Category: Science


Looking at Serum Cholesterol Levels and Cognitive Performance of Participants in the Framingham Heart Study

If, like most of us, you watch TV, read magazines or newspapers, you’re probably being bombarded by advertisements focused on the message that cholesterol is about the worst thing for your health and longevity. Each day in my office I amazed at how pervasive this message has become. Basically, we’ve been lead to believe that cholesterol threatens all aspects of our health, and the lower the number the better. In reality, nothing is further from the truth, especially as it relates to brain health. The Framingham Heart Study is arguably one of the most well respected epidemiological studies ever conducted. The data it has generated has had wide ranging implications in terms of recommendations for health, and rightfully so. In a recent report entitled, Serum Cholesterol and Cognitive Performance in the Framingham Heart Study 789 men and 1105 women were examined to determine the relationship between total cholesterol and cognitive performance. All subjects were free of dementia and stroke at the beginning of the study and were followed for 16 to 18 years. Cognitive tests were performed every 4 to 6 years evaluating things like learning, memory, attention, concentration, abstract reasoning, concept formation, and organizational abilities, all things that are compromised in patients with Alzheimer’s disease. As the study reported:

There was a significant positive linear association between total cholesterol and measures of verbal fluency, attention/concentration, abstract reasoning, and a composite score measuring multiple cognitive domains.

And further:

“participants with ‘desirable’ total cholesterol (less than 200) performed less well than participants with borderline high total cholesterol levels (200-239) and participants with high total cholesterol levels (greater than 240).

The conclusion of this well respected study stated:

lower naturally occurring total cholesterol levels are associated with poor performance on cognitive measures, which placed high demand on abstract reasoning, attention/concentration, word fluency, and executive functioning.

This study again reaffirms the fundamental importance of cholesterol as it related to brain health and function.  Cholesterol is a desperately important brain nutrient and is critical for the function of neurons. It acts as a brain antioxidant and also a precursor to important brain supportive elements like vitamin D, as well as the steroid hormones. Most importantly, cholesterol serves as an important fuel for the neurons. Neurons themselves are unable to generate significant cholesterol and rely upon delivery of cholesterol from the blood stream. With this information in mind, no wonder the FDA recommended label changes to statin medications used for cholesterol lowering in February of 2012, stating:

Certain cognitive (brain-related) effects have been reported with statin use.

Statin labels will now include information about some patients experiencing memory loss and confusion.

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  • Dorothy Murphy

    Dr. , is it possible that some alzheimers patients have been created (unwittingly) by the prescribing of statins and/or a very low fat diet regimen?

    • David Perlmutter

      I absolutely believe this to be the case. Indeed a recent Mayo Clinic report in The Journal of Alzheimer’s Disease confirmed that a low-fat high-carb diet was dramatically associated with an increased risk for dementia as we reviewed in Grain Brain. Take a look at this recent editorial I wrote for Newsweek: http://www.thedailybeast.com/articles/2013/08/22/why-we-can-and-must-focus-on-preventing-alzheimer-s.html

      • Teresita Clark

        Can you post link to the J Alz Dis article? Also do you know of any scholarly articles showing the negative effects of over-treated cholesterol (i.e. total chol <150) and impaired cognition or brain atrophy – in animals or humans?Thanks!

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