Statin Cessation Improves Cognition, Function and Epilepsy in An Elderly Woman

Introduction

Statins are one of the most commonly prescribed cholesterol-lowering agents in the world. In the UK, around 7.5 million adults are prescribed a statin, both for primary and secondary prevention [1]. However, researchers have questioned the efficacy of cholesterol-lowering as a strategy for cardiovascular disease [2,3], and there is evidence that high levels of total cholesterol is associated with lower all-cause mortality in terms of cancers, infection and death [4-6] This is especially true in elderly patients, where there is an inverse correlation between cholesterol levels and mortality. [7,8] Cholesterol is an essential substance that is needed by the brain and nerves for myelin production, as well as cell-to-cell communication with the help of lipid rafts. It is unsurprising that cholesterol lowering comes with a variety of neuropsychiatric side effects that have been documented in the literature. Some of these side effects include dementia-like symptoms, seizures, depression, suicidal ideation, homicidal ideation, insomnia, and aggression. [9-11] There is even evidence that stopping a statin has reversed dementia-like symptoms in elderly patients, symptoms of which returned with rechallenge [12,13].

Case Report

An 82-year-old woman with a history of Hypertension, Type 2 Diabetes, Ischaemic Heart Disease, Heart Failure, Multiple Myocardial Infarctions, Epilepsy, Anxiety, Depression and Dementia presented to hospital with general functional decline, and increased seizure episodes. Her family reported that she became non-verbal for the past 1 month, and was not recognizing family members as much. She was diagnosed with Dementia 9 years ago, and CT scan revealed age related involutional changes, and chronic microvascular ischaemic changes.

Liver functions were abnormal (ALT 338, AST 116, ALP 67), therefore the statin was suspended. Post suspension of statin, patients' cognition improved significantly, so did her liver functions, seizures frequency.

  

    
Parameter
    
Before
    
After
  
  

    
Seizures 
    
3-4 Generalized Tonic Clonic Seizures a month
    
No seizures reported
  
  

    
Liver functions 
    
ALT 338, AST 116, ALP 67
    
ALT 55, AST 20, ALP 56
  
  

    
Cognition 
    
Non-verbal, not responsive, or talking or    recognizing family members
    
Started talking again, recognizing and responding    to family members, asking to go home
  
  

    
Functional status 
    
Reduced mobility, bedbound 
    
Started moving and sitting out on a chair