Magazine article Clinical Psychiatry News

Hormone Therapy May Benefit Cognition, Memory

Magazine article Clinical Psychiatry News

Hormone Therapy May Benefit Cognition, Memory

Article excerpt

CHICAGO -- Hormone therapy might preserve cognition and memory in postmenopausal women, and even attenuate some of the cognitive deficits that occur in Alzheimer's disease, new research suggests.

Controversy exists over the possible cognitive benefits of hormone therapy in older women, Mary Tierney, Ph.D., said at the International Conference on Alzheimer's Disease. "While preclinical and observational studies have shown a positive effect of estradiol on the brain and cognitive function, randomized controlled trials using conjugated equine estrogens have shown no treatment effects in women at risk for Alzheimer's disease, or in women who have the illness."

In fact, the most widely quoted study, the Women's Health Initiative Memory Study (WHIMS), suggested that hormone therapy might even hurt, rather than help, said Dr. Tierney of the Sunnybrook Health Sciences Centre, Toronto. The 4-year substudy of the Women's Health Initiative examined the effect of hormone therapy on mild cognitive impairment and dementia in more than 7,000 women aged 65-79 years.

"Forty women in the estrogen plus progesterone group developed dementia of any type, but only 21 in the placebo group did," Dr. Tierney said. "However, there were no significant differences in the estrogen-only arm compared to placebo."

Additionally, she noted, a breakdown of the dementias by etiology showed that many of them were vascular in nature--playing into the criticism of WHI for including women who had experienced stroke.

These concerns, plus her own hypothesis that the "minidoses" of hormones used in many randomized trials might be too low to offer protective benefit, prompted Dr. Tierney and her colleagues to undertake a new study. The 2-year trial randomized 142 women aged 61-87 years to either placebo or to 1 mg estradiol daily plus 0.35 mg progestin 3 days per week.

The primary outcome was the annual change in scores on the short-delay verbal recall portion of the California Verbal Learning Test (CVLT).

None of the women selected for the trial had demantia, but all had normal or below normal baseline memory scores, Dr. Tierney noted. The subjects' mean age was 74 years; their mean age at menopause was 49 years.

There was no significant difference between groups on the primary end point of delayed recall, Dr. Tierney said. But when she split the group according to baseline CVLT scores, significant differences did emerge. Compared with women who scored below the 50th percentile on their baseline test, those on therapy who scored above the 50th percentile showed significantly less decline in delayed verbal recall than did those in the placebo group. Similar, but nonsignificant, differences occurred on immediate recall, interference recall, cued recall, and recognition memory.

The findings suggest that hormone therapy might exert a protective influence on memory among women who have not begun to experience significant cognitive decline, Dr. Tierney said. "Our findings suggest that the critical period for estrogen exposure to benefit cognition may not be limited to the menopause transition, since these women were more than 20 years postmenopausal."

Two studies by another group of researchers suggest that hormone therapy positively influences postmenopausal memory and hippocampal activity, and might offer some protective effect against the cognitive decline seen in Alzheimer's.

Kara Bottiggi Dassel, Ph.D., of the Barrow Neurological Institute, Phoenix, examined the effect of past hormone use on the cognitive deficits of Alzheimer's patients. …

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