BMJ  2004;328:1514 (26 June), doi:10.1136/bmj.328.7455.1514-b

News

Oestrogen doesn't protect mental function in older women

New York

The "oestrogen only" treatment arm of the women's health initiative memory study shows that oestrogen does not protect against mild cognitive impairment or dementia and slightly increases the risk, say two reports published in JAMA ( 2004;291: 2947-58, 2959-68)[Abstract/Free Full Text]. Mild cognitive impairment strongly predicts dementia.

Previous studies have suggested that oestrogen might prevent cognitive decline, said Lon Schneider, professor of psychiatry, neurology, and gerontology at the University of Southern California in Los Angeles, who commented on the studies in an editorial ( JAMA 2004;291: 3005-7[Free Full Text]). He told the BMJ that the finding which showed oestrogen might increase the risk of cognitive impairment and dementia was unexpected. "The studies show that giving oestrogen or oestrogen and progestin [progestogen] to women over 65 in hopes of delaying dementia or increasing cognitive function is misplaced. They should not be getting oestrogen."

Two years ago, the women's health initiative—a trial to evaluate oestrogen and progestogen in 27000 postmenopausal women—was stopped early ( BMJ 2002;325: 61[Free Full Text]). The oestrogen only part of the trial continued until February 2004 ( BMJ 2004;328: 602[Free Full Text]).

The two new reports cover cognitive function in the oestrogen only study and pooled results with the oestrogen-progestogen study.

The oestrogen only study included 2808 women aged 65-79 who had a baseline test of global cognitive function and at least one follow up test with the modified mini-mental state examination (3MSE): 1387 women who took 0.625 mg of combined equine oestrogen daily and 1421 who took a placebo. During a mean follow up of 5.4 years, probable dementia was diagnosed in 28 women receiving oestrogen and in 19 receiving placebo (hazard ratio 1.49; 95% confidence interval 0.83 to 2.66).

Lead author Mark Espeland, professor of public health sciences at Wake Forest University School of Medicine in WinstonSalem, North Carolina, told the BMJ that women with relatively low cognitive function at baseline were at particularly high risk of deterioration.

Dr Sally Shumaker, the principal national investigator of the memory study and associate dean for research at Wake Forest, and colleagues pooled data from the oestrogen only trial and the trial of combined 0.625 mg of oestrogen plus 2.5 mg of medroxyprogesterone acetate per day in 4532 women aged 65-79. They found the overall hazard ratio for probable dementia was 1.76 (95% confidence interval 1.19 to 2.60; P=0.005).

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Rapid Responses:

Read all Rapid Responses

same mechanism as HRT and increased breast cancer...

James M. Howard
bmj.com, 25 Jun 2004 [Full text]

Dementia increase with oestrogen and progesterone use is predictable.

Ellen C G Grant
bmj.com, 27 Jun 2004 [Full text]

Re: Dementia increase with oestrogen and progesterone use is predictable.

James M. Howard
bmj.com, 1 Jul 2004 [Full text]

Re: Re: Dementia increase with oestrogen and progesterone use is predictable.

Ellen C G Grant
bmj.com, 2 Jul 2004 [Full text]

Re: Re: Re: Dementia increase with oestrogen and progesterone use is predictable.

James M. Howard
bmj.com, 3 Jul 2004 [Full text]