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Objective  This study measured and analyzed the serum levels of 24‐hydroxycholesterol in patients with probable Alzheimer's disease ( AD ) and age‐/sex‐matched controls.    Methods  A case‐control study involving 40  AD  patients and 40 controls was performed at a tertiary neurological teaching hospital in eastern India. Blood and serum samples were collected for   APOE   genotyping and 24‐hydroxycholesterol levels, respectively.    Results  Serum 24‐hydroxycholesterol was significantly lower in  AD  patients compared to controls (median concentration: controls, 47.14 ng/ mL  (interquartile range, 16.34);  AD  patients, 32.93 ng/ mL  (interquartile range, 9.45);  P  &lt; 0.001) but showed no significant correlation with Mini Mental State Examination ( MMSE ) score in  AD  cases ( r  = −0.169,  P  = 0.298) or in controls ( r  = 0.18,  P  = 0.26). No statistically significant difference was observed between serum 24‐hydroxycholesterol levels of the   APOE 4 ‐positive and ‐negative subgroups in  AD  patients ( P  = 0.79). Findings were consistent and unchanged even when the ratio of serum 24‐hydroxycholesterol to serum total cholesterol was considered.    Conclusion  The decreased 24‐hydroxycholesterol level in peripheral circulation in  AD  cases observed in the present study may suggest its role in  AD  pathogenesis. The lack of a clear correlation between serum levels of 24‐hydroxycholesterol and  MMSE  score—a surrogate marker of  AD  severity—raises the question as to whether 24‐hydroxycholesterol level declines with decreasing neuronal mass or whether the steroid continues to play a protective role.

Serum 24‐hydroxycholesterol in probable Alzheimer's dementia: Reexploring the significance of a tentative Alzheimer's disease biomarker