Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois 60612, USA
Address for correspondence: Pauline M. Maki, Ph.D., Departments of Psychiatry and Psychology, Center for Cognitive Medicine, Neuropsychiatric Institute-MC913, University of Illinois at Chicago, 912 S. Wood St., Chicago, IL 60612. Voice: 312-996-6941; fax: 312-413-7856. pmaki{at}psych.uic.edu
The putative protective effects of hormone therapy (HT) have
been cast in doubt by recent findings from the Women's Health
Initiative Memory Study showing an increase in dementia and
an increased likelihood of impaired cognitive status in women
initiating HT after age 65. To explore the external generalizability
of those findings to younger postmenopausal women, the medical
literature was surveyed for randomized, double-blind, placebo-controlled
trials of treatment with either estrogen alone or estrogen plus
a progestin on neuropsychological test performance. Findings
from trials in younger women (<65 years) are presented separately
from those in older women (
65 years). This review finds little
support for beneficial cognitive effects in older women of estrogen
alone or in combination with progestin. However, evidence from
younger women suggests potential beneficial effects in select
cognitive domains, particularly among symptomatic women and
recently menopausal women, and scant evidence of harm. There
is a dearth of studies of the cognitive effects of estrogen
plus progestin in younger women. Future studies systematically
exploring the effect of age and progestin use are needed to
better characterize the effects of HT on cognition in younger
women. Without firm evidence of benefit to younger women, it
is prudent to caution early postmenopausal women about the cognitive
risks observed in WHI, recognizing the low likelihood of dementia
at that age.
