Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers MS, PA-C

Second Advisor

Rob Rosenow PharmD, OD

Abstract

Background: The prevention and treatment of cognitive decline in the elderly population is reaching an increasing significance as people are living longer than they have in the past due to better healthcare services. Dementia is a major contributor to morbidity and mortality in the aging population, and society would greatly benefit from strategies to delay or decrease the progression. It has been suggested that certain medications, dietary measures, mental activity, and exercise may decrease the risk of cognitive impairment in the elderly population. There has been mixed evidence that people who use a specific cholesterol lowering medication, the HMG-CoA reductase class, better known as statins, are less likely to develop dementia. However, direct evidence of statin effects of neuropathologic markers of Alzheimer’s disease is lacking. This paper will review recent research on the usage of statins in the treatment of dementia and its efficacy and validity.

Methods: A systematic review of the past six years of published literature was conducted using the search engines MEDLINE, CINAHL, and PubMed using keywords dementia, Alzheimer’s, cognitive decline, and statins. Relevant references were retrieved and reviewed. Original research and cohort studies that included statin usage and cognitive decline were analyzed. Meta-analyses were excluded. Only studies published within the past six years were analyzed. The population included older adults greater than 60 years old who did not have baseline dementia at the time the study was initiated, and who used statin therapy for at least four months, monitored over the course of at least five years. Articles of original research that examined the effects of statin medications on cognitive function were selected. Seven studies were selected that met the above criteria, and were analyzed for quality and significant results.

Results: Results from studies varied as to whether statins had any protective effects in the decline of dementia. Some studies made conclusions based on patient’s function on cognitive tests alone, while other looks into more advanced tests such as cranial MRI scans or even brain biopsies. Of the seven studies reviewed, three concluded a decrease in cognitive decline while taking a statin medication, however four did not. One exam looked into cognitive decline as well as brain biopsies and found that although there was no significant change in cognitive outcome, there were some benefits on brain autopsy of statin users. However, another study where brain biopsies were performed did not find any significant improvement due to statin medications. MRI analysis did not yield any significant benefit from statin drugs.

Conclusion: Based on the above results, there are no significant consistent indications to use statins in the prevention of dementia. Statins may play a role in limiting cognitive decline, however more detailed analysis needs to be performed in order to better understand the role that statins play.

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