Statin Use and Risk of Cognitive Decline in Older Adults: Evidence from a Systematic Review and Meta-analysis

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.