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High cholesterol, cognitive decline link diminishes at very old age
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Study findings indicated that cognitively healthy people aged 85 to 94 years with increased cholesterol levels at midlife were less likely to experience marked cognitive decline over the next decade compared with those aged 75 to 84 years who also had elevated cholesterol levels at midlife.
“High cholesterol, especially when measured at midlife, has been associated with bad cognitive outcomes. Most of those studies had mean outcome age — age at follow-up cognitive assessment — up to the mid-70s. Longitudinal studies for older outcome ages were inconsistent,” Jeremy M. Silverman, PhD, and James Schmeidler, PhD, department of psychiatry, Icahn School of Medicine at Mount Sinai, wrote in Alzheimer’s & Dementia. “When comparing studies of associations of cholesterol with risk of bad cognitive outcomes, attention has focused primarily on differences by midlife vs. late-life cholesterol measurement, not by outcome age.”
Researchers examined the link between marked cognitive decline and five total cholesterol values — midlife total cholesterol, late-life total cholesterol, mean total cholesterol since midlife, linear change since midlife and quadratic change since midlife — using data from a long-term, ongoing cardiovascular cohort study on 1,897 participants with intact cognition at entry. They also analyzed whether the associations with those values changed depending on the age at cognitive examination and assessed decline at ages 75 to 84 years and 85 to 94 years.
Although some cholesterol values were linked to increased risk for marked cognitive decline, this association diminished or reversed with increasing cognitive outcome age, the researchers found. Analysis of the cognitively healthy adults aged 85 to 94 years showed high cholesterol level at midlife was linked to a lower risk for marked cognitive decline.
"The data are consistent with our protected survivor model — among individuals who survive to very old age with intact cognition, those with high risk factor levels are more likely to possess protective factors than those with lower risk factor levels,” Silverman said in a press release.
The survival model demonstrated that the correlation between risk for cognitive decline and rising linear slope in cholesterol measures from midlife reverses in direction at the crossover age. For the 75 to 84 age sample, the association of rising linear slope with risk for cognitive decline approached significance, whereas for the older sample, rising linear slope was significantly associated with reduced risk.
“One key message related this study concerns future efforts to identify genes and other factors for successful cognitive aging,” Silverman told Healio Psychiatry. “But, specifically for clinicians, while I want to stress that we don’t think increased cholesterol becomes a good thing for cognition (protective) for the oldest-old, our study does suggest that, at least in relation to cognition, having high cholesterol need not be a source of concern and might suggest that the individual does carry some protection against dementia.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.