Postmenopausal hormone treatment alters neural pathways but does not improve verbal cognitive function.
Postmenopausal hormone treatment alters neural pathways but does not improve verbal cognitive function.
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DOI：
10.1097/gme.0000000000001157
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
Smith YR
中科院分区：
文献类型：
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作者：
Berent-Spillson A;Kelley AS;Persad CC;Love T;Frey KA;Reame NE;Koeppe R;Zubieta JK;Smith YR
绝经后激素治疗试验中的认知结果并不一致。不同的结果可能归因于激素配方、治疗持续时间和时机以及不同的认知领域影响。我们之前证明了治疗对视觉认知功能的益处。在当前的研究中，我们描述了激素治疗对同一女性言语结果的影响，试图了解先前与当前激素治疗对言语功能的影响。这是对 57 名女性（38 名激素使用者[25 名先前长期使用者和 13 名当前使用者]和 19 名从未使用者）的横断面评估。激素使用者从绝经后 2 年内开始，服用相同配方的雌激素或雌激素 + 孕激素（0.625 毫克/天结合马雌激素，含或不含醋酸甲羟孕酮）至少 10 年。女性接受了言语功能测试和言语辨别任务的功能性 MRI 评估。所有女性在言语功能评估（霍普金斯言语学习测试和功能磁共振成像扫描过程中执行的言语辨别任务）上得分相似，然而，曾经接受过激素治疗的女性在言语任务期间左额下皮质（T = 3.72；p < 0.001）和右前额叶皮层（T = 3.53；p < 0.001）激活更多。接受激素治疗的女性在言语辨别任务中表现稍差（平均准确度为 81.72 ± 11.57 曾治疗过，85.30 ± 5.87 从未治疗过，p = 0.14），需要更长的时间做出反应（平均反应时间为 1.10 ± 0.17 秒曾经治疗过，1.02 ± 0.11 从未治疗过，p = 0.03），并且记住了更少的以前看过的单词（平均准确度62.21 ± 8.73 曾治疗过，65.45 ± 7.49 从未治疗过，p = 0.18）。后扣带回活动增加与较长的反应时间（R = 0.323，p = 0.015）和更差的延迟言语回忆（R = -0.328，p = 0.048）相关，这表明激活增加与认知处理效率较低有关。我们没有检测到左前额叶皮层、上额叶皮层、丘脑或枕叶/顶叶交界处的激活存在组间差异。尽管当前和过去的激素治疗与言语辨别过程中使用的神经通路的差异有关，但与从未使用过的人相比，言语功能并不更高。
Cognitive outcomes in trials of postmenopausal hormone treatment have been inconsistent. Differing outcomes may be attributed to hormone formulation, treatment duration and timing, and differential cognitive domain effects. We previously demonstrated treatment benefits on visual cognitive function. In the current study, we describe the effects of hormone treatment on verbal outcomes in the same women, seeking to understand the effects of prior versus current hormone treatment on verbal function. This is a cross-sectional evaluation of 57 women (38 hormone users [25 prior long-term users and 13 current users] and 19 never-users). Hormone users took identical formulations of estrogen or estrogen + progestin (0.625 mg/day conjugated equine estrogens with or without medroxyprogesterone acetate) for at least 10 years, beginning within 2 years of menopause. Women were evaluated with tests of verbal function and functional MRI of a verbal discrimination task. All women scored similarly on assessments of verbal function (Hopkins Verbal Learning Test and a verbal discrimination task performed during the fMRI scanning session), however women ever-treated with hormones had more left inferior frontal (T = 3.72; p < 0.001) and right prefrontal cortex (T = 3.53; p < 0.001) activation during the verbal task. Hormone-treated women performed slightly worse on the verbal discrimination task (mean accuracy 81.72 ± 11.57 ever-treated, 85.30 ± 5.87 never-treated, p = 0.14), took longer to respond (mean reaction time 1.10 ± 0.17 seconds ever-treated, 1.02 ± 0.11 never-treated, p = 0.03), and remembered fewer previously viewed words (mean accuracy 62.21 ± 8.73 ever-treated, 65.45 ± 7.49 never-treated, p = 0.18). Increased posterior cingulate activity was associated with longer response times (R = 0.323, p = 0.015) and worse delayed verbal recall (R = −0.328, p = 0.048), suggesting that increased activation was associated with less efficient cognitive processing. We did not detect between group differences in activation in the left prefrontal cortex, superior frontal cortex, thalamus, or occipital/parietal junction. Although current and past hormone treatment was associated with differences in neural pathways used during verbal discrimination, verbal function was not higher compared to never-users.