Hormone replacement therapy for cognitive function in postmenopausal women

University of Auckland, O&G FMHS, Grafton Rd, Private Bag 92019, Auckland, New Zealand, 1142.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2008; 1(1):CD003122. DOI: 10.1002/14651858.CD003122.pub2
Source: PubMed


Animal studies (performed both in the laboratory and on living animals) suggest that estrogen alone might protect the brain as women get older. After the menopause, levels of estrogens decline in women and estrogen therapy has been claimed to maintain or enhance cognitive function in postmenopausal women. This review found no evidence of a benefit of any types of estrogen on overall cognitive functioning in older postmenopausal women when given either as short term or longer term (up to five years) therapy. There was also no evidence of a beneficial effect of combined estrogen and progestagen therapy overall. There was insufficient evidence to determine whether any type of hormone replacement therapy had beneficial or harmful effects on specific types of cognitive ability, such as verbal or visual memory.

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    • "Memory complaints are highly prevalent during this midlife period (Woods et al., 2000). Some observational studies support a positive association between use of estrogen-containing hormone therapy and cognitive function in healthy women, but the results of randomized controlled trials have failed to show clear evidence of benefit (Henderson and Sherwin, 2007; Lethaby et al., 2008), and there is even some suggestion of mild detriment (Espeland et al., 2004; Maki et al., 2007). While this topic remains one of ongoing debate, the basic question of whether endogenous serum levels of these hormones influence cognitive performance remains uncertain. "
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    • "ischaemic stroke was increased by 44%, is added, it is clear that the use of HRT and ERT cannot be justified in the primary prevention of dementia, at least in those over 65, or in the treatment of dementia. The termination of WHIMS led to other studies being stopped, but further evidence on HRT on cognitive function in post-menopausal women has emerged and is included in the up-to-date Cochrane review (Lethaby et al., 2008) which concluded that ERT and HRT do not protect against cognitive ageing in older post-menopausal women and may increase the risk of dementia. "
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    • "and Gabor, 2003) However, the current epidemiologic data provide mixed support for this hypothesis. Results from observational studies have been inconsistent,(Lethaby et al., 2008) and the Women's Health Initiative Memory Study (WHIMS), a randomized trial of women aged ≥65 years have reported detrimental effects of HT in relation to change in cognitive function,(Espeland et al., 2004; Rapp et al., 2003; Resnick et al., 2006; Shumaker et al., 2004; Shumaker et al., "
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    ABSTRACT: Associations between postmenopausal hormone therapy (HT) and cognitive decline may depend on apolipoprotein E (APOE) status or timing of initiation. We included 16,514 Nurses' Health Study participants aged 70-81 years who were followed since 1976 and completed up to 3 telephone cognitive assessments (2 years apart), between 1995 and 2006. The tests assessed general cognition (Telephone Interview of Cognitive Status; TICS), verbal memory, and category fluency. We used longitudinal analyses to estimate differences in cognitive decline across hormone groups. APOE genotype was available in 3697 participants. Compared with never users, past or current HT users showed modest but statistically significant worse rates of decline in the TICS: the multivariable-adjusted difference in annual rate of decline in the TICS among current estrogen only users versus never users was -0.04 (95% confidence interval, -0.07 to -0.004); for current estrogen + progestin users, the mean difference was -0.05 (95% confidence interval, -0.10 to -0.002). These differences were equivalent to those observed in women who are 1-2 years apart in age. We observed no protective associations with early timing of hormone initiation. We found suggestive interactions with APOE e4 status (e.g., on TICS, p interaction, 0.10), where the fastest rate of decline was observed among APOE e4 carriers who were current HT users. Regardless of timing of initiation, HT may be associated with worse rates of decline in general cognition, especially among those with an APOE e4 allele.
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