Critical window hypothesis of hormone therapy and cognition: a scientific update on clinical studies.
Critical window hypothesis of hormone therapy and cognition: a scientific update on clinical studies.
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DOI：
10.1097/gme.0b013e3182960cf8
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Maki PM
中科院分区：
文献类型：
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作者：
Maki PM
激素治疗（HT）和认知功能的临界窗口假说指出，HT的作用取决于年龄和/或绝经过渡期的开始时间，早期开始的最佳效果是明显的。本文综述了这一假说的临床研究。认识到HT使用的典型模式是早期HT启动，审查描述了以往使用HT的观察性研究和观察性研究的结果，特别是在AD和认知测试性能的HT的时间。HT和文字记忆的随机试验进行了讨论，神经影像学研究轴承的假设进行了审查。观察数据表明，HT通常可降低阿尔茨海默病（AD）的风险。三个观察性研究，专门检查启动时间与AD风险的关系，每个提供支持的窗口，而三个HT时间和认知测试性能的五个观察性研究做。在年轻女性中进行的雌激素治疗的随机临床试验支持这一假设。结合马雌激素/醋酸甲羟孕酮（CEE/MPA）增加风险，无论时间。关于其他组合HT制剂的认知效应知之甚少。一个明确的试验来检验临界窗口假设是不可行的。从其他来源获得的证据为这一假设提供了初步的支持。虽然这些发现与使用HT治疗血管痉挛症状的女性相关，但HT目前不适用于治疗认知障碍或预防痴呆症。
The critical window hypothesis of hormone therapy (HT) and cognitive function states that the effects of HT depend on the timing of initiation with respect to age and/or the menopausal transition and that optimal effects are evident with early initiation. This article reviews the clinical studies that bear on this hypothesis. Recognizing that the typical pattern of HT use is early HT initiation, the review describes findings from observational studies of ever use of HT and observational studies that looked specifically at timing of HT on AD and cognitive test performance. Randomized trials of HT and verbal memory are discussed, and neuroimaging studies bearing on the hypothesis are reviewed. Observational data suggest that HT reduces the risk of Alzheimer’s disease (AD) generally. Three of three observational studies that specifically examined timing of initiation in relation to AD risk each provide support for the window, whereas three of five observational studies of HT timing and cognitive test performance do. Randomized clinical trials of estrogen therapy in younger women find support for the hypothesis. Conjugated equine estrogen/medroxyprogesterone acetate (CEE/MPA) increases risks regardless of timing. Little is known about the cognitive effects of other combination HT formulations. A definitive trial to test the critical window hypothesis is not feasible. Evidence drawn from other sources provides initial support for the hypothesis. Although these findings are relevant to women who use HT to treat vasomotor symptoms, HT is currently not indicated for the treatment of cognitive complaints or dementia prevention.