Wednesday, January 12, 2011

Can Hormone Therapy Prevent Dementia?

As our population ages and more members are developing dementia (primarily Alzheimer's), scientists are constantly on a quest to look for ways to prevent dementia. In the past, we felt the data supported that estrogen ("HRT"- hormone replacement therapy-given to women in menopause) might prevent Alzheimer's. Subsequently, the tide turned and evidence showed that not only did it not prevent, but it may worsen your risk. What do we think today?

A recently published study in the Annals of Neurology, Timing of hormone therapy and dementia: The critical window theory revisited, represents hope and a bit of a compromise. This study suggests that women who take HRT WHEN THEY BECOME MENOPAUSAL (but not later in life) have a significantly reduced risk of developing dementia!

The study was a good size- around 5500 women. Their pharmacy records were used to verify HRT use in their mid-life (average age around 49) and then evaluated again roughly 30 years later, when the women were in their late 70s and 80s. Over a quarter of these women developed dementia (27%) which may sound shocking, but is consistent with the growing incidence of dementia.

The analysis showed that women who TOOK HRT ONLY IN THEIR MIDLIFE had a 26% reduction in their risk of developing dementia compared with women who never took HRT, whereas those who took HRT only in their later life had a 48% INCREASED risk. Interesting, those women that took HRT BOTH midlife and later life had the same risk as those women who NEVER took it.

BOTTOM LINE: Current evidence-based medicine suggests that taking HRT at the time of menopause may DECREASE your risk of developing dementia, but starting HRT late in life can INCREASE your risk. Women, please factor this in when you have your discussion with your physician regarding pros and cons of HRT!

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