New insights on statins may prompt doctors to rethink their approach and prescribing habits
MDlinx Feb 14, 2025
Industry Buzz
"If a patient notices brain fog or memory issues after starting a statin, I do not dismiss their concerns. Sometimes, switching to a different statin or adjusting the dosage can help.” - Randall Turner, DO, board-certified in psychiatry and addiction medicine
“In reality, high cholesterol and vascular disease are much bigger threats to brain health than statins.” - Raj Dasgupta, MD, board-certified physician
Find more of your peers' perspectives and insights below.
Nearly 50% of patients discontinue statins within a year, with adherence decreasing over time.
Lending RE. Guest Editorial: Statins and brain fog: Confusing for patients, prescribers, and me. National Lipid Association. 2020
Among those experiencing side effects (real or perceived), 75% decline to restart therapy. One frequently reported concern is cognitive decline.
One Reddit user described their experience: “I’m on rosuvastatin, and it’s like I’m stoned. Walking around high all the time and forgetting things, dropping things, general tiredness.”
Statins and cognitive function
Despite large trials and meta-analyses indicating that long-term use of statins may offer protective effects from dementia, in clinical practice, patients continue to report experiencing cognitive side effects while taking the drug.
Westphal Filho FL, Moss Lopes PR, Menegaz de Almeida A, et al. Statin use and dementia risk: a systematic review and updated meta-analysis. Alzheimers Dement (N Y). 2025;11(1):e70039.
Often described as "brain fog," these symptoms include memory loss, forgetfulness, amnesia, and confusion. They are reportedly reversible with a median resolution time of three weeks after discontinuation.
Lending RE. Guest Editorial: Statins and brain fog: Confusing for patients, prescribers, and me. National Lipid Association. 2020
The mechanisms for the cognitive effects remain unclear. One hypothesis suggests statins affect brain cholesterol levels, potentially influencing cognition. Another consideration is their diabetogenic effect, as increased blood glucose levels have been linked to cognitive decline, and statins can elevate glucose concentrations in some patients.
Gauthier JM, Massicotte A. Statins and their effect on cognition: Let's clear up the confusion. Can Pharm J (Ott). 2015;148(3):150–155.
“The possible risk of raising Hb-A1C and diabetes exists with Crestor (rosuvastatin). However, the benefits outweigh the risks,” says Robert Segal, MD, board-certified cardiologist.
“In reality, high cholesterol and vascular disease are much bigger threats to brain health than statins,” agrees Raj Dasgupta, MD, board-certified physician.
Choosing the right statin
Randall Turner, DO, board-certified in psychiatry and addiction medicine, stresses the importance of individualized patient care: "If a patient notices brain fog or memory issues after starting a statin, I do not dismiss their concerns. Sometimes, switching to a different statin or adjusting the dosage can help.”
“This [brain fog] can be solved by switching to a hydrophilic statin (e.g., pravastatin or rosuvastatin),” says Dr. Segal.
Based on their lipophilicity, statins differ in their ability to cross the blood-brain barrier. Lipophilic statins like simvastatin, lovastatin, and atorvastatin more readily enter the brain than hydrophilic statins like pravastatin and rosuvastatin. However, the research is inconclusive on whether this distinction significantly affects cognition.
Kazibwe R, Rikhi R, Mirzai S, et al. Do statins affect cognitive health? A narrative review and critical analysis of the evidence. Curr Atheroscler Rep. 2024;27(1):2.
Dosage consideration
High-dose statins may provide greater neuroprotection. However, some studies suggest that high-intensity statins (atorvastatin 40-80 mg, rosuvastatin 20-40 mg) may have a stronger association with cognitive impairment than moderate-intensity statins.
Kazibwe R, Rikhi R, Mirzai S, et al. Do statins affect cognitive health? A narrative review and critical analysis of the evidence. Curr Atheroscler Rep. 2024;27(1):2.
Dr. Segal recommends a gradual dosing approach for patients concerned about side effects. “If patients are concerned about possible side effects, it’s best to start with a low dose and increase the dosage as necessary so patients feel confident. Start them on an every-other-day dosage (Monday, Wednesday, Friday) and weekends off, and continue therapy until they get used to the medication.”
In a social media post, Dr. Scott Jensen highlights that patients sometimes mistake "brain fog" for early-onset dementia. He suggests a "cessation trial," temporarily discontinuing statins for a month to assess symptom changes. If symptoms return upon restarting, this could indicate a causal relationship.
For high-risk patients unable to tolerate statins, Dr. Dasgupta recommends alternatives such as PCSK9 inhibitors, ezetimibe, and bempedoic acid.
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