Statins and the Flyer

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Statins and the Flyer

 

 

Excerpted from the book:

Lipitor, Thief of Memory, by Graveline and Richardson.

( Currently in the publication process.)

 

Transient Global Amnesia (TGA) probably has been around as long as man but the

first reported case of this bizarre theft of memory was made in 1955. TGA,

simply put, is the sudden inability to formulate new memory, known as

anterograde amnesia, combined with varying degrees of retrograde memory loss,

sometimes for decades into the past. Until recently, the most common trigger

events for these abrupt and completely unheralded amnesia cases have been sudden

vigorous exercise, sex, emotional crises, cold water immersion, head trauma and

cerebral angiography. In the past four years, however, a new trigger agent has

been added – the use of the stronger statin drugs such as Lipitor, Zocor and

Mevacor. Statin drug associated TGA is now being seen with increasing frequency

in emergency rooms across the country. When one reviews the mechanism of action

of these cholesterol lowering agents, known collectively as HMG- CoA reductase

inhibitors, their potential for memory impairment becomes very

easy to understand.

 

My own introduction into the incredible world of TGA occurred six weeks after

Lipitor was started during my annual astronaut physical at Johnson Space Center.

My cholesterol had been trending upward for several years and " the time had

come " according to my flight surgeon doctors. My dosage was 10 mg daily. A blood

study at six weeks showed my total serum cholesterol had plummeted from 240 to

150 mg on this amazingly effective drug and all was well until several days

later when my wife found me aimlessly walking about the yard after my usual walk

in the woods that morning. I did not know WHO she was, AND I reluctantly

accepted cookies and milk but refused to go into my now unfamiliar home. Somehow

she got me to my family doctor and later that day to a neurologist who found my

examination normal except for the amnesia and made the diagnosis of TGA, cause

unknown. About six hours after its onset and while in the office of the

neurologist the condition abruptly passed and I felt well

enough to drive home while my wife related this incredible tale of how I had

spent my day. The MRI several days later was normal. Since Lipitor was the only

new medicine I was on, the doctor in me made me suspect a possible side effect

of this drug and, despite the protestations of the examining doctors that statin

drugs did not do this, I stopped the drug. The year passed uneventfully and soon

it was time for my next astronaut physical. NASA doctors joined the chorus I had

come to expect from physicians and pharmacists DURING THE ENSUING year, that

statin drugs did not do this and at their bidding I reluctantly restarted

Lipitor at one-half the previous dose. Six weeks later I again descended into

the black pit of amnesia, this time for twelve hours and with a retrograde loss

of memory back to my high school days. During that terrible interval, when my

entire adult life had been eradicated, I had no awareness of my marriage and

four children, my medical school days, my ten

adventure filled years as a USAF flight surgeon, my selection as scientist

astronaut or of my post retirement decade as a writer of medical fiction. The

names of my books - like the names of my children – WERE gone from my mind as

completely as if they had never happened. Fortunately and typically for this

obscure condition my memory returned and again I drove home listening to my

wife's amazing tale of how my day (and hers) had gone. She said that if I asked

her once, " What IS happening? " , I must have asked her ten thousand times during

that terrible period when all recall was lost.

 

It was then after this retrograde loss during which time my " teenage " brain

told me I had never been married, had no children, had never been to medical

school and knew nothing of the space program that I first posed the question,

" What if I had been flying my taildragger at the time? My flight instruction had

come during my ten years as a USAF flight surgeon. If my ability to pilot an

aircraft had been eradicated by this event, what might have been my reaction?

How could I ever have brought it in for a safe landing? My personal conviction

is that since my technical skills and training had vanished during this 35 year

period, I probably would have panicked and crashed! What alternatives existed?

With total amnesia of my life during my flight training period, I knew nothing

of flying. The same could be said for my medical training or my status as a

father of four. My adolescent brain would have laughed at the joke being played

on my mind. The more I thought about this, the more

convinced I became that this was an issue of major concern to others. I had

been a USAF flight surgeon for ten years, an Army flight surgeon to a helicopter

squadron for fourteen additional years and an FAA aviation medical examiner

throughout the entire time period. No one was in a better position to pose the

question of the potential for statin associated amnesia than a flight surgeon

who had experienced it.

 

How much of previously learned behavior persists during an attack of transient

global amnesia? What does the medical literature reveal? Unfortunately, my

review of the existing case reports is far from reassuring as to the question of

retention of specific learned skills during an episode of TGA. Riding a bicycle

is a skill usually preserved because rarely does a retrograde element extend

that far back into a person's past life. Driving an automobile also is a skill

usually maintained in our TGA episodes simply because it was learned early on.

Many cases of people with TGA tell of their touringthe country in their

mysterious auto journey, stopping as usual for gasoline and other necessities

but when once home and confronted with credit card evidence of purchases and

travel, they deny vehemently that they ever could have done such a mad thing.

Their amnesia for the trip is complete but their ability to operate a motor

vehicle is preserved. A bicycle repair man steadfastly continued to

repair bicycles throughout his TGA attack, oblivious to the loss of all recent

events in his life including his recent marriage and new wife. A ballroom dancer

continued to glide about the floor with almost no hitch except to his perceptive

associate who recognized his friend had abruptly reverted to old dance steps

learned many years previously. During his attack the retrograde component of his

TGA had wiped out those steps learned in the past recent months. Similarly, a

man fluent in English reverted to Spanish, the language of his childhood, during

his TGA attack. He had lost English completely.

 

Although a literature review reveals no specific instances of TGA while flying,

the inference is inescapable - unless the TGA victim had learned the essential

of flying very early on, the ability to pilot an aircraft might be lost

completely during an event. Even if the airline or military pilot involved did

have light aircraft training in his younger days, with abrupt onset TGA, he

would hardly be equipped to handle the incredible shock of suddenly " awakening "

to the totally unfamiliar controls of a multi-engine jet transport, F-14 fighter

or Apache helicopter where such specific training had come many years later and

now finding himself in the " black zone " of a retrograde TGA episode. The outcome

of such an event would likely be disaster. One wonders how many " pilot error "

aircraft accidents just might have a TGA factor since there would be complete

absence of clues to the investigative board.

 

This potential problem of statin drug associated memory dysfunction while flying

is further confounded by the reality that amnesia is but the tip of the iceberg

of the many other forms of memory lapses that occur far more commonly. An

increased tendency for disorientation, confusion and forgetfulness can be easy

to miss in many individuals, for a certain degree of this is in the nature of

all of us. And although I have focused this presentation directly on pilots and,

by inference, flight crews, what of commercial truck and bus drivers and heavy

equipment operators? What about the operators of dangerous tools? The list is

limited only by one's imagination.

 

As to recommendations, at the very least, patients on statin drugs and their

prescribing doctors must be informed of the potential for impaired brain

function. Vigilance on the part of both patient and doctor can only be helpful

and may spot a tendency for memory lapses early but Even this can hardly be

expected to foresee TGA, which customarily strikes with no warning. It is hardly

reassuring that although most of the cognitive case reports occur soon after the

statin drug is started or an increase in dosage is made, some of worst cases

have occurred after several trouble free years on a fixed dosage. One can only

caution against the current tendency for ever increasing use of statin drugs for

primary prevention such as we now see in both military and civilian pilots. The

mind-robbing potential of this class of drugs is not only theoretical - it is

real. Responsible physicians must take heed.

 

Duane Graveline MD MPH

Former USAF flight surgeon

Former NASA astronaut

Retired family doctor

June 2003

 

 

 

 

Statin Dialogues

 

Lipitor - Thief of Memory

 

Books by Doc Graveline

 

e-mail Doc Graveline

 

 

 

Additional e-mail contacts for statin drug side effects.

 

Doctor Golomb of the UCSD statin research study

 

Jay Cohen MD, author of OVERDOSE

 

Joe Graedon of Peoples Pharmacy column

 

John McGuire, our statin activist

 

 

 

 

 

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