We agree that the biochemistry of cholesterol is complex. While it is true that the epidemiology of cholesterol and AD has proven complicated, far more is understood about the biochemistry of cholesterol. One short report cannot cover the complexity of a field such as cholesterol biology and epidemiology; hence, we focused on the parts that were understood and relevant to AD. We disagree that this is "misleading."
Dr Muldoon's letter consistently confuses cognitive decline with AD. It is likely that the pathophysiologic features of cognitive decline associated with normal aging are different from those of AD. The mechanism of the former is poorly understood, but the mechanism of the latter is clearly related to the accumulation of β-amyloid. Because the 2 processes differ in pathophysiology, reducing β-amyloid could delay the onset of AD and reduce morbitiy, even though it might be deleterious for normal aging. Hence, it is incorrect to equate the cognitive decline of normal aging with that of AD.
Wolozin B. In reply. Arch Neurol. 2001;58(7):1166-1167. doi: