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Statin Therapy and Cognition in Older People: What is the Evidence?

Whether to start, continue or discontinue statins in older people remains a clinical and ethical dilemma. While there is clinical trial evidence that statins reduce cardiovascular morbidity in older people, recently concerns have been raised about side effects in this population. Adverse effects of statins reported in older people include muscle-related symptoms, diabetes, impaired physical function and cognitive impairment. The cognitive effects of statins are not well understood and remain contentious. In younger and healthier people with baseline intact cognitive function, short-term data suggest no adverse effects of statins on cognition whereas long-term data support a beneficial role for statins in delaying dementia. Insufficient evidence is currently available to establish causality in relation to statins and cognitive function in older people specifically. The objective of this narrative review is to analyse the current evidence in relation to statin therapy and cognition, and discuss challenges in translating the current evidence to older people.