Estrogen replacement therapy and cognitive decline in memory-impaired post-menopausal women

Background: Estrogen replacement therapy (ERT) may delay dementia-related c ognitive decline in post-menopausal women, but few studies have longitudina lly examined this relationship and none has controlled for baseline functio ning or concurrent medication. Methods: We report the results of a 1-year retrospective longitudinal study examining cognitive functioning in female estrogen and nonestrogen users ( n = 3128) who presented to the state of California memory disorder clinics in a naturalistic multisite study of senile dementia, Alzheimer's type (SDA T), and other cognitive impairments. Results: Ar baseline, estrogen users had significantly lower rates of SDAT diagnoses (possible and probable) than nonestrogen users, and significantly higher rates of the lesser diagnoses of "cognitive impairment" and "no dem entia." ERT was significantly associated,vith higher cognitive functioning at baseline and at 1 year follow-up (n = 358), Nonestrogen users deteriorat ed significantly from baseline to follow-up; estrogen users did not. Result s were similar in groups marched on baseline Blessed-Roth Dementia Rating S cale (BRDRS) ratings (n = 32) and in a variety of subpopulations. Conclusions: These findings are consistent with estrogen acting as a protec tive factor against cognitive deterioration in post-menopausal women,with S DAT and other cognitive impairments, and may suggest an increased effect in earlier stages of cognitive impairment. (C) 1999 Society of Biological Psy chiatry.