Cognitive Effects of Hormone Therapy Continuation or Discontinuation in a Sample of Women at Risk for Alzheimer Disease.
Cognitive Effects of Hormone Therapy Continuation or Discontinuation in a Sample of Women at Risk for Alzheimer Disease.
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DOI：
10.1016/j.jagp.2015.05.009
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Rasgon NL
中科院分区：
文献类型：
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作者：
Wroolie TE;Kenna HA;Williams KE;Rasgon NL
使用基于雌激素的激素治疗（HT）作为对认知能力下降和阿尔茨海默病的保护是有争议的，尽管累积数据支持在接近绝经期开始时使用HT，含17β-雌二醇（17β-E）的雌激素制剂优于结合马雌激素制剂。关于可能从HT中获益的特定女性人群知之甚少。AD风险升高的女性（年龄49-69岁），所有人都服用HT至少一年，其中大多数在接近绝经期时开始HT，接受认知评估，然后随机继续或停止HT。在随机化后2年重复评估。持续HT的女性在认知领域表现更好，包括言语记忆，注意力，工作记忆和处理速度的综合测量。使用17β-E与结合型马雌激素的妇女，无论是随机继续或停止HT，在2年随访评估时均显示出更好的言语记忆表现。还发现HT随机化和一级亲属中的AD家族史存在相互作用。AD患者的所有女性后代的言语记忆下降，然而，继续HT的女性比停止HT的女性下降得少。没有一级亲属患有AD的女性的言语记忆持续改善（可能是由于练习的影响），并随着HT的停止而下降。在接近绝经期开始时，继续使用HT似乎可以保护AD风险升高的女性的认知能力。
Use of estrogen-based hormone therapy (HT), as a protection from cognitive decline and Alzheimer’s disease, is controversial although cumulative data supports HT use when initiated close to menopause onset with estrogen formulations containing 17β-estradiol (17β-E) being preferable to conjugated equine estrogen formulations. Little is known regarding specific populations of women who may derive benefit from HT. Women with heightened risk for AD (aged 49-69), all of whom were taking HT for at least one year, most of whom initiated HT close to menopause onset, underwent cognitive assessment followed by randomization to continue or discontinue HT. Assessments were repeated at two years after randomization. Women who continued HT performed better on cognitive domains composed of measures of verbal memory, and combined attention, working memory, and processing speed measures. Women who used 17β-E versus conjugated equine estrogen, whether randomized to continue or discontinue HT showed better verbal memory performance at the 2-year follow-up assessment. An interaction was also found with HT randomization and family history of AD in a first degree relative. All women offspring of patients with AD declined in verbal memory however, women who continued HT declined less than women who discontinued HT. Women without a first-degree relative with AD showed verbal memory improvement (likely due to practice effects) with continuance and declined with discontinuance of HT. Continuation of HT use appears to protect cognition in women with heightened risk for AD when initiated close to menopause onset.