Cholesterol-modifying strategies for Alzheimer disease: promise or fallacy?

Authors

Katia Azarfar, Department of Pharmacology and Neurosciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Boris Decourt, Department of Pharmacology and Neurosciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Brandon Sanchez Camacho, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
John Joshua Lawrence, Department of Pharmacology and Neurosciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Tania R. Omondi, Department of Pharmacology and Neurosciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Marwan N. Sabbagh, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.

Document Type

Article

Abstract

INTRODUCTION: As the world population ages, Alzheimer disease (AD) prevalence increases. However, understanding of AD etiology continues to evolve, and the pathophysiological processes involved are only partially elucidated. One compound suspected to play a role in the development and progression of AD is cholesterol. Several lines of evidence support this connection, yet it remains unclear whether cholesterol-modifying strategies have potential applications in the clinical management of AD. AREAS COVERED: A deep literature search using PubMed was performed to prepare this narrative review. The literature search, performed in early 2024, was inclusive of literature from 1990 to 2024. After providing an overview of cholesterol metabolism, this study summarizes key preclinical studies that have investigated cholesterol-modifying therapies in laboratory models of AD. It also summarizes past and current clinical trials testing specific targets modulated by anti-cholesterol therapies in AD patients. EXPERT OPINION: Based on current epidemiological and mechanistic studies, cholesterol likely plays a role in AD etiology. The use of cholesterol-modifying therapies could be a promising treatment approach if administered at presymptomatic to early AD phases, but it is unlikely to be efficient in mild, moderate, and late AD stages. Several recommendations are provided for hypercholesterolemia management in AD patients.

Medical Subject Headings

Alzheimer Disease (drug therapy, physiopathology, metabolism); Humans; Cholesterol (metabolism); Anticholesteremic Agents (pharmacology, administration & dosage); Animals

Publication Date

5-1-2025

Publication Title

Expert review of neurotherapeutics

E-ISSN

1744-8360

Volume

25

Issue

5

First Page

521

Last Page

535

PubMed ID

40140971

Digital Object Identifier (DOI)

10.1080/14737175.2025.2483928

Recommended Citation

Azarfar, Katia; Decourt, Boris; Sanchez Camacho, Brandon; Lawrence, John Joshua; Omondi, Tania R.; and Sabbagh, Marwan N., "Cholesterol-modifying strategies for Alzheimer disease: promise or fallacy?" (2025). Neurology. 2012.
https://scholar.barrowneuro.org/neurology/2012