Register for Hormone replacement does not improve cognition in elderly women
Heart DiseaseDecember 19, 2002
2002 DEC 19 - (NewsRx.com & NewsRx.net) -- Hormone replacement therapy has been the subject of some controversy recently concerning potential benefits and risks.
A study from the University of California, San Francisco, the San Francisco VA Medical Center, Wyeth-Ayerst Research, and the University of California, San Diego, examines whether this therapy can improve cognitive function in elderly women with coronary disease.
Previous findings of several randomized trials suggest that estrogen therapy improves cognition in postmenopausal women without pre-existing dementia. According to the authors, "… all of these trials were small (18-64 participants), several reported improved cognition in the estrogen-treated group but did not compare these changes with those in the placebo group, and most enrolled women were recently menopausal and likely to be suffering from menopausal symptoms. Relief of vasomotor symptoms and insomnia by estrogen therapy might have resulted in better concentration and improvement in cognitive performance."
Using subjects from the Heart and Estrogen/Progestin Replacement Study (HERS), a randomized, placebo-controlled trial involving 2763 women with coronary disease, participants at 10 of the 20 HERS centers were invited to enroll in the cognitive function substudy. Subjects were followed for more than 4 years and cognitive function was measured in 517 women in the hormone group and 546 in the placebo group using 6 standard tests: the modified Mini-Mental Status Examination, Verbal Fluency, Boston Naming, Word List Memory, Word List Recall, and Trails B.
In this study, published in the American Journal of Medicine, treatment with oral estrogen plus progestin therapy for 4 years did not result in better cognitive function compared with treatment with placebo in elderly women with coronary disease.
All prior trials have studied unopposed estrogen. In this trial, it is possible that the addition of medroxyprogesterone acetate negated a beneficial effect of estrogen. Because all hormone-treated women in HERS received estrogen and progestin, the trial provides no evidence regarding the effect of unopposed estrogen therapy on cognitive function. Estrogen therapy has also been hypothesized to improve function in women with known dementia, but a recent randomized trial found no benefit in women with documented Alzheimer disease.
Clinical trials are currently in progress to determine if estrogen therapy reduces the risk of developing Alzheimer disease and other forms of dementia (Grady D., Yaffe K., Kristof M., et al., Effect of postmenopausal hormone therapy on cognitive function: The heart and estrogen/progestin replacement study. Am J Med, 2002;113(7)). This article was prepared by Women's Health Weekly editors from staff and other reports.
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