Dyslipidemia and Dementia: Current Epidemiology, Genetic Evidence, and Mechanisms Behind the Associations

Abstract

The role of cholesterol in the etiology of Alzheimer’s disease (AD) is still controversial. Some studies aiming to explore the association between lipids and/or lipid lowering treatment and AD indicate a harmful effect of dyslipidemia and a beneficial effect of statin therapy on AD risk. The findings are supported by genetic linkage and association studies that have clearly identified several genes involved in cholesterol metabolism or transport as AD susceptibility genes, including Apolipoprotein E (APOE), Apolipoprotein J (APOJ, CLU) and the sortilin-related receptor (SORL1). Functional cell biology studies support a critical involvement of lipid raft cholesterol in the modulation of AbetaPP processing by β- and γ-secretase resulting in altered Aβ production. Contradictory evidence comes from epidemiological studies showing no or controversial association between dyslipidemia and AD risk, cell biology studies suggesting that there is little exchange between circulating and brain cholesterol, that increased membrane cholesterol is protective by inhibiting loss of membrane integrity through amyloid cytotoxicity, and that cellular cholesterol inhibits co-localization of BACE1 and AbetaPP in non-raft membrane domains and thereby increasing generation of plasmin, an Aβ-degrading enzyme. The aim of this review is to summarize the findings of epidemiologic and cell biologic studies aiming to elucidate the role of cholesterol in AD etiology.