Department of Psycho-Neurosciences and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, nr 1 Universitatii Street, 410087 Oradea, Romania.
Neurology Ward, Clinical Municipal Hospital "dr. G. Curteanu", nr 12 Corneliu Coposu Street, 410469 Oradea, Romania.
Medicina (Kaunas). 2021 Jun 13;57(6):616. doi: 10.3390/medicina57060616.
The efficacy of hydroxy methyl glutaryl-coenzyme A reductase inhibitors (statins) in reducing the incidence of cardiovascular events pushed the target LDL-cholesterol (LDL-C) levels lower and lower in successive guidelines despite signals regarding potential cognitive side effects. We evaluated the relationship between cognitive impairment and LDL-C levels in elderly ischemic stroke patients. 29 ischemic stroke patients aged 65 and above with LDL-C levels ≤70 mg/dL, classified according to the TOAST criteria, underwent detailed neuropsychological testing comprising the MMSE test, Montreal Cognitive Assessment (MoCA) and Addenbrooke's Cognitive Evaluation (ACE-III) test. Their performances were compared to those of 29 age-matched ischemic stroke patients with LDL-Cl levels >71 mg/dL. The MMSE test failed to detect significant cognitive differences between the two groups. The MoCA and ACE-III tests detected impairments in visuo-spatial/executive function, attention, and recall/memory in patients with low LDL-C. A stepwise linear regression model of the ACE-III total scores revealed that LDL-cholesterol levels could contribute to 13.8% of the detected cognitive dysfunction, second in importance only to age, which contributed to 38.8% of the detected impairment. Physicians should be cautious when prescribing statins to elderly people. Hydrophilic ones may be preferred in cognitively impaired patients.
羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）在降低心血管事件发生率方面的疗效，促使连续指南中的 LDL-胆固醇（LDL-C）目标水平越来越低，尽管有关于潜在认知副作用的信号。我们评估了认知障碍与老年缺血性脑卒中患者 LDL-C 水平之间的关系。 根据 TOAST 标准，29 名年龄在 65 岁及以上且 LDL-C 水平≤70mg/dL 的缺血性脑卒中患者接受了详细的神经心理学测试，包括 MMSE 测试、蒙特利尔认知评估（MoCA）和 Addenbrooke 认知评估（ACE-III）测试。将他们的表现与 29 名 LDL-C 水平>71mg/dL 的年龄匹配的缺血性脑卒中患者进行比较。 MMSE 测试未能检测到两组之间存在显著的认知差异。MoCA 和 ACE-III 测试检测到低 LDL-C 患者在视空间/执行功能、注意力和回忆/记忆方面存在障碍。ACE-III 总分的逐步线性回归模型显示，LDL-胆固醇水平可导致 13.8%的认知功能障碍，仅次于仅占 38.8%的年龄因素。 医生在为老年人开他汀类药物时应谨慎。在认知障碍患者中，亲水他汀类药物可能更受欢迎。
