The effect of estrogen replacement therapy on cognitive function in women: A critical review of the literature
The effect of estrogen replacement therapy on cognitive function in women: A critical review of the literature
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DOI：
10.1016/s0895-4356(97)00169-8
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发表时间：
1997-11-01
影响因子：
7.2
通讯作者：
Horwitz, RI
中科院分区：
文献类型：
--
作者：
Haskell, SG;Richardson, ED;Horwitz, RI
目的：对现有的临床试验进行回顾，以确定是否有足够的证据支持以下结论：雌激素替代疗法对绝经后妇女和患有阿尔茨海默氏病的妇女的认知能力有有益影响。通过 MEDLINE 搜索 1970 年至 1996 年间所有出现“雌激素和认知”或“雌激素和记忆”一词的英语出版物，确定了相关研究。数据提取：提取每项研究的数据，包括受试者特征和资格标准、随访持续时间和治疗方案。评估基线特征，包括年龄；更年期状态；卵泡刺激素、黄体生成素和雌二醇水平；情绪;和认知功能的测量。评估心理测试的结构效度。结果：回顾了 19 项研究，包括 10 项雌激素替代疗法与安慰剂的随机试验。受试者之间的极端异质性以及研究中认知测量使用的差异性妨碍了进行定量总结。在这 10 项随机试验中，有 8 项声称雌激素疗法有治疗效果，其中 3 项报告显示记忆力显着改善，其中 2 项显示注意力有所改善。这些研究没有控制潜在的混杂因素，例如抑郁和血管舒缩症状。在九项观察性研究中，五项发现雌激素的使用与认知功能之间存在显着关联。结论：虽然一些观察性研究为雌激素对认知功能的有益作用提供了令人鼓舞的证据，但目前随机对照试验的证据不足，无法支持雌激素替代疗法可改善绝经后妇女或患有阿尔茨海默氏痴呆症的妇女认知功能的结论。 (C) 1997 爱思唯尔科学公司。
Objective: To conduct a review of the available clinical trials to determine whether sufficient evidence exists to support the conclusion that estrogen replacement therapy has a beneficial effect on cognitive performance in post-menopausal women and in women with Alzheimer's disease. Studies were identified through a MEDLINE search of all English-language publications between 1970 and 1996 in which the words estrogen and cognition or estrogen and memory appeared. Data Extraction: Data were extracted for each study, including features of subjects and eligibility criteria, duration of follow-up, and treatment regimen. Baseline characteristics were evaluated, including age; menopausal status; follicle-stimulating hormone, luteinizing hormone, and estradiol levels; mood; and measures of cognitive function. Psychological tests were evaluated for construct validity. Results: Nineteen studies were reviewed, including 10 randomized trials of estrogen replacement therapy versus placebo. Extreme heterogeneity among subjects and variability in the use of cognitive measures across the studies precluded performing a quantitative summary. Of the 10 randomized trials, eight claimed therapeutic benefits for estrogen therapy, three of which reported significant improvements in memory and two of which showed improvements in attention. These studies did not control for potential confounds such as depression and vasomotor symptoms. Of the nine observational studies, five found a significant association between estrogen use and cognitive function. Conclusion: Although several observational studies provide encouraging evidence for the beneficial effect of estrogen on cognitive function, there is currently inadequate evidence available from randomized, controlled trials to support the conclusion that estrogen replacement therapy improves cognitive function in post-menopausal women or women with Alzheimer's dementia. (C) 1997 Elsevier Science Inc.