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Estrogen Linked to Dementia Risk

Estrogen Linked to Dementia Risk USA TODAY - June 23, 2004 Older women taking estrogen are more likely to develop dementia than women who aren’t on any hormones, a study reports today. The findings come from the Women’s Health Initiative Memory Study, a spinoff of a government-sponsored trial of postmenopausal hormones. Several observational studies, in which women decided whether they should take estrogen, as well as animal research, suggested that estrogen protected against dementia. But scientists couldn’t be sure whether the treatment or some other characteristic of hormone users deserved credit. For a definitive answer about risks and benefits, the Women’s Health Initiative randomly assigned volunteers to estrogen plus progestin to protect their uterus if they had one, estrogen alone if they didn’t, or a placebo. Researchers halted the estrogen-plus-progestin study in July 2002 when it became apparent that the risks -- a higher chance of heart attack, stroke, breast cancer and blood clots -- outweighed the benefits, namely a lower chance of fractures and colon cancer. They halted the estrogen-only study in February after concluding that the benefits did not outweigh the risks. The memory study focused on 7,479 women 65 to 79. About 4,500 got either estrogen plus progestin or a placebo, the remainder estrogen or a placebo. None had dementia at the study’s start. Women on estrogen alone were 50% more likely to develop dementia than those on placebo, says a report in today’s Journal of the American Medical Association. The actual number of cases was small: 28 in the estrogen group, 19 in the placebo group. About half appeared to have Alzheimer’s disease. In May 2003, researchers reported that women on estrogen plus progestin had double the risk of developing dementia as those on placebo. In a second article today, the researchers report that women on estrogen were more likely to experience a decline in thinking ability, especially if they were at the lower end of normal to begin with. It’s possible that hormone use earlier in menopause might protect the brain, says co-author Stephen Rapp, a psychiatry professor at the Wake Forest University School of Medicine. ’’Maybe there’s a window of opportunity for estrogen exposure, which has been suggested by a number of studies.’’ In an accompanying editorial, Lon Schneider of the University of Southern California suggests that Rapp’s team follow the younger women in their larger trial for at least the next decade to see if those who took hormones are any less likely to develop dementia than those who were on placebo. But Rapp says there currently are no plans to do so.

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