ESTROGEN REPLACEMENT THERAPY AND COGNITIVE FUNCTION IN OLDER WOMEN
ESTROGEN REPLACEMENT THERAPY AND COGNITIVE FUNCTION IN OLDER WOMEN
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DOI：
10.1001/jama.269.20.2637
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发表时间：
1993-05-26
影响因子：
120.7
通讯作者：
KRITZSILVERSTEIN, D
中科院分区：
文献类型：
--
作者：
BARRETTCONNOR, E;KRITZSILVERSTEIN, D
目的：确定替代雌激素是否延缓或防止老年妇女认知功能的丧失。设计：一项为期15年的前瞻性和横断面研究。背景：兰乔贝尔纳多，南加州的一个地理定义的社区。参与者。-800名妇女(原兰乔贝尔纳多队列中80%的当地幸存妇女)年龄在65岁至95岁之间。在1972年至1974年的基线和1988年至1991年的随访中，对雌激素的使用进行了评估。主要结果衡量标准。-在1988年至1991年的随访中，对8种标准仪器进行了12项认知功能测试。结果：在这一年龄较大、受过教育的队列中，近一半曾在绝经后的某个时间使用过雌激素，三分之一是目前的使用者。与年龄相关的认知功能减退与现在、过去或从未使用雌激素的女性相似。经年龄和教育调整后的比较也没有显示出认知功能测试的表现与基线、过去、现在或从未使用雌激素、雌激素剂量或使用时间之间的任何一致联系。在132个统计比较中，只观察到5个具有统计学意义的差异，少于仅凭偶然预期的数量。此外，这些显著的差异出现在不同的认知功能测试中，只有一种情况下，测试分数与当前雌激素使用有关。没有发现可以解释这些负面结果的偏见。结论--在这些老年女性中，没有发现令人信服的或内部一致的证据表明雌激素对认知功能的影响。这些数据不支持绝经后使用雌激素可以在老年时保留认知功能的假设。
Objective.-To determine whether replacement estrogen delays or prevents loss of cognitive function in elderly women.Design.-A 15-year prospective and cross-sectional study.Setting.-Rancho Bernardo, a geographically defined community in Southern California.Participants.-Eight hundred women (80% of local surviving women from the original Rancho Bernardo cohort) aged 65 to 95 years. Estrogen use was evaluated at baseline between 1972 and 1974 and at follow-up between 1988 and 1991.Main Outcome Measures.-Twelve tests of cognitive function from eight standard instruments administered at follow-up between 1988 and 1991.Results.-Almost half of this older, educated cohort had used estrogen at some time after menopause, and one third were current users. The age-related decrement in cognitive function was similar for women who were current, past, or never users of estrogen. Age- and education-adjusted comparisons also failed to show any consistent association between performance on tests of cognitive function and baseline, past, current, or never estrogen use; estrogen dose; or duration of use. Among 132 statistical comparisons, only five statistically significant differences were observed, less than the number expected by chance alone. Furthermore, these significant differences occurred with different tests of cognitive function, and in only one instance was the better test score associated with current estrogen use. No biases were identified that could explain these negative results.Conclusions.-No compelling or internally consistent evidence for an effect of estrogen on cognitive function was found in these older women. These data do not support the hypothesis that estrogen use after the menopause preserves cognitive function in old age.