High Cholesterol May Improve Cognition in Schizophrenia

Fasting before lipid tests not necessary
Fasting before lipid tests not necessary
An evaluation of the CATIE trial finds high lipid levels may boost cognition in schizophrenia patients.

TORONTO — While having high cholesterol may open individuals to cardiovascular risks, there is evidence that elevated lipid levels may actually improve cognition in schizophrenia patients.

The finding was based on an assessment of the breakthrough 2005 CATIE study (Clinical Antipsychotic Trials of Clinical Effectiveness), according to Henry Nasrallah, MD, chairman of the Department of the Neurology and Psychiatry at St. Louis University School of Medicine, in Missouri.

“If [patients] had higher cholesterol, they had higher cognitive scores,” Nasrallah said during a presentation at the American Psychiatric Association Annual Meeting here. He added this also applied to high levels of triglycerides, another type of fat found in the blood. Better cognition was also associated with high HDL cholesterol levels.

The CATIE study also found that patients who gained weight while on antipsychotics also tended to do have better scores on the Positive and Negative Syndrome Scale (PANSS), a common measure used to measure schizophrenia severity.

“No matter which antipsychotic [a patient took], if they gained even a little bit of weight, they did better,” he said. Those “that kept their weight or lost weight didn’t do as well.”

However, he added that weight gain itself was not associated with improved cognition.

Nasrallah noted that there are currently no treatments available shown to improve cognition in schizophrenia, an unmet medical need. However, the prospect of having psychiatrists suggest that schizophrenia patients maintain high cholesterol levels puts them in a bind as such levels increase cardiovascular risks.

As to why high lipid levels may benefit cognition in schizophrenia patients, Nasrallah suggested that lipids play an important role in cell wall structure, and may also be good for brain circuitry.

In response to a question from an audience member, Nasrallah said that omega-3 fatty acids may also serve as a protective factor for the brain, though he suggested that they are more beneficial in stemming brain inflammation rather than improving cognition.


Nasrallah H. Elevated Cholesterol and Triglycerides Are Associated With Better Cognitive Functioning in Schizophrenia: Data From the Catie Study. Presentation at: APA 2015. May 16-20, 2015; Toronto, Canada.