Hormone Use and Cognitive Performance in Women of Advanced Age

J. Galen buckwalter, PhD; Valerie C. Crooks, DSW; Sean B. Robins; Diana B. Petitti, MD, MPH


J Am Geriatr Soc. 2004;52(2) 

In This Article

Abstract and Introduction

Objectives: To explore the association between hormone replacement therapy (HRT) and cognitive performance in a group of elderly women (≥75) using a battery of well-standardized neuropsychological instruments.
Design: Equivalent samples from existing cohort.
Setting: Healthcare provider organization.
Participants: All women enrolled were participants in an ongoing study of the association between HRT and the prevalence and incidence of dementia. Prescription records were used to establish HRT status. Fifty-eight users and 47 nonusers of HRT participated in this substudy.
Measurements: Given previous reports that HRT has a positive effect on verbal memory, the California Verbal Learning Test and the Logical Memory Test were used as primary outcomes. A range of validated tests that assess other cognitive domains was also included.
Results: There were no significant differences between users and nonusers of HRT on any cognitive measures.
Conclusion: Given equivalent groups of users and nonusers of HRT no support was found for the hypothesis that use of HRT improves cognitive performance in older women.

Although the role of hormone replacement therapy (HRT) on cognitive performance has been increasingly studied, a coherent picture has yet to emerge. Given unequivocal evidence of positive neuronal effects, including neurotrophic and neuroprotective effects[1,2] and enhancement of several neurotransmitters, including the cholinergic system, serotonin, and dopamine,[3] there is much interest in the role that exogenous supplementation of estrogen plays in cognitive performance. However, recent critical reviews of the literature provide less-than-compelling evidence for a positive role for estrogen supplementation.[4,5,6]

Numerous factors have been suggested to explain the inconsistent findings, including the use of tests with poor psychometric properties, failure to include tests of domains sensitive to the potentially domain-specific effects of estrogen, and inclusion of women who may or may not have postmenopausal symptoms. Furthermore, cohort and cross-sectional studies are open to the criticism that women who choose to use estrogen differ on crucial demographic and clinical factors from those who do not. The current study addressed the matter of group differences by testing the cognitive functioning of a sample of pharmacy-verified users of hormones and a sample from the same population who were not taking hormones. It was hypothesized that estrogen users would show better cognitive performance.


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