ESTROGEN REPLACEMENT THERAPY IN OLDER WOMEN - COMPARISONS BETWEEN ALZHEIMERS-DISEASE CASES AND NONDEMENTED CONTROL SUBJECTS
ESTROGEN REPLACEMENT THERAPY IN OLDER WOMEN - COMPARISONS BETWEEN ALZHEIMERS-DISEASE CASES AND NONDEMENTED CONTROL SUBJECTS
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DOI：
10.1001/archneur.1994.00540210068014
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发表时间：
1994-09-01
影响因子：
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通讯作者：
BUCKWALTER, JG
中科院分区：
文献类型：
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作者：
HENDERSON, VW;PAGANINIHILL, A;BUCKWALTER, JG
目的：我们假设口服雌激素替代疗法在符合阿尔茨海默病（AD）标准的老年妇女中比在非痴呆老年妇女中更不常见。对于AD的女性，我们假设雌激素使用者将执行更好的认知任务比nonusers.Design：雌激素替代治疗的病例对照研究，其中分层程序被用来控制潜在的年龄和教育的混杂效应。当我们比较雌激素使用者和非使用者的AD患者的认知表现时，痴呆症状的持续时间是一个额外的控制变量。受试者是连续登记的老年妇女的志愿者样本，主要从社区招募，符合可能AD的临床标准（n=143）或符合非痴呆控制状态的标准（n=92）。随后死亡的70例患者符合AD的组织病理学标准;另一名不符合AD尸检标准的痴呆妇女被排除在所有analysis.Main结果测量：目前使用的雌激素替代治疗的时间登记的控制对象或AD病例患者的主要照顾者的报告。在这些病例中，我们比较了雌激素使用者（n=10）和非使用者（n=128）在简要认知筛查工具上的表现。阿尔茨海默病病例患者使用雌激素替代品的可能性明显低于对照组（7%对18%），但在处方药总数或最常处方的药物类别（甲状腺药物）方面，两组无差异。使用雌激素的痴呆病例患者与未使用雌激素的患者在年龄、教育程度或症状持续时间方面没有显著差异，但他们在认知筛查工具上的平均表现明显更好（简易精神状态检查评分为14.9 vs 6.5）。
Objectives: We hypothesized that oral estrogen replacement therapy would be less common among elderly women meeting criteria for Alzheimer's disease (AD) than among nondemented elderly women. For women with AD, we hypothesized that estrogen users would perform better on a cognitive task than would nonusers.Design: A case-control study of estrogen replacement therapy, in which hierarchical procedures were used to control for potentially confounding effects of age and education. When cognitive performances were compared between estrogen users and nonusers with AD, the duration of dementia symptoms was an additional control variable.Setting: Alzheimer's Disease Research Center at the University of Southern California, Los Angeles.Subjects: Subjects were a volunteer sample of consecutively enrolled elderly women, recruited primarily from the community, who met clinical criteria for probable AD (n=143) or met criteria for nondemented control status (n=92). Seventy case patients who have subsequently died met histopathologic criteria for AD; one other demented woman who did not meet the autopsy criteria for AD was excluded from all analyses.Main Outcome Measures: Current use of estrogen replacement at the time of enrollment as reported by control subjects or by the primary caregivers of AD case patients. Among cases, performances on a brief cognitive screening instrument were compared between estrogen users (n=10) and nonusers (n=128) for whom this information was available.Results: Alzheimer's disease case patients were significantly less likely than control subjects to use estrogen replacement (7% vs 18%), but groups did not differ with regard to the total number of prescription medications or to the most frequently prescribed class of drug (thyroid medication). Demented case patients using estrogen did not differ significantly from those not using estrogen in terms of age, education, or symptom duration, but their mean performance on a cognitive screening instrument was significantly better (Mini-Mental State examination scores of 14.9 vs 6.5).