Tips from gaining health

High doses of statins prevent dementia in older people, according to research presented at the ESC Congress today by Dr. Tin-Tse Lin from Taiwan. The study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.

The study examined whether statin use was associated with new diagnoses of dementia. The researchers used a random sample of 1 million patients covered by Taiwans National Health Insurance. From this they identified 57,669 patients aged >65 years who had no history of dementia in 1997 and 1998. The analysis included pre-senile and senile dementia but excluded vascular dementia.

There were 5,516 new diagnoses of dementia during approximately 4.5 years of follow-up. The remaining 52,153 patients aged >65 formed the control group. Subjects were divided into tertiles according to their mean daily equivalent1 dosage and total (across the entire follow up period) equivalent dosage.

The adjusted hazard ratios (HRs) for dementia were significantly inversely associated with increased daily or total equivalent statin dosage. The HRs for the three tertiles of mean equivalent daily dosage (lowest to highest) were 0.622, 0.697 and 0.419 vs control (p<0.001 for trend). The HRs for the three tertiles of total equivalent dosage (lowest to highest) were 0.773, 0.632 and 0.332 vs control (p<0.001 for trend). The protective effect of statins remained in different age, gender and cardiovascular risk subgroups.

Dr Lin said: "The adjusted risks for dementia were significantly inversely associated with increased total or daily equivalent statin dosage. Patients who received the highest total equivalent doses of statins had a 3-fold decrease in the risk of developing dementia. Similar results were found with the daily equivalent statin dosage."

He added: "It was the potency of the statins rather than their solubility (lipophilic or hydrophilic) which was a major determinant in reducing dementia. High potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia in a dose-response manner. Higher doses of high potency statins gave the strongest protective effects against dementia."

Dr Lin continued: "The results were consistent when analysing daily doses of different kinds of statins. Almost all the statins (except lovastatin) decreased the risk for new onset dementia when taken at higher daily doses. A high mean daily dosage of lovastatin was positively associated with the development of dementia, possibly because lovastatin is a lipophilic statin while the anti-inflammatory cholesterol lowering effect of lovastatin is not comparable to that of atorvastatin and simvastatin."

Dr Lin concluded: "To the best of our knowledge, this was the first large-scale, nation-wide study which examined the effect of different statins on new onset dementia (except vascular dementia) in an elderly population. We found that high doses of statins, particularly high potency statins, prevent dementia."

Poor physical performance on activities including walking was associated with increased odds of dementia in a study of individuals 90 years and older, according to a report published Online First by Archives of Neurology, a JAMA Network publication.

Individuals 90 years and older are a unique segment of society that has not been well studied. Previous studies have suggested a relationship between poor physical performance and cognitive impairment in the younger elderly populations, according to the study background.

The study conducted by Szofia S. Bullain, M.D., and colleagues from the University of California, Irvine, involved 629 participants from the 90+ Study on aging and dementia performed at the university from January 2003 through November 2009. The average age of participants was 94 years, and most (72.5 percent) were women.

"Our cross-sectional study found a strong dose-dependent association between poor physical performance and dementia in the oldest old, with higher odds of dementia associated with poorer physical performance," the authors note. "The results reveal that even modest declines in physical performance are associated with increased odds of dementia. The strongest association is seen with gait slowing, followed by five chair stands, grip strength and standing balance."

The odds ratios for every unit decrease in a physical performance score were 2.1 for a four-meter walk, 2.1 for chair stands, 1.9 for standing balance and 1.7 for grip strength, according to the study results.

Participants who were unable to walk (score of 0) "were almost 30 times more likely to have dementia than people with the fastest walking time," the study results indicate. Even minimal slowing in the walking speed (less than or equal to 1.5 seconds, from score 4 to score 3) was associated with four times greater odds of dementia, according to the results.

"In summary, similar to younger elderly populations, our study found that poor physical performance is associated with increased odds of dementia in the oldest old. The establishment of this association may serve as a major stepping stone to further investigate whether poor physical performance is in the causal pathway and a potentially modifiable risk factor for late-age dementia," the authors conclude.