HRT exposure linked to reduced cognitive decline in older women

NEW YORK (Reuters Health) – A relatively short period of hormone replacement therapy (HRT), roughly 6 years, may have long-term cognitive benefits for older women, study results suggest.

Principal investigator, Dr. Michelle C. Carlson of Johns Hopkins in Baltimore, told Reuters Health that findings on the potential cognitive benefits of HRT in healthy aging women have been mixed; some studies have found a protective effect, while others have not. This inconsistency may reflect, in part, a failure to account for different health habits in HRT users relative to non-users, she said.

Dr. Carlson's team compared global cognitive function in those who had ever used HRT with never-users in a population sample of 2073 nondemented, older (age 65+) female residents of Cache County, Utah. This county is characterized by "overall enhanced health-seeking behaviors" and good access to healthcare, with minimal use of alcohol and tobacco, Dr. Carlson said.

The results suggest that HRT may help prevent the onset of dementia in women with mild cognitive difficulty and may mitigate "normal" age-related cognitive decline. That is, in adjusted analyses, lifetime HRT use was associated with better baseline scores on the Modified Mini-Mental State Examination (MMSE) and a slower rate of cognitive decline.

The observed decrease of 1.50 points in the annual rate of modified MMSE decline at the mean age of 76, "suggests that the effects apparent with HRT use are clinically as well as statistically significant," Dr. Carlson's team reports in the December 26, 2001 issue of the journal Neurology.

The greatest improvement in global cognition was among the oldest old (85+ years). "In other words, those who stand to lose the most cognitively may gain the most from HRT exposure," Dr. Carlson said. She believes the observed benefits of HRT with increasing age may reflect latent benefits that become apparent as cognitive reserve is progressively depleted with age, or as individuals reach an age where they are increasingly likely to develop Alzheimer's disease.

"These findings have implications for future clinical trials in that the apparent cognitive benefits were maintained regardless of duration, onset, or recency of HRT use," Dr. Carlson said. "If our findings hold, a relatively 'short' duration of exposure averaging 6 years may suffice to confer long-term benefits that will be evident over relatively brief study periods."

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