synaptogenesis and neurotransmitter transport),

• speed up transmission (called myelination),

• brain defense (as part of the blood-brain barrier), and more.

However, if you have too much cholesterol it can cause memory problems through:

• heart attacks and strokes which can lead to vascular dementia.

• increased deposition of amyloid β and tau which can lead to Alzheimer’s dementia

This means that you need cholesterol for proper brain function, but not too much, otherwise you can end up with damage to the brain.

The goal is therefore to maintain a balance between cholesterol going into your cells (the type called “LDL cholesterol”) and cholesterol going out of your cells & body (the type called “HDL cholesterol”) to achieve your optimally healthy state.

Is high cholesterol linked to memory problems?

Yes.

Excess LDL cholesterol in your body is believed to be responsible for 7% of dementia cases in the world, according to the latest Lancet dementia prevention update (here).

On an individual level, high LDL increases your baseline lifetime risk of dementia by 30% (which means going from 10% lifetime risk up to 13%. If you have a family history of dementia, your lifetime risk becomes about 32%).

This is through the link between cholesterol and heart attacks, strokes, and increased beta-amyloid and tau proteins in the brain, which can lead to vascular and Alzheimer’s dementia respectively.

Are statins linked to memory problems?

Yes, but not in most people. Some studies actually show reduced dementia risk when taking statins.

Statins are the most commonly used medication for high cholesterol.

There have been some reports of memory problems after starting statins, particularly those that are “lipophilic”, namely Atorvastatin and Simvastatin (Wagstaff et al, Pharmacotherapy, 2003, found here).

Other statins, such as Rosuvastatin and Pravastatin have not had the same degree of case reports.

Symptoms usually started about 2 months after starting the medication, and went away in about 2 weeks after stopping the medication.

How to talk to your doctor

If you are worried about memory or other side effects of statins, here are some general suggestions to talk to your doctor about:

1. If new memory symptoms occur within a few months of starting a statin, talk to your doctor about stopping

2. Once stopped, wait and observe for the memory symptoms to resolve.

3. If memory symptoms resolve, talk to your doctor about resuming the medication

4. If memory symptoms return, you now have your answer for how you uniquely respond to the medication - ie. the symptoms are only there when you are taking the statin.

5. Talk to your doctor about other options - either a different statin such as rosuvastatin, or other treatment options.

Remember: memory problems are rare with statins, while heart attacks, strokes, and dementia from high cholesterol are more common. If you don’t have side effects of statins, the benefits of taking a statin likely outweigh the risks (read more here).

As well, if you were started on a statin after a stroke, it is possible that your decline in memory is from the stroke itself, not the statin. The only way to know would be to switch to a different drug and see if your memory improves. We wouldn’t suggest stopping a statin in someone who has recently had a stroke.

In closing…

• Some cholesterol is needed in your body to be healthy.

• Too much cholesterol can build-up in your cells, causing strokes and heart attacks, which can then lead to dementia.

• Balancing your cholesterol at a healthy level is best done by changing what you eat

• If using a medication to balance your levels, it is always a good idea to monitor for side effects - memory or otherwise

• If you experience memory changes within a few months of starting a statin, talk to your doctor about stopping, then re-starting, to see if the symptoms are clearly linked to when you are taking the medication *but don’t stop without the guidance of a healthcare professional

• Consider switching to a different statin or a different drug.

Key References:

1. Statin-associated memory loss: analysis of 60 case reports and review of the literature. (Wagstaff et al, Pharmacotherapy, 2003, found here)

2. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. (Livingston et al, Lancet, 2024, found here).

3. Emulating a target trial of statin use and risk of dementia using cohort data. (Caniglia et al, Neurology, 2020, found here; in which only the composite outcome of dementia or death was reduced with statin use, not dementia alone).

4. Is statin-associated cognitive impairment clinically relevant? A narrative review and clinical recommendations. (Rojas-Fernandez and Cameron, Annual Pharmacotherapy, 2012, found here).

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