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More on Hormones and Cognitive Function

Does estrogen prevent dementia? It depends. Two studies highlight the diversity of the postmenopausal population.

Whether hormone replacement therapy (HRT) prevents or slows dementia remains controversial. Two recent studies provide some answers.

Researchers looked at data from the Heart and Estrogen/progestin Replacement Study, a manufacturer-sponsored, double-blind, placebo-controlled, randomized trial, to determine the effect of 36 months of progestin/estrogen therapy on quality of life in 2763 postmenopausal women (mean age, 67) with documented coronary artery disease. At 3 years, quality of life was diminished in participants with older age, diabetes, hypertension, chest pain, or heart failure. Mean scores of HRT and placebo recipients declined on standardized measures of physical functioning, mental health, and energy/fatigue. However, HRT recipients who at baseline had "hot flashes" showed improved mental health and fewer depressive symptoms, compared with placebo recipients. HRT recipients without hot flashes had significantly worse energy/fatigue and physical functioning than did placebo patients.

Another study did not examine the effect of HRT but has implications regarding its use. Researchers in Thailand assayed endogenous estradiol levels in 135 older, community-based men and women, 72 with dementia (mean age, 70) and 63 without (mean age, 65). Only 5 had undergone estrogen therapy, 4 of whom had stopped 5 years before the study. After controlling for age, investigators found that behavior disturbance, compromised daily activities, and impaired cognition were significantly associated with lower levels of endogenous estrogen in both men and women.

Comment: Results from the first study imply that postmenopausal women form a diverse group; if HRT is prescribed to improve quality of life, it should be given to women whose symptoms are associated with menopause. Although the results from the second study suggest possible positive effects of HRT, findings from other studies do not. Perhaps, these conflicting results also demonstrate the diversity of the postmenopausal population.

— Gary Tucker, MD

Published in Journal Watch Psychiatry April 10, 2002

Citation(s):

Hlatky MA et al. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: Results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002 Feb 6; 287:591-7.

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• Medline abstract (Free)

Senanarong V et al. Endogenous estradiol in elderly individuals: Cognitive and noncognitive associations. Arch Neurol 2002 Mar; 59:385-9.

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• Medline abstract (Free)