As clinicians, we are all familiar with the increasing concern about cognitive decline in aging patients. Dementia, a broad term encompassing disorders that affect memory, language, problem-solving, and other cognitive functions to the extent that they interfere with daily life, is a significant issue for millions of older adults.
A recent study published by the American Heart Association has raised questions about the role of fluctuating cholesterol levels in the development of dementia. The research suggests that older adults with significant fluctuations in their cholesterol levels may be at an increased risk for cognitive decline.
The exact causal relationship remains unclear, however, and the study’s findings have sparked ongoing discussions among cardiologists and neurologists alike regarding the broader implications for brain health. They want to know what this emerging research means for their clinical practice and if they should be altering their approach to patient care based on these findings.
What constitutes fluctuating cholesterol?
Most individuals experience relatively stable cholesterol levels over time. However, some patients may exhibit significant variations in their cholesterol within a short time span – say, within a year.
Jonathan Fialkow, M.D.
“Most people have steady cholesterol levels with changes over many years,” explains cardiologist Jonathan Fialkow, M.D., chief medical executive of Population Health, Value and Primary Care for Baptist Health, deputy director of clinical cardiology at Baptist Health Miami Cardiac & Vascular Institute, and chief of cardiology services at Baptist Health Baptist Hospital. “A few people have been found to have levels that can drastically change over a short period of time, like one year. This is what would be called ‘fluctuating cholesterol levels.’”
The role of cholesterol in cognitive health
Cholesterol plays a critical role in various physiological functions, including cellular structure, hormone synthesis, and brain health. The relationship between cholesterol and cognitive function, however, is complex and multifaceted.
“There is a clear link between cholesterol (lipids) and dementia. For a common cause of dementia, ‘vascular dementia,’ the risk factors are the same as they are for coronary disease, and the interplay between the lipids in our body and inflammation of the blood vessels can cause this,” Dr. Fialkow notes. “Vascular dementia, for instance, results from cerebrovascular damage, often secondary to conditions such as hyperlipidemia and hypertension, both of which contribute to arterial inflammation and plaque formation.”
G. Peter Gliebus, M.D., a neurologist at Marcus Neuroscience Institute, also part of Baptist Health, points out that elevated levels of LDL cholesterol – what we know as “bad” cholesterol – have been linked to dementia risk. “The direct relationship between cholesterol and dementia is still unclear, though elevated levels of LDL cholesterol are considered a risk factor for dementia,” he says.
G. Peter Gliebus, M.D.
The need for further research
Although the findings of the study are intriguing, both Dr. Fialkow and Dr. Gliebus caution against making premature conclusions. Dr. Fialkow emphasizes, “While the study’s findings are compelling, it is still too early to conclude that fluctuating cholesterol directly causes cognitive decline. I don’t think we’re ready for any type of assessment or treatment change.” He adds that the observed fluctuations may reflect broader metabolic changes that predispose individuals to dementia, rather than a direct cause-and-effect relationship.
Dr. Gliebus echoes this sentiment, noting, “The observed changes may represent just one aspect of the metabolic changes occurring in the body, which could predispose individuals to developing dementia.” He adds that further studies are needed to better understand the potential role of fluctuating cholesterol levels in the pathophysiology of dementia.
Lifestyle modifications reduce risk
As the science around the cholesterol-dementia connection continues to evolve, the importance of a healthy lifestyle in mitigating the risk of dementia remains clear. Advising patients to adopt a heart-healthy, brain-healthy lifestyle is fundamental, says Dr. Fialkow.
“Keeping a healthy diet rich in fruits, vegetables, whole grains and healthy fats – combined with regular exercise, adequate sleep, stress management, and avoiding tobacco and excessive alcohol – remain the pillars of decreasing your risk of both heart disease and dementia,” says Dr. Fialkow. Regular health check-ups that monitor lipid profiles and other metabolic markers are critical for identifying potential risks early, before they manifest as more serious conditions, he adds.
Dr. Fialkow emphasizes the importance of focusing on overall metabolic health. “A healthy lifestyle leading to a healthy metabolism is the key to decreasing the risk of developing chronic diseases and the consequences of these, such as heart attack, heart failure, stroke, dementia, kidney failure and more. Prioritizing a heart-healthy, brain-healthy lifestyle remains the most effective way to reduce the risk of dementia as we age.”
Conclusion
While recent studies raise the intriguing possibility of a link between fluctuating cholesterol levels and dementia, much more research is needed before we can make definitive clinical recommendations.
As we await further clarification, we can confidently continue to advise patients that a healthy lifestyle – including a balanced diet, regular exercise and good sleep hygiene – remains the cornerstone of dementia prevention. In the interim, we must remain vigilant in monitoring both cardiovascular and cognitive health, fostering an integrated approach to patient care.
To refer a patient to our expert cardiology team, please call 786-204-4200 or click here for more information. To refer a patient to our expert neurology team, please call 561-955-4600 or click here to learn more.
