Hormone replacement therapy for cognitive function in postmenopausal women
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.
Available from: Wendy Mack
- "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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ABSTRACT: Gonadal hormones may influence cognitive function. Postmenopausal midlife women in the population-based Melbourne Women's Midlife Health Project cohort were administered a comprehensive battery of neuropsychological tests on two occasions 2 years apart. Participants (n = 148, mean age 60 years) had undergone natural menopause and were not using hormone therapy. Estrone, total and free estradiol, and total and free testosterone levels were measured at time of the first testing. Principal-component analysis identified four cognitive factors. In multiple linear regression analyses, better semantic memory performance was associated with higher total (p = 0.02) and free (p = 0.03) estradiol levels and a lower ratio of testosterone to estradiol (p = 0.007). There were trends for associations between better verbal episodic memory and lower total testosterone (p = 0.08) and lower testosterone/estradiol ratio (p = 0.06). Lower free testosterone levels were associated with greater 2-year improvement on verbal episodic memory (p = 0.04); higher testosterone/estradiol predicted greater semantic memory improvement (p = 0.03). In postmenopausal midlife women, endogenous estradiol and testosterone levels and the testosterone/estradiol ratio are associated with semantic memory and verbal episodic memory abilities.
Neurobiology of aging 07/2012; 33(7):1138-47. DOI:10.1016/j.neurobiolaging.2012.04.011 · 5.01 Impact Factor
Available from: bap.org.uk
- "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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ABSTRACT: The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D the weakest (case studies or expert opinion). Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and brain imaging can improve diagnostic accuracy (B). Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) are effective for mild to moderate Alzheimer's disease (A) and memantine for moderate to severe Alzheimer's disease (A). Until further evidence is available other drugs, including statins, anti-inflammatory drugs, vitamin E and Ginkgo biloba, cannot be recommended either for the treatment or prevention of Alzheimer's disease (A). Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment (A). Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation (A), though selective serotonin reuptake inhibitors may help behavioural (but not cognitive) features (B). Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias (Parkinson's disease dementia and dementia with Lewy bodies (DLB)), especially for neuropsychiatric symptoms (A). Cholinesterase inhibitors and memantine can produce cognitive improvements in DLB (A). There is no clear evidence that any intervention can prevent or delay the onset of dementia. Although the consensus statement focuses on medication, psychological interventions can be effective in addition to pharmacotherapy, both for cognitive and non-cognitive symptoms. Many novel pharmacological approaches involving strategies to reduce amyloid and/or tau deposition are in progress. Although results of pivotal studies are awaited, results to date have been equivocal and no disease-modifying agents are either licensed or can be currently recommended for clinical use.
Journal of Psychopharmacology 11/2010; 25(8):997-1019. DOI:10.1177/0269881110387547 · 3.59 Impact Factor
Available from: Jae H Kang
- "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.
Neurobiology of aging 11/2010; 33(7):1129-37. DOI:10.1016/j.neurobiolaging.2010.10.007 · 5.01 Impact Factor
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