Associations of Hearing Loss and Menopausal Hormone Therapy with Change in Global Cognition and Incident Cognitive Impairment among Postmenopausal Women.
Associations of Hearing Loss and Menopausal Hormone Therapy with Change in Global Cognition and Incident Cognitive Impairment among Postmenopausal Women.
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DOI：
10.1093/gerona/glz173
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发表时间：
2019-07
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通讯作者：
Nicole M. Armstrong;M. Espeland;J. Chen;K. Masaki;J. Wactawski‐Wende;Wenjun Li;M. Gass;M. Stefanick;J. Manson;J. Deal;S. Rapp;F. Lin;S. Resnick
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作者：
Nicole M. Armstrong;M. Espeland;J. Chen;K. Masaki;J. Wactawski‐Wende;Wenjun Li;M. Gass;M. Stefanick;J. Manson;J. Deal;S. Rapp;F. Lin;S. Resnick
听力损失（HL）和绝经期激素（结合马雌激素[CEE]和/或醋酸甲羟孕酮[MPA]）分别与认知能力下降和认知功能障碍风险增加相关。HL和HT的联合作用可能与绝经后女性整体认知能力的叠加或协同下降以及认知功能障碍的风险有关。方法使用妇女健康倡议（WHI）记忆研究，从1996年至2009年，对7，220名绝经后妇女进行HL、整体认知（改良简易精神状态检查评分）和认知障碍（轻度认知障碍和痴呆的中央裁定诊断）测量。多变量线性混合效应模型用于分析整体认知的变化率。加速失效时间模型用于评估至发生认知功能损害的时间，按HT分层。结果：在CEE单独试验中，观察到的CEE单独对整体认知变化的不良影响与HL无差异，HL和CEE单独的联合效应估计与偶发性认知障碍无关。在CEE+MPA试验中，HL并未独立加速至认知障碍的时间，CEE+MPA的不良反应在老年HL女性中升高。接受CEE+MPA治疗的HL（时间比，[TR]=0.82，95%置信区间，[CI]：0.71，0.94）或听力正常（TR=0.86，95% CI：0.76，0.97）老年女性发生认知功能障碍的时间比听力正常和安慰剂组更快。结论：HL可能加重CEE+MPA（而非单用CEE）对绝经后HT女性整体认知功能下降（而非偶发认知功能障碍）的不良影响。
BACKGROUND Hearing loss (HL) and menopausal hormone (conjugated equine estrogens [CEE] and/or medroxyprogesterone acetate [MPA]) are separately associated with cognitive decline and increased risk of incident cognitive impairment. Joint effects of HL and HT could be associated with additive or synergistic decline in global cognition and risk of incident cognitive impairment among postmenopausal women. METHODS Using the Women's Health Initiative (WHI) Memory Study, 7,220 postmenopausal women with measures of HL, global cognition (Modified Mini- Mental State Examination score), and cognitive impairment (centrally-adjudicated diagnoses of mild cognitive impairment and dementia) from 1996-2009. Multivariable linear mixed effects models were used to analyze rate of change in global cognition. Accelerated failure time models were used to evaluate time to incident cognitive impairment, stratified by HT. RESULTS Within the CEE-Alone trial, observed adverse effects of CEE-Alone on change in global cognition did not differ by HL, and estimated joint effects of HL and CEE-Alone were not associated with incident cognitive impairment. Within the CEE+MPA trial, HL did not independently accelerate time to cognitive impairment, the adverse effect of CEE+MPA was heightened in older women with HL. Older women on CEE+MPA either with HL (Time Ratio, [TR]=0.82, 95% Confidence Interval, [CI]: 0.71, 0.94) or with normal hearing (TR=0.86, 95% CI: 0.76, 0.97) had faster time to cognitive impairment than those with normal hearing and placebo. CONCLUSIONS HL may accentuate the adverse effect of CEE+MPA, not CEE-Alone, on global cognitive decline, not incident cognitive impairment, among postmenopausal women on HT.