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Increased Risk of Dementia in Postmenopausal Women on Hormone Therapy: Presented at NAMS

By Deanna M Green, PhD

MIAMI, FL -- September 19, 2003 -- Postmenopausal women on oestrogen/progesterone replacement therapy have an increased risk of dementia, according to findings presented here September 18^th at the 14^th Annual Meeting of The North American Menopause Society.

Dementia is diagnosed as a marked decline in memory function that significantly affects daily activities, and is not simply age associated memory loss. Some of the known aetiologies of dementia are Alzheimer's disease, vascular disease, or a combination of the two. There are no known therapies for the prevention or treatment of dementia.

A growing number of studies have suggested that hormone therapy has protective effects on Alzheimer's disease, all-cause dementia, and cognitive impairment.

To determine whether hormone therapy protects against dementia and cognitive impairment, Sally A Shumaker, PhD, and colleagues at Wake Forest University Health Sciences, Winston Salem, North Carolina, evaluated the effects of combination hormone therapy on dementia progression in postmenopausal women.

The study included 4,532 community-dwelling women between the ages of 65 and 80 years of age that participated in the oestrogen/progesterone arm of the Women's Health Initiative.

The women were randomised to receive either conjugated equine oestrogen 0.625 mg/day and medroxyprogesterone acetate 2.5 mg/day or placebo. Mild cognitive impairment and dementia were assessed annually using the Modified Mini-Mental Status Examination with clinical follow up when needed.

Results indicated that women on hormone therapy were twice as likely to have probable dementia as those not taking hormones. Estimated analysis determined that hormone therapy causes an excess of 23 dementia cases per 10,000 women.

Further study indicated that the increased incidence of dementia was present regardless of the potential cause of dementia and whether or not high risk dementia patients were included in the analysis.

No difference in the incidence of mild cognitive impairment was seen between groups. However, Dr. Shumaker note, "these women are still being followed in order to analyse the progression to dementia in women with mild cognitive impairment with or without hormones."

Dr. Shumaker concluded, "The risk of being diagnosed with probable dementia is twice as high with hormone therapy in postmenopausal women." In future studies, she plans to more specifically analyse "the role of progestin and the effects of timing, duration, and mode of hormone therapy in the progression to dementia."


[Study title: Effects of estrogen plus progestin on progression to dementia in postmenopausal women: results from the Women's Health Initiative Memory Study. Abstract S1]

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