Could overly aggressive lowering of lipid levels in elderly patients interfere with the passage of fat-soluble vitamins and minerals across the blood-brain barrier and result in damage to neurons and the neuroglial system? Might this be contributing to the rising incidence of depression and dementia in this patient population?
—Israel R. Brignoni, MD, San Sebastián, P.R.

Studies are inconclusive as to whether statins help or hinder dementia patients, but some observational data indicate that statins may actually delay onset of dementia or at least not make symptoms worse (Arch Neurol. 2002;59:378-384). This is probably not so much a function of their lipid-lowering effects, but rather of their anti-inflammatory actions, since inflammation may play a larger role in dementia than previously believed. Hopefully, results of randomized clinical trials now in progress will provide more definitive data.
—Peter F. Cohn, MD (119-14)