Cognitive effects of estradiol after menopause A randomized trial of the timing hypothesis
Cognitive effects of estradiol after menopause A randomized trial of the timing hypothesis
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DOI：
10.1212/wnl.0000000000002980
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发表时间：
2016-08-16
期刊：
影响因子：
9.9
通讯作者：
Mack, Wendy J.
中科院分区：
文献类型：
--
作者：
Henderson, Victor W.;John, Jan A. St.;Mack, Wendy J.
目的：为了验证这一假设，即含雌激素的激素治疗对认知能力的影响不同绝经后妇女之间的接近，并进一步从，menopaus.Methods：在这个随机，双盲，安慰剂对照试验，健康妇女在6年内绝经或绝经后10年以上被随机分配到口服17 β-雌二醇1毫克/天或安慰剂。有子宫的妇女接受了周期性微粉化黄体酮阴道凝胶或安慰剂。治疗组之间在2.5年和5年时评估的主要结局是评估言语情景记忆的神经心理学测试评分标准化复合评分的变化。次要结果评估执行功能和全球cognition.Results：共有567名妇女被列入修改后的意向治疗分析后，平均治疗时间为57个月。对于非文字记忆，平均雌二醇减去安慰剂标准化的复合评分差异（-0.06，95%置信区间20.22 - 0.09）不显著（双尾p = 0.33）。绝经早期和晚期组的差异相似（双尾相互作用p = 0.88）。绝经后组之间的相互作用和治疗组之间的差异并不显着的执行功能或全球cognition.Conclusions：绝经后6年内开始的雌二醇不影响言语记忆，执行功能，或全球认知不同的治疗开始10+年绝经后。证据分类：本研究提供了I类证据，表明绝经后6年内开始的雌二醇与绝经后10年以上开始的雌二醇相比，不会影响2.5年后的认知能力。
Objective: To test the hypothesis that effects of estrogen-containing hormone therapy on cognitive abilities differ between postmenopausal women near to, and further from, menopause.Methods: In this randomized, double-blind, placebo-controlled trial, healthy women within 6 years of menopause or 10+ years after menopause were randomly assigned to oral 17 beta-estradiol 1 mg/d or placebo. Women with a uterus received cyclic micronized progesterone vaginal gel or placebo. The primary outcome assessed at 2.5 and 5 years, compared between treatment groups, was change in a standardized composite of neuropsychological test scores assessing verbal episodic memory. Secondary outcomes assessed executive functions and global cognition.Results: A total of 567 women were included in modified intention-to-treat analyses after a mean treatment duration of 57 months. For verbal memory, the mean estradiol minus placebo standardized difference in composite scores (-0.06, 95% confidence interval 20.22 to 0.09) was not significant (2-tailed p = 0.33). Differences were similar in early and late postmenopause groups (2-tailed interaction p = 0.88). Interactions between postmenopause groups and differences between treatment groups were not significant for executive functions or global cognition.Conclusions: Estradiol initiated within 6 years of menopause does not affect verbal memory, executive functions, or global cognition differently than therapy begun 10+ years after menopause. Estradiol neither benefits nor harms these cognitive abilities regardless of time since menopause.Classification of evidence: This study provides Class I evidence that estradiol initiated within 6 years of menopause does not affect cognition at 2.5 years differently than estradiol initiated 10+ years after menopause.