Mm. Rice et al., Postmenopausal estrogen and estrogen-progestin use and 2-year rate of cognitive change in a cohort of older Japanese American women - The Kame Project, ARCH IN MED, 160(11), 2000, pp. 1641-1649
Citations number
77
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: The relation between estrogen and cognition among postmenopausa
l women remains controversial. Also uncertain is whether the proposed assoc
iation varies between women taking unopposed estrogen and those taking estr
ogen combined with progestin.
Objective: To determine whether unopposed estrogen and combined estrogen-pr
ogestin use were associated with the rate of cognitive change in a cohort o
f older, Japanese American, postmenopausal women.
Methods: A prospective observational study in a population-based cohort of
older Japanese Americans (aged greater than or equal to 65 years) living in
King County, Washington. Cognitive performance was measured in 837 women a
t baseline (1992-1994) and 2-year follow-up (1994-1997) examinations using
the 100-point Cognitive Abilities Screening Instrument (CASI). Least square
s means general linear models were used to estimate the 2-year rate of cogn
itive change according to categories of postmenopausal estrogen use.
Results: Approximately half of this cohort (n = 455) had never used estroge
n at any time since menopause, 186 were past users, 132 were current unoppo
sed estrogen users, and 64 were current estrogen-progestin users. The major
ity of current estrogen users were taking conjugated estrogens, and all wom
en receiving combined therapy were taking medroxyprogesterone acetate. Afte
r adjusting for age, education, language spoken at the interview, surgical
menopause, and baseline CASI score, women who had never used postmenopausal
estrogen improved slightly on the CASI scale (mean adjusted change, 0.79;
SEM, 0.19). This change was significantly greater for current unopposed est
rogen users (mean adjusted change, 1.68; SEM, 0.36; P=.04) and significantl
y worse for current estrogen-progestin users (mean adjusted change, -0.41;
SEM, 0.50; P=.02) compared with never users. The improvement observed in pa
st users (mean adjusted change, 1.12; SEM, 0.29) was intermediate between t
he changes for never users and current unopposed estrogen users and not sig
nificantly greater than that for never users (P=.35).
Conclusions: Our findings support a modest beneficial association between c
urrent unopposed estrogen use and the rate of cognitive change. We also obs
erved a modest detrimental association between current estrogen-progestin u
se and the rate of cognitive change. The clinical significance of these mod
est differences, however, is uncertain. Data from large, long-term randomiz
ed trials are required before applying this information to the clinical set
ting.