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Am J Geriatr Psychiatry. 2015 Nov;23(11):1117-26. doi: 10.1016/j.jagp.2015.05.009. Epub 2015 May 21.

Cognitive Effects of Hormone Therapy Continuation or Discontinuation in a Sample of Women at Risk for Alzheimer Disease.

Author information

1
Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA.
2
Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA. Electronic address: nrasgon@stanford.edu.

Abstract

OBJECTIVE:

Use of estrogen-based hormone therapy (HT) as a protection from cognitive decline and Alzheimer disease (AD) is controversial, although cumulative data support HT use when initiated close to menopause onset with estrogen formulations containing 17β-estradiol preferable to conjugated equine estrogen formulations. Little is known regarding specific populations of women who may derive benefit from HT.

METHODS:

Women with heightened risk for AD (aged 49-69), all of whom were taking HT for at least 1 year and most of whom initiated HT close to menopause onset, underwent cognitive assessment followed by randomization to continue or discontinue HT. Assessments were repeated at 2 years after randomization.

RESULTS:

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-estradiol 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 female 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 because of practice effects) with continuance and declined with discontinuance of HT.

CONCLUSION:

Continuation of HT use appears to protect cognition in women with heightened risk for AD when initiated close to menopause onset.

KEYWORDS:

Alzheimer disease; Hormone therapy; cognition; postmenopausal women

PMID:
26209223
PMCID:
PMC4654994
DOI:
10.1016/j.jagp.2015.05.009
[Indexed for MEDLINE]
Free PMC Article

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