Statin Use and Risk of Cognitive Decline in Older Adults: Evidence from a Systematic Review and Meta-analysis
Carlos Wagner Leal Cordeiro Júnior
*
Universidade Nove de Julho (UNINOVE), Campus Mauá, São Paulo, Brazil.
Vanessa Santana Lobo
Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.
Samuel Cândido Freres
Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
João Francisco Severo-Santos
Instituto Brasileiro de Geografia e Estatística (IBGE), Rio de Janeiro, Rio de Janeiro, Brazil.
Maria Eduarda Dorneles Ferraz
Faculdade de Ciências Médicas de Montes Claros (FUNORTE), Montes Claros, Minas Gerais, Brazil.
Juliano dos Santos
Instituto Nacional de Câncer (INCA), Rio de Janeiro, Rio de Janeiro, Brazil.
Claudia Jemima Passos Pinto
Universidade Estadual de Santa Cruz (UESC), Ilhéus, Bahia, Brazil.
Rebeca Augusto Silvestre
Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil.
Élida Lúcia Ferreira Assunção
Universidade Estadual de Montes Claros (UNIMONTES), Montes Claros, Minas Gerais, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Aims: To evaluate the efficacy of statin therapy in preventing cognitive decline and dementia among older adults through an updated systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies.
Study Design: Systematic review and meta-analysis conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251176162).
Methods/Data Sources: Data were collected from international electronic databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and LILACS) from inception to October 2025.
Methodology: We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and LILACS up to October 2025 for RCTs and prospective cohort studies comparing statin therapy with placebo or no treatment in adults aged ≥60 years. Primary outcomes included incident cognitive decline or dementia. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.
Results: Ten studies (five RCTs and five cohorts) encompassing approximately 230,000 participants were included. Statin use was not significantly associated with overall cognitive decline or dementia (OR = 0.94; 95% CI 0.60–1.47). For Alzheimer’s disease, the association was neutral (OR = 1.28; 95% CI 0.42–3.85), while cohort data suggested a modest protective effect (OR = 0.97; 95% CI 0.94–0.99). Heterogeneity was low to moderate (I² = 0–48%).
Conclusion: Statin therapy appears cognitively safe in older adults and may confer slight neuroprotective effects in selected populations. Clinicians should continue prescribing statins for cardiovascular prevention without concern for adverse cognitive outcomes, while ongoing trials will clarify their potential role in dementia prevention.
Keywords: Statins, cognitive decline, dementia, Alzheimer’s disease, vascular dementia, meta-analysis, elderly, HMG-CoA reductase inhibitors