Sally A Shumaker

Wake Forest University, Winston-Salem, North Carolina, United States

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Publications (121)825.72 Total impact

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    ABSTRACT: The Women's Health Initiative has collected data on the aging process of postmenopausal women for over two decades, including data on many women who have achieved age 80 years and older. However, there has not been any previous effort to characterize the 80+ cohort and to identify associated retention factors. We include all women at baseline of the Women's Health Initiative who would be at least 80 years of age as of September 17, 2012. We summarize retention rates during the study and across two re-enrollment campaigns as well as the demographic and health-related characteristics that predicted retention. Further, we describe the longitudinal change from baseline in the women identified as members of the 80+ cohort. Retention rates were lower during each of two re-enrollment periods (74% and 83% retained during re-enrollment periods 1 and 2, respectively) than during the first and second data collection periods (90% each). Women who were retained were more likely to be white, educated, and healthier at baseline. Women age 80 and older saw modest changes in body mass index and depression burden, despite lower physical activity and increased cardiovascular disease. The characteristics of women who were retained in the 80+ cohort differ in significant ways compared with their peers at baseline. Identifying the characteristics associated with attrition in older cohorts is important because aging and worsening health has a negative impact on study attrition. Strategies should be implemented to improve retention rates among less healthy older adults. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 04/2015; DOI:10.1093/gerona/glv050 · 4.98 Impact Factor
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    Alzheimer's and Dementia 07/2014; 10(4):P787-P788. DOI:10.1016/j.jalz.2014.05.1525 · 17.47 Impact Factor
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    ABSTRACT: To determine whether smaller brain volumes in older women who had completed Women's Health Initiative (WHI)-assigned conjugated equine estrogen-based hormone therapy (HT), reported by WHI Memory Study (WHIMS)-MRI, correspond to a continuing increased rate of atrophy an average of 6.1 to 7.7 years later in WHIMS-MRI2. A total of 1,230 WHI participants were contacted: 797 (64.8%) consented, and 729 (59%) were rescanned an average of 4.7 years after the initial MRI scan. Mean annual rates of change in total brain volume, the primary outcome, and rates of change in ischemic lesion volumes, the secondary outcome, were compared between treatment groups using mixed-effect models with adjustment for trial, clinical site, age, intracranial volumes, and time between MRI measures. Total brain volume decreased an average of 3.22 cm(3)/y in the active arm and 3.07 cm(3)/y in the placebo arm (p = 0.53). Total ischemic lesion volumes increased in both arms at a rate of 0.12 cm(3)/y (p = 0.88). Conjugated equine estrogen-based postmenopausal HT, previously assigned at WHI baseline, did not affect rates of decline in brain volumes or increases in brain lesion volumes during the 4.7 years between the initial and follow-up WHIMS-MRI studies. Smaller frontal lobe volumes were observed as persistent group differences among women assigned to active HT compared with placebo. Women with a history of cardiovascular disease treated with active HT, compared with placebo, had higher rates of accumulation in white matter lesion volume and total brain lesion volume. Further study may elucidate mechanisms that explain these findings.
    Neurology 02/2014; 82(5):427-34. DOI:10.1212/WNL.0000000000000079 · 8.30 Impact Factor
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    ABSTRACT: In a recent article, Sarrel et al.(1) assert that estrogen avoidance since 2002 has caused tens of thousands of premature deaths among posthysterectomy women aged 50 to 59 years in the United States. They fault Women's Health Initiative (WHI) investigators for inadequate efforts to communicate the benefits of unopposed estrogen and to contrast (unopposed) estrogen findings from those for estrogen plus progestin in reporting on the WHI randomized controlled trials.(2-5) (Am J Public Health. Published online ahead of print October 17, 2013: e1. doi:10.2105/AJPH.2013.301604).
    American Journal of Public Health 10/2013; 103(12). DOI:10.2105/AJPH.2013.301604 · 4.23 Impact Factor
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    ABSTRACT: IMPORTANCE Postmenopausal hormone therapy with conjugated equine estrogens (CEEs) may adversely affect older women's cognitive function. It is not known whether this extends to younger women. OBJECTIVE To test whether prescribing CEE-based hormone therapy to postmenopausal women aged 50 to 55 years has longer-term effects on cognitive function. DESIGN Trained, masked staff assessed participants with an annual telephone-administered cognitive battery that included measures of global and domain-specific cognitive functions. Cognitive testing was conducted an average of 7.2 years after the trials ended, when women had a mean age of 67.2 years, and repeated 1 year later. Enrollment occurred from 1996 through 1999. SETTING Forty academic research centers. PARTICIPANTS The study population comprised 1326 postmenopausal women, who had begun treatment in 2 randomized placebo-controlled clinical trials of hormone therapy when aged 50 to 55 years. INTERVENTION The clinical trials in which the women had participated had compared 0.625 mg CEE with or without 2.5 mg medroxyprogesterone acetate over a mean of 7.0 years. MAIN OUTCOMES AND MEASURES The primary outcome was global cognitive function. Secondary outcomes were verbal memory, attention, executive function, verbal fluency, and working memory. RESULTS Global cognitive function scores from women who had been assigned to CEE-based therapies were similar to those from women assigned to placebo: mean (95% CI) intervention effect of 0.02 (-0.08 to 0.12) standard deviation units (P = .66). Similarly, no overall differences were found for any individual cognitive domain (all P > .15). Prespecified subgroup analyses found some evidence that CEE-based therapies may have adversely affected verbal fluency among women who had prior hysterectomy or prior use of hormone therapy: mean treatment effects of -0.17 (-0.33 to -0.02) and -0.25 (-0.42 to -0.08), respectively; however, this may be a chance finding. CONCLUSIONS AND RELEVANCE CEE-based therapies produced no overall sustained benefit or risk to cognitive function when administered to postmenopausal women aged 50 to 55 years. We are not able to address whether initiating hormone therapy during menopause and maintaining therapy until any symptoms are passed affects cognitive function, either in the short or longer term.
    JAMA Internal Medicine 08/2013; 173(15):1429-1436. DOI:10.1001/jamainternmed.2013.7727 · 13.25 Impact Factor
  • Alzheimer's and Dementia 07/2013; 9(4):P529-P530. DOI:10.1016/j.jalz.2013.04.269 · 17.47 Impact Factor
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    ABSTRACT: The Women's Health Initiative Memory Study-Younger (WHIMS-Y) was designed to assess the effect of prior random assignment to hormone therapy (HT) (conjugated equine estrogen (CEE) alone or CEE plus medroxyprogesterone acetate (MPA)) on global cognitive function in younger middle-aged women relative to placebo. WHIMS-Y was an ancillary study to the Women's Health Initiative (WHI) HT trial and enrolled 1361 women who were aged 50–55 years and postmenopausal at WHI enrollment. WHIMS-Y will examine whether an average of 5.4 years of HT during early menopause has longer term protective effects on global cognitive function and if these effects vary by regimen, time between menopause and study initiation, and prior use of HT. We present the study rationale and design. We describe enrollment, adherence to assigned WHI therapy, and compare risk factor characteristics of the WHIMS-Y cohort at the time of WHI enrollment to similar aged women in the WHI HT who did not enroll in WHIMS-Y. Challenges of WHIMS-Y include lower than expected and differential enrollment. Strengths of WHIMS-Y include balance in baseline risk factors between treatment groups, standardized and masked data collection, and high rates of retention and on-trial adherence and exposure. In addition, the telephone-administered cognitive battery showed adequate construct validity. WHIMS-Y provided an unprecedented chance to examine the hypothesis that HT may have protective effects on cognition in younger postmenopausal women aged 50–55 years. Integrated into the WHI, WHIMS-Y optimized the experience of WHI investigators to ensure high retention and excellent quality assurance across sites.This article is part of a Special Issue entitled Hormone Therapy.
    Brain research 04/2013; 1514:3–11. DOI:10.1016/j.brainres.2013.03.047 · 2.83 Impact Factor
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    ABSTRACT: BACKGROUND: After clinical trials end, continued follow-up of the assembled cohort often is desirable for additional research. Factors influencing participants' decisions to consent to additional follow-up and how these shape posttrial cohorts have not been broadly studied. PURPOSE: We examined how two re-enrollment campaigns and the passage of time altered features of the posttrial cohorts compared with the original Women's Health Initiative (WHI) Hormone Therapy clinical trials. METHODS: We examined associations that markers of sociodemography, health, lifestyle, and on-trial experiences had with re-enrollment and contrasted the characteristics of successive posttrial cohorts with those of the original enrollees. RESULTS: The posttrial enrollment campaigns re-enrolled 81.1% and 82.5% of available women, respectively. Women who re-enrolled tended to have better health characteristics than those not re-enrolled. Compared to women of comparable age in the original cohort, women retained for the second posttrial follow-up less often had a history of cardiovascular disease (odds ratio (OR) = 0.36), hypertension (OR = 0.57), diabetes (OR = 0.59), or measured cognitive deficit (OR = 0.40). These women more often had graduated from high school (OR = 1.72) and had participated in other WHI trials (OR = 1.76). LIMITATIONS: We have examined experience with creating follow-up cohorts from participants in a single study. Thus, our findings may not apply to other cohorts and protocols. CONCLUSIONS: Posttrial enrollment in follow-up studies can be successful; however, the characteristics of the resulting cohort may differ substantially from the originally assembled group of trial participants. Collection during the original trial of potential predictors of differential re-enrollment may strengthen interpretation of findings.
    Clinical Trials 03/2013; 10(3). DOI:10.1177/1740774513477931 · 1.94 Impact Factor
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    ABSTRACT: ABSTRACT Objectives: This study examined the relationship between positive and negative affect, depressive symptoms, and cognitive performance. Methods: The sample consisted of 1479 non-demented, postmenopausal women (mean age = 67 years) at increased risk of breast cancer enrolled in the National Surgical Adjuvant Breast and Bowel Project's Study of Tamoxifen and Raloxifene. At each annual visit, women completed a standardized neuropsychological battery and self-report measures of affect and depression. Data from three visits were used in linear mixed models for repeated measures using likelihood ratio tests. Separate analyses were performed to relate positive/negative affect and depression to each cognitive measure. Results: Higher positive affect was associated with better letter fluency (p = .006) and category fluency (p < .0001). Higher negative affect was associated with worse global cognitive function (p < .0001), verbal memory (CVLT List B; p = .002), and spatial ability (p < .0001). Depressive symptoms were negatively associated with verbal knowledge (p = .004), figural memory (p < .0001), and verbal memory (p's ≤ .0001). Discussion: Findings are consistent with some prior research demonstrating a link between positive affect and increased verbal fluency and between depressive symptoms and decreased memory. The most novel finding shows that negative affect is related to decreased global cognition and visuospatial ability. Overall, this research in a large, longitudinal sample supports the notion that positive affect is related to increases and negative affect to decreases in performance on distinct cognitive measures.
    Aging Neuropsychology and Cognition 12/2012; DOI:10.1080/13825585.2012.747671 · 1.07 Impact Factor
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    ABSTRACT: Background The Prostate Cancer Prevention Trial (PCPT)-a randomized placebo-controlled study of the efficacy of finasteride in preventing prostate cancer-offered the opportunity to prospectively study effects of finasteride and other covariates on the health-related quality of life of participants in a multiyear trial. Methods We assessed three health-related quality-of-life domains (measured with the Health Survey Short Form-36: Physical Functioning, Mental Health, and Vitality scales) via questionnaires completed by PCPT participants at enrollment (3 months before randomization), at 6 months after randomization, and annually for 7 years. Covariate data obtained at enrollment from patient-completed questionnaires were included in our model. Mixed-effects model analyses and a cross-sectional presentation at three time points began at 6 months after randomization. All statistical tests were two-sided. Results For the physical function outcome (n = 16 077), neither the finasteride main effect nor the finasteride interaction with time were statistically significant. The effects of finasteride on physical function were minor and accounted for less than a 1-point difference over time in Physical Functioning scores (mixed-effect estimate = 0.07, 95% confidence interval [CI] = -0.28 to 0.42, P = .71). Comorbidities such as congestive heart failure (estimate = -5.64, 95% CI = -7.96 to -3.32, P < .001), leg pain (estimate = -2.57, 95% CI = -3.04 to -2.10, P < .001), and diabetes (estimate = -1.31, 95% CI = -2.04 to -0.57, P < .001) had statistically significant negative effects on physical function, as did current smoking (estimate = -2.34, 95% CI = -2.97 to -1.71, P < .001) and time on study (estimate = -1.20, 95% CI = -1.36 to -1.03, P < .001). Finasteride did not have a statistically significant effect on the other two dependent variables, mental health and vitality, either in the mixed-effects analyses or in the cross-sectional analysis at any of the three time points. Conclusion Finasteride did not negatively affect SF-36 Physical Functioning, Mental Health, or Vitality scores.
    CancerSpectrum Knowledge Environment 09/2012; 104(18):1373-85. DOI:10.1093/jnci/djs359 · 15.16 Impact Factor
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    ABSTRACT: To evaluate the validity and reliability of a cognitive test battery and questionnaires administered by telephone. Observational study; 110 participants randomly assigned to receive two administrations of the same cognitive test battery 6 months apart in one of four combinations (Time 1 administration/Time 2 administration): telephone/telephone, telephone/face to face, face to face/telephone, face to face/face to face. Academic medical center. One hundred ten women aged 65 to 90 without dementia. The battery included tests of attention; verbal learning and memory; verbal fluency; executive function; working memory; global cognitive functioning; and self-reported measures of perceived memory problems, depressive symptoms, sleep disturbance, and health-related quality of life. Test–retest reliability, concurrent validity, relative bias associated with telephone administration, and change scores were evaluated. There were no statistically significant differences in scores on any of the cognitive tests or questionnaires between participants randomly assigned to telephone or face-to-face administration at the Time 1 assessment, indicating equivalence across administration modes. There was no significant bias for tests or questionnaires administered by telephone (P's > .01), nor was there a difference in mean change scores between administration modes except for Category Fluency (P = .01) and California Verbal Learning Test long-delay free recall (P = .004). Mean test–retest coefficients for the battery were not significantly different between groups, although individual test–retest correlation coefficients were generally higher within modes than between modes. Telephone administration of cognitive tests and questionnaires to older women is reliable and valid. Use of telephone batteries can substantially reduce the cost and burden of cognitive assessments and increase enrollment, retention, and data completeness, thereby improving study validity.
    Journal of the American Geriatrics Society 09/2012; 60(9):1616-1623. DOI:10.1111/j.1532-5415.2012.04111.x · 4.22 Impact Factor
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    ABSTRACT: Investigation of patients' subjective perspective regarding the effectiveness - as opposed to efficacy - of antipsychotic medication has been hampered by a relative shortage of self-report measures of global clinical outcome. This paper presents data supporting the feasibility, inter-item consistency, and construct validity of the Patient Assessment Questionnaire (PAQ)-a self-report measure of psychiatric symptoms, medication side effects and general wellbeing, ultimately intended to assess effectiveness of interventions for schizophrenia-spectrum patients. The original 53-item instrument was developed by a multidisciplinary team which utilized brainstorming sessions for item generation and content analysis, patient focus groups, and expert panel reviews. This instrument and additional validation measures were administered, via Audio Computer-Assisted Self-Interviewing (ACASI), to 300 stable, medicated outpatients diagnosed with schizophrenia or schizoaffective disorder. Item elimination was based on psychometric properties and Item-Response Theory information functions and characteristic curves. Exploratory factor analysis of the resulting 40-item scale yielded a five factor solution. The five subscales (General Distress, Side Effects, Psychotic Symptoms, Cognitive Symptoms, Sleep) showed robust convergent (β's=0.34-0.75, average β=0.49) and discriminant validity. The PAQ demonstrates feasibility, reliability, and construct validity as a self-report measure of multiple domains pertinent to effectiveness. Future research needs to establish the PAQ's sensitivity to change.
    Psychiatry Research 07/2012; 200(2-3). DOI:10.1016/j.psychres.2012.06.006 · 2.68 Impact Factor
  • Alzheimer's and Dementia 07/2012; 8(4):P168. DOI:10.1016/j.jalz.2012.05.448 · 17.47 Impact Factor
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    ABSTRACT: To examine the association between retinopathy and cognitive decline or brain lesions and volumes in older women. This study included 511 women aged 65 and older who were simultaneously enrolled in the Women's Health Initiative Memory Study and the Sight Examination Study. In this analysis, we examined the link between retinopathy, assessed using fundus photography (2000-2002), cognitive performance over time assessed by the modified Mini-Mental State Examination (3MSE) (1996-2007), and white matter hyperintensities and lacunar infarcts in the basal ganglia. Presence of retinopathy was associated with poorer 3MSE scores (mean difference = 1.01, SE: 0.43) (p = 0.019) over a 10-year follow-up period and greater ischemic volumes in the total brain (47% larger, p = 0.04) and the parietal lobe (68% larger, p = 0.01) but not with measures of regional brain atrophy. The correspondence we found between retinopathy and cognitive impairment, along with larger ischemic lesion volumes, strengthens existing evidence that retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease that may influence cognitive performance and related brain changes. Retinopathy may be useful as a clinical tool if it can be shown to be an early marker related to neurologic outcomes.
    Neurology 03/2012; 78(13):942-9. DOI:10.1212/WNL.0b013e31824d9655 · 8.30 Impact Factor
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    ABSTRACT: In this work we use a large scale regularization approach based on penalized logistic regression to automatically classify structural MRI images (sMRI) according to cognitive status. Its performance is illustrated using sMRI data from the Alzheimer Disease Neuroimaging Initiative (ADNI) clinical database. We downloaded sMRI data from 98 subjects (49 cognitive normal and 49 patients) matched by age and sex from the ADNI website. Images were segmented and normalized using SPM8 and ANTS software packages. Classification was performed using GLMNET library implementation of penalized logistic regression based on coordinate-wise descent optimization techniques. To avoid optimistic estimates classification accuracy, sensitivity, and specificity were determined based on a combination of three-way split of the data with nested 10-fold cross-validations. One of the main features of this approach is that classification is performed based on large scale regularization. The methodology presented here was highly accurate, sensitive, and specific when automatically classifying sMRI images of cognitive normal subjects and Alzheimer disease (AD) patients. Higher levels of accuracy, sensitivity, and specificity were achieved for gray matter (GM) volume maps (85.7, 82.9, and 90%, respectively) compared to white matter volume maps (81.1, 80.6, and 82.5%, respectively). We found that GM and white matter tissues carry useful information for discriminating patients from cognitive normal subjects using sMRI brain data. Although we have demonstrated the efficacy of this voxel-wise classification method in discriminating cognitive normal subjects from AD patients, in principle it could be applied to any clinical population.
    Frontiers in Neuroinformatics 10/2011; 5:22. DOI:10.3389/fninf.2011.00022
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    ABSTRACT: The efficacy of non-pharmacological intervention approaches such as physical activity, strength, and cognitive training for improving brain health has not been established. Before definitive trials are mounted, important design questions on participation/adherence, training and interventions effects must be answered to more fully inform a full-scale trial. SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA) and/or cognitive training intervention (CT) in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment. Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004), the interventions produced marked changes in cognitive and physical performance measures (p≤0.05), and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p=0.01). Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome) or 2,000 participants (categorical outcome). Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible. Clinicaltrials.gov Identifier: NCT00688155.
    BMC Geriatrics 05/2011; 11:27. DOI:10.1186/1471-2318-11-27 · 2.00 Impact Factor
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    ABSTRACT: To compare the relative effects of conjugated equine estrogens (CEE), raloxifene, and tamoxifen therapies on cognition among women aged > or =65 years. Annual Modified Mini-Mental State (3MS) examinations were used to assess global cognitive function in the two randomized placebo-controlled clinical trials of CEE therapies of the Women's Health Initiative Memory Study (WHIMS) and the Cognition in the Study of Tamoxifen and Raloxifene (CoSTAR). Analyses were limited to women who had 3MS testing at baseline and the first 3 years of follow-up and, because of potential ethnic-related differences between studies, to Caucasian women (WHIMS n = 6211, CoSTAR n = 250). Covariate adjustment was used to compare the postrandomization mean 3MS scores among the three active therapies with placebo therapy while controlling for differences between groups with respect to dementia risk factors. At baseline, the average (SD) 3MS scores by group were 95.24 (4.28) for placebo, 95.19 (4.33) for CEE, 94.60 (4.76) for raloxifene, and 95.02 (4.03) for tamoxifen. Compared with placebo, each active therapy was associated with a small mean relative deficit in 3MS scores of < or =0.5 units, which was fairly consistent between women with and without prior hysterectomy. Relative deficits were slightly greater for tamoxifen (p = 0.001) and less marked for raloxifene (p = 0.06) and CEE (p = 0.02) therapies. Relative deficits appeared to be greater among women with lower baseline 3MS scores: p = 0.009 (tamoxifen), p = 0.08 (raloxifene), and p = 0.03 (CEE). Although unmeasured differences between trials may have confounded analyses, these findings raise the possibility that both tamoxifen and raloxifene adversely affect cognitive function in older women; however, the magnitude of the effect is small, and the long-term consequences are unknown.
    Journal of Women's Health 02/2010; 19(3):371-9. DOI:10.1089/jwh.2009.1605 · 1.90 Impact Factor
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    ABSTRACT: This review discusses major findings from the Women's Health Initiative Memory Study (WHIMS). WHIMS reported hormone therapy (HT)--conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA)--increased the risk for dementia (HR 1.76 [95% CI, 1.19-2.60]; P=0.005) and global cognitive decline, with a mean decrement relative to placebo of 0.21 points on the Modified Mini Mental State Examination (3MS) (P=0.006) in women age 65 and older. A subset of WHIMS participants joined the ancillary WHI Study of Cognitive Aging (WHISCA) trials, in which domain-specific cognitive tests and mood were measured annually. Compared with placebo, CEE+MPA had a negative impact on verbal memory over time (P=0.01); and CEE-Alone was associated with lower spatial rotational ability (P < or = 0.01) at the initial assessment, but the difference diminished over time. The ancillary WHIMS-MRI study measured subclinical cerebrovascular disease to possibly explain the negative cognitive findings reported by WHIMS and the increased clinical stroke in older women reported by the WHI. WHIMS-MRI reported that while CEE+MPA and CEE-Alone were not associated with increased ischemic brain lesion volume relative to placebo; both CEE+MPA and CEE-Alone were associated with lower mean brain volumes in the hippocampus (P=0.05); frontal lobe (P=0.004); and total brain (P=0.07). HT-associated reductions in hippocampal volumes were greatest in women with baseline 3MS scores < or = 90.
    The Journal of steroid biochemistry and molecular biology 11/2009; 118(4-5):304-10. DOI:10.1016/j.jsbmb.2009.11.007 · 4.05 Impact Factor
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    ABSTRACT: To compare the effects of two selective estrogen receptor modulators, tamoxifen and raloxifene, on global and domain-specific cognitive function. The National Surgical Adjuvant Breast and Bowel Project's Study of Tamoxifen and Raloxifene (STAR) study was a randomized clinical trial of tamoxifen 20 mg/d or raloxifene 60 mg/d in healthy postmenopausal women at increased risk of breast cancer. The 1,498 women who were randomly assigned in STAR were age 65 years and older, were not diagnosed with dementia, and were enrolled onto the Cognition in the Study of Tamoxifen and Raloxifene (Co-STAR) trial, beginning 18 months after STAR enrollment started. A cognitive test battery modeled after the one used in the Women's Health Initiative Study of Cognitive Aging (WHISCA) was administered. Technicians were centrally trained to administer the battery and recertified every 6 months. Analyses were conducted on all participants and on 273 women who completed the first cognitive battery before they started taking their medications. Overall, there were no significant differences in adjusted mean cognitive scores between the two treatment groups across visits. There were significant time effects across the three visits for some of the cognitive measures. Similar results were obtained for the subset of women with true baseline measures. Tamoxifen and raloxifene are associated with similar patterns of cognitive function in postmenopausal women at increased risk of breast cancer. Future comparisons between these findings and patterns of cognitive function in hormone therapy and placebo groups in WHISCA should provide additional insights into the effects of tamoxifen and raloxifene on cognitive function in older women.
    Journal of Clinical Oncology 09/2009; 27(31):5144-52. DOI:10.1200/JCO.2008.21.0716 · 18.43 Impact Factor
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    ABSTRACT: The authors analyzed data from the Women's Health Initiative (WHI) Calcium and Vitamin D Supplementation Trial (CaD) to learn more about factors affecting adherence to clinical trial study pills (both active and placebo). Most participants (36,282 postmenopausal women aged 50-79 years) enrolled in CaD 1 year after joining either a hormone trial or the dietary modification trial of WHI. The WHI researchers measured adherence to study pills by weighing the amount of remaining pills at an annual study visit; adherence was primarily defined as taking > or = 80% of the pills. The authors in this study examined a number of behavioral, demographic, procedural, and treatment variables for association with study pill adherence. They found that relatively simple procedures (ie, phone contact early in the study [4 weeks post randomization] and direct social contact) later in the trial may improve adherence. Also, at baseline, past pill-use experiences, personal supplement use, and relevant symptoms may be predictive of adherence in a supplement trial.
    Behavioral Medicine 02/2009; 34(4):145-55. DOI:10.3200/BMED.34.4.145-155 · 1.14 Impact Factor

Publication Stats

12k Citations
825.72 Total Impact Points

Institutions

  • 1992–2015
    • Wake Forest University
      • • Department of Social Sciences and Health Policy
      • • Department of Public Health Sciences
      • • School of Medicine
      Winston-Salem, North Carolina, United States
  • 1998–2014
    • Wake Forest School of Medicine
      • • Department of Social Sciences and Health Policy
      • • Division of Public Health Sciences
      • • Department of Psychiatry and Behavioral Medicine
      Winston-Salem, North Carolina, United States
  • 2009
    • University of Illinois at Chicago
      • Department of Psychology
      Chicago, Illinois, United States