Statin-Associated Memory Loss: Analysis of 60 Case Reports and Review of the Literature

Leslie R. Wagstaff, Pharm.D., Melinda W. Mitton, Pharm.D., Beth McLendon Arvik, Pharm.D., P. Murali Doraiswamy, M.D.

Disclosures

Pharmacotherapy. 2003;23(7) 

In This Article

Conclusion

The cardiovascular benefits of statins are established; we reviewed the emerging links between statins and human memory. Research using MedWatch data has many limitations, such as incomplete data, lack of controls, and various biases, such as detection or attribution bias. Nevertheless, MedWatch reports can provide a signal for infrequent adverse events. In particular, the reports of statin-associated memory loss suggest that some patients may experience subjective memory loss after statin therapy is begun. In some patients the memory loss appeared to resolve after discontinuation of the statin. The relationship between statin dosage, lipid levels, and memory loss could not be determined in our series because of lack of information. More reports of memory loss were associated with lipophilic statins (e.g., atorvastatin and simvastatin), although it is not clear whether atorvastatin actually crosses the blood-brain barrier. Until causality is assessed in more rigorous studies, awareness of this issue may help clinicians better counsel patients and improve monitoring of adverse events.

Neither observational studies nor case reports can prove causality. There is no prospective evidence of any neurocognitive benefits or risks associated with statins. Overall, statins clearly offer substantial cardiovascular benefits, and a small number of case reports of memory loss should not discourage appropriate statin administration. Because cholesterol synthesis is essential for neuronal function, greater attention to cognitive outcomes in patients receiving statins is warranted, especially in populations already at risk for memory loss. Although the evidence does not yet support routine administration of serial bedside memory tests in otherwise healthy patients receiving statins, clinicians must be able to detect memory changes among their patients and routinely inquire about mental status. Given the high background rate of memory loss in the population receiving statins, prospective controlled studies comparing the short- and long-term effects of various statins on cognitive function are warranted.

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