Department of Neurology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
J Stroke Cerebrovasc Dis. 2012 Aug;21(6):436-44. doi: 10.1016/j.jstrokecerebrovasdis.2010.11.002. Epub 2011 Jan 14.
Lipid-lowering medications (LLMs) and especially statin drugs can delay cognitive decline and dementia onset in individuals with and without mild cognitive impairment (MCI) at baseline.
A longitudinal, observational study was conducted of 3069 cognitively healthy elderly patients (≥75 years of age) who were enrolled in the Ginkgo Evaluation of Memory Study. The primary outcome measure was the time to adjudicated all-cause dementia and Alzheimer dementia (AD). The secondary outcome measure was the change in global cognitive function over time measured by scores from the Modified Mini-Mental State Exam (3MSE) and the cognitive subscale of the AD Assessment Scale (ADAS-Cog).
Among participants without MCI at baseline, the current use of statins was consistently associated with a reduced risk of all-cause dementia (hazard ratio [HR], 0.79; 95% confidence interval [95% CI], 0.65-0.96; P = .021) and AD (HR, 0.57; 95% CI, 0.39-0.85; P = .005). In participants who initiated statin therapy, lipophilic statins tended to reduce dementia risk more than nonlipophilic agents. In contrast, there was no significant association between LLM use (including statins), dementia onset, or cognitive decline in individuals with baseline MCI. However, in individuals without MCI at baseline, there was a trend for a neuroprotective effect of statins on cognitive decline.
Statins may slow the rate of cognitive decline and delay the onset of AD and all-cause dementia in cognitively healthy elderly individuals, whereas individuals with MCI may not have comparable cognitive protection from these agents. However, the results from this observational study need to be interpreted with caution and will require confirmation by randomized clinical trials stratifying treatment groups based on MCI status at baseline.
降脂药物（LLMs），尤其是他汀类药物，可以延缓基线时有或没有轻度认知障碍（MCI）的个体认知能力下降和痴呆的发作。
对 3069 名认知健康的老年患者（≥75 岁）进行了一项纵向观察性研究，这些患者均参加了银杏叶评估记忆研究。主要结局指标是经裁决的全因痴呆和阿尔茨海默病痴呆（AD）的时间。次要结局指标是通过改良简易精神状态检查（3MSE）和 AD 评估量表的认知子量表（ADAS-Cog）的评分随时间的变化来衡量的全球认知功能变化。
在基线时没有 MCI 的参与者中，当前使用他汀类药物与全因痴呆（风险比 [HR]，0.79；95%置信区间 [95%CI]，0.65-0.96；P =.021）和 AD（HR，0.57；95%CI，0.39-0.85；P =.005）的风险降低相关。在开始他汀类药物治疗的参与者中，亲脂性他汀类药物降低痴呆风险的作用强于非亲脂性药物。相比之下，基线时有 MCI 的个体中，LLM 使用（包括他汀类药物）、痴呆发作或认知能力下降与痴呆之间没有显著关联。然而，在基线时没有 MCI 的个体中，他汀类药物对认知能力下降有神经保护作用的趋势。
他汀类药物可能会减缓认知健康的老年个体认知能力下降的速度，并延缓 AD 和全因痴呆的发作，而基线时有 MCI 的个体可能不会从这些药物中获得类似的认知保护。但是，需要谨慎解释这项观察性研究的结果，并且需要通过基于基线时 MCI 状态对治疗组进行分层的随机临床试验来证实。
