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. 2024 May 30;24(1):474.
doi: 10.1186/s12877-024-05030-0.

Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan

Hsin-Te Chang  1   2 , Po-Chi Chan  3 , Pai-Yi Chiu  4   5
Affiliations

Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan

Hsin-Te Chang et al. BMC Geriatr. .

Abstract

Background: Adverse effects of rigorously lowering low-density lipoprotein cholesterol on cognition have been reported; therefore, we aimed to study the contribution of serum cholesterol in cognitive decline in older people with or without dementia.

Methods: Cognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI). We investigated associations between serum cholesterol with cognitive decline using multiple regressions controlling for the effects of demographics, vascular risk factors, and treatments.

Results: Most associations between cholesterol and CASI scores could be explained by non-linear and inverted U-shaped relationships (R2 = 0.003-0.006, p < 0.016, Šidákcorrection). The relationships were most evident between changes in cholesterol and CASI scores in older people at the preclinical or prodromal stages of dementia (R2 = 0.02-0.064, p values < 0.016). There were no differences in level of changes in CASI scores between individuals in 1st decile and 10th decile groups of changes in cholesterol (p = 0.266-0.972). However, individuals in the 1st decile of triglyceride changes and with stable and normal cognitive functions showed significant improvement in CASI scores compared to those in the 10th decile (t(202) = 2.275, p values < 0.05).

Conclusion: These findings could implicate that rigorously lowering cholesterol may not be suitable for the prevention of cognitive decline among older people, especially among individuals in preclinical or prodromal stages of dementia.

Keywords: Cholesterol; Cognitive function; Dementia; Mild cognitive impairment; Subjective cognitive decline.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Selection process of study participants. CVD: cerebrovascular disease; HAICDDS, History-Based Artificial Intelligent Clinical Dementia Diagnostic System. CASI: Cognitive Assessment Screening Instrument; TC: Total cholesterol
Fig. 2
Fig. 2
Relationship between serum TC levels and CASI scores. The upper panel denotes the relationship between baseline cholesterol levels and baseline CASI scores. The lower left plot denotes the relationship between baseline cholesterol levels and changes in CASI score. The lower right plot denotes the relationship between changes in cholesterol levels and CASI scores. Asterisk sign denotes a significant quadratic relationship. Abbreviations are the same as those used in Fig. 1
Fig. 3
Fig. 3
Relationship between serum LDL-c levels and CASI scores. LDL-c: Low-density lipoprotein cholesterol. Note and other abbreviations are the same as those used in Fig. 1
Fig. 4
Fig. 4
Relationship between serum LDL-c levels and CASI scores across individuals with different cognitive states. Note and abbreviations are the same as those used in Fig. 3
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