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Memory Deficit in Middle Age Linked to Low HDL 6-30-08
Middle-age patients with an HDL of less than 40 mg/dL had significantly
poorer short-term verbal memory, an examination of links between lipid levels
and cognitive function revealed.
Action Points
* Explain to patients that memory loss in middle age has been associated with
low levels of HDL.
* Note that the findings came from a retrospective review of a large database.
* Note also that the findings do not prove that low HDL causes memory loss.
Moreover, a decline in memory over a five-year period paralleled a decrease in
HDL, Archana Singh-Manoux, Ph.D., of the French National Institute for Health
and Medical Research, and colleagues reported in Arteriosclerosis, Thrombosis,
and Vascular Biology.
"The 'life-long' view of dementia stresses the importance of risk factors in
midlife," the authors said. "Our findings on individuals ages 55 and 61 at the
two phases of data collection suggest that low levels of HDL-C may be an
important risk factor."
A commonality in risk factors for cardiovascular disease and dementia has helped
blur the distinction between vascular dementia and Alzheimer's disease, they
said.
And, although high cholesterol is a proven risk factor for cardiovascular
disease, the association with cognition has been complicated by inconsistent
findings from various studies. Moreover, studies of lipid-lowering therapies --
most of which dealt with LDL or total cholesterol -- have yielded mixed results
with respect to cognitive function, the researchers continued.
Associations with HDL have remained largely unexplored. To address that
limitation, the researchers examined data from Whitehall II, a long-term cohort
study involving 10,308 British civil servants.
The current analysis comprised 3,673 men and women who participated in two
Whitehall II data-collection periods: 1995 to 1997 and 2002 to 2004. Lipid
profiles were evaluated during both periods, and short-term verbal memory was
assessed by means of a 20-word list.
Using lipid categories from the 2001 report of the National Cholesterol
Education Program, the investigators examined associations between lipids and
memory deficit, defined as recall of four or fewer words or a decrease of two or
more words between the two data-collection periods.
As compared with high HDL levels (60 mg/dL or greater), low HDL (40 mg/dL or
less) was associated with a nonsignificant memory deficit at the first
data-collection period (OR 1.27, 95% CI 0.91 to 1.77), when participants had a
median age of 55.
The difference increased during the five-year interval between data collection
and became statistically significant during the second period (OR 1.53, 95% CI
1.04 to 2.25), when participants were a median 61 years of age.
Moreover, a decline in HDL between the two periods had a significant association
with a decline in memory (OR 1.61, 95% CI 1.19 to 2.16).
The differences emerged after adjustment for education, occupational position,
coronary heart disease, stroke, hypertension, medication use, diabetes, smoking,
and alcohol consumption. The investigators also found no evidence of interaction
with APOE e4 genotype, a risk factor for Alzheimer's disease.
The study showed no association between memory deficit or decline and either
total cholesterol or triglycerides.
The authors cited several possible mechanisms that could account for
associations between HDL and cognitive function:
* Regulation of β-amyloid production and deposition in the brain
* Modification of the risk for cerebral atherosclerosis, stroke, and subclinical
vascular disease
* Neurodegenerative processes related to anti-inflammatory or antioxidant
properties
The authors also noted that lipid levels can fluctuate over the course of the
evolution and progression of dementia, making the time-point of measurement a
critical issue.
In an accompanying editorial, Anatol Kontush, Ph.D., and M. John Chapman, Ph.D.,
D.Sc., of Pierre and Marie Curie University in Paris, said "low plasma
concentrations of HDL-C have been repeatedly reported in association with
dementia. ... Moreover, elevated HDL-C levels ... are also associated with
longevity, improved cognition, and dementia-free survival."
With respect to potential underlying mechanisms cited by the authors, the
editorialists said, "In all of these scenarios, it remains unclear as to how low
levels of HDL-C measured in plasma can be translated into defective
functionality of HDL in the brain."
In conclusion, Drs. Kontush and Chapman said, "HDL-C remains a potentially
promising but still remote target in the prevention of dementia and memory loss.
Nonetheless, these studies demand that we focus more effort on research at the
interface between HDL and brain function."
Comment:
What do you do when you need to increase cholesterol? It's harder than you think! To low of cholesterol can also be a problem. If you are on cholesterol medication it may be to much! You must increase healthy oils such as olive, coconut, peanut, avocado, fish oil, and cranberry juice!