Is high cholesterol beneficial in older adults

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The Mount Sinai Health System

People over 85, with a cholesterol increase, showed less decline in cognition and thinking. Should we stop our statins and change our diets? 

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People aged 85 and older whose total cholesterol had increased from their levels at midlife had a reduced risk for marked cognitive decline, compared with those a decade younger whose cholesterol was similarly elevated, Mount Sinai researchers report in a new study. 

The results of the study appear in Alzheimer's & Dementia: The Journal of the Alzheimer's Association. The researchers found that people aged 85-94 with good cognitive function whose total cholesterol increased from midlife had a 32 percent reduced risk for marked cognitive decline over the next ten years, compared with people aged 75-84, who had a 50 percent increased risk. 

Increase Our Cholesterol?

The researchers said that the results did not suggest that those 85 and older should increase their cholesterol for better cognitive health, but rather that those in that age cohort with good cognition and high cholesterol probably also had some protective factor that someday could be identified and studied. 

The research team evaluated the association of five total cholesterol values with a substantial decline in cognitive function from normal function, called marked cognitive decline. The five values were midlife (average age 40) total cholesterol, late-life (average age 77) total cholesterol, mean total cholesterol since midlife, linear change since midlife (in other words, whether it was increasing or decreasing), and quadratic change since midlife (whether the linear change was accelerating or decelerating). Data were obtained from the original Framingham Heart Study, a long-term, ongoing cardiovascular cohort study on residents of Framingham, Massachusetts. That study began in 1948 with 5,209 adult subjects and is now on its third generation of participants

Over 85, Under 75

The team assessed whether marked cognitive decline was associated with the five cholesterol values, and whether the associations with those values changed depending on the age of cognitive assessment. They found several cholesterol values including high last cholesterol, increasing levels, and decreasing acceleration were predictors associated with increased risk of a marked cognitive decline, that were associated with increased risk of a marked cognitive decline. However, as the outcome age increased, some associations were reduced, or even reversed. Furthermore, in the subgroup of cognitively healthy 85-94 year olds, a high midlife cholesterol level was associated with a reduced risk for marked cognitive decline. This contrasts with samples in other studies that have focused on elderly subjects primarily below age 75, where midlife cholesterol was associated with increased risk of cognitive decline.

Successful Cognitive Aging

"Our results have important implications for researching genetic and other factors associated with successful cognitive aging," said the study's first author, Jeremy Silverman, PhD, Professor of Psychiatry, Icahn School of Medicine at Mount Sinai. "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. Long-lived individuals who are cognitively intact despite high risk should be targeted in research studies seeking protective factors, which could help identify future drugs and therapies to treat dementia and Alzheimer's disease." 

Dr. Silverman notes that these results do not imply that those 85 and older should increase their cholesterol. His research team will next study other risk factors for cognitive decline, including body mass index and blood pressure.. 

"We don't think high cholesterol is good for cognition at 85, but its presence might help us identify those who are less affected by it. We hope to identify genes or other protective factors for cogitive decline by focusing on cognitively healthy very old people who are more likely to carry protective factors."

SOURCE:

• The Mount Sinai Health System is New York City's largest integrated delivery system encompassing seven hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. For more information, visit http://www.mountsinai.org

The Alzheimer's cholesterol connection

Advance
Although the causes of Alzheimer's disease are not fully understood, there may be a clear connection between high cholesterol and the risk of developing the disease.

Emma Roberts is 73 years old and spends most of her days sitting in her favorite chair. She is incapable of conversation and often babbles incoherently. Her soft, baby blue eyes are wide and glossy, giving her the look of a lost child. For some 10 years now, Emma has been fighting a losing battle with Alzheimer's disease. In that time, the disease has slowly and steadily erased her identity. Nearly all traces of her former self — her exuberant personality, warm understanding and quick-witted sense of humor — have disintegrated in such a way that she is barely familiar to her closest family members. But more importantly, those family members are no longer familiar to Emma.

As sad as Emma's situation may be, she is just one of about 4 million Americans who suffer from Alzheimer's. The disease is associated with the elderly, as it usually begins after age 60, with risks increasing with age. Ten percent of all Americans over the age of 65 — and nearly half of those over 85 — have the disease.1 Furthermore, a strong increase in the prevalence of the disease is expected over the next 50 years.1 It is estimated that by the middle of this century, 14 million Americans will have Alzheimer's.1

Alzheimer's disease is a progressive neurological disease that results in the irreversible loss of nerve cells in the brain, inhibiting a person's ability to remember, think and talk. The disease starts off by causing mild memory problems that may go unnoticed, but it ends up causing serious mental damage and possibly death. Alzheimer's disease also leads to changes in behavior and mood. People with Alzheimer's often become delusional, depressed and very agitated. Alzheimer's can also cause anxiety, hallucinations, insomnia and wandering.

It is not yet clear what causes Alzheimer's disease, and there is no known cure. Some scientists, however, hope that by researching common health risks that occur in the pre-elderly (age 40 to 60) stages of life, they will find links to a disease that is prevalent among the elderly.

Within the last 10 years, scientists have made great strides against deadly diseases that are most common among the elderly. There is a mounting body of evidence that indicates that several health threats of the elderly are interconnected.1 When studying the conditions that impinge on the elderly, scientists closely examine health conditions of the middle aged. Vital signs at midlife could help predict the development of Alzheimer's or, at least, the risks of developing Alzheimer's. Cholesterol, for example, has been identified as a significant risk factor for Alzheimer's disease.

A Finnish Study

A Finnish study that followed 1,449 men and women from middle age to old age suggests that people with high cholesterol are more likely to develop Alzheimer's disease later in life.1 Scientists measured the blood levels and cholesterol levels of the subjects in the 1970s, when they were in their 40s and 50s. The participants were examined again in 1998, when they were ages 65 to 79. After analyzing the data from the study, researchers concluded that those with high systolic blood pressure or high cholesterol levels were far.......read the whole article

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