P3‐391: Statins for the treatment of dementia

Abstract

There is accumulating evidence that cholesterol may be implicated in the pathogenesis of dementia and this has led investigators to assess the possible role of lipid lowering agents in the treatment of dementia. This Cochrane review evaluated the efficacy of statins in the treatment of Alzheimer's disease (AD) and vascular dementia (VaD). Randomised double-blind placebo-controlled trials in which a statin was given for at least 6 months to patients with a diagnosis of AD or VaD were identified by a complete search of the Dementia and Cognitive Improvement Group Specialized Register, The Cochrane Library, MEDLINE, EMBASE, PsyclINFO, CINAHL and LILACS, trials databases and grey literature sources. Any type of statin (hydrophilic and lipophilic) given in appropriate dose compared to placebo was considered. Primary outcome measures were a change in MMSE and ADAS-Cog in patients with a diagnosis of AD/VaD on treatment with statins. 3 studies with 730 participants were identified - Simons 2002, ADCLT 2005, LEADe 2008. The 3 studies assessed change in ADAS-Cog from baseline in patients with AD. Mean change was entered into a meta-analysis; when the 3 studies were combined there was no significant difference in ADAS-Cog between the statin group and the placebo group [mean difference 0.18, 95% CI -1.11, 1.48, p = 0.78]. 2 studies assessed change in MMSE from baseline (Simons 2002, ADCLT 2005); there was a significant difference in MMSE between the statin group and the placebo group (favouring statins) when the two studies were combined [mean difference1.81, 95% CI 0.69, 2.98, p = 0.002]. There were no studies identified assessing changes in cognition in patients with VaD. There was no evidence that statins were detrimental to cognition. There is some evidence from the smaller trials (Simons 2002, ADCLT 2005) that statins may be beneficial in treatment of dementia but this is not borne out in the larger LEADe study. Further studies are required to be certain.