THE ROLE OF ESTROGEN IN THE TREATMENT OF ALZHEIMERS-DISEASE

Multiple factors appear to contribute to the expression of Alzheimer's disease (AD). About 30% of cases of dementia of the Alzheimer's type can be attributed to genetic factors. These observations raise the pos sibility of identifying multiple interventions that may modify the dis ease process and, therefore, the clinical expression of the dementia. Prominent among factors that may contribute to dementia and, specifica lly, to dementia of the Alzheimer's type is cerebral vascular disease. Estrogen is a potent factor that not only prevents vascular disease b ut also improves blood flow in diseased vessels, including blood flea in regions of the brain affected by AD. Estrogen also has direct effec ts on neuronal function that may play an important role not only in th e preservation of neurons but in repair of neurons damaged by the dise ase process. These effects of estrogen on the CNS suggest that the hor mone may be effective not only in the prevention of dementia but also in its treatment. The results of clinical trials, reviewed in this pre sentation, are very promising but are limited by the paucity of subjec ts and often the lack of adequate controls. Larger, randomized, placeb o-controlled trials are needed to definitively establish the efficacy of estrogen in the treatment of dementia of the Alzheimer's type.