COMMENTARY

Hormone Exposure and Risk for Dementia Later in Life

Andrew M. Kaunitz, MD

Disclosures

January 08, 2020

This transcript has been edited for clarity.

Most cases of Alzheimer disease occur in women, suggesting that the cause of this common condition may reflect sex-specific factors.

In a recently published study, researchers used data from a prospective cohort study of cognitive function and aging conducted among women aged 65 years or older living in an ethnically and socioeconomically homogeneous county in Utah.

The authors estimated lifetime endogenous hormone exposure, reflecting years of ovulatory cycles, and exogenous hormone exposure, reflecting years of menopausal hormone therapy (HT). They also assessed timing of initiation and ongoing use of HT. Finally, they correlated estrogen exposure with cognitive status based on a validated test conducted every 4 years during 12 years of follow-up.

The authors found that endogenous exposure to sex steroids, as well as longer duration of HT use, were associated with prevention of age-related cognitive decline. In particular, initiating HT within 5 years of menopause onset was associated with cognitive function superior to later initiation.

Early age at menopause is associated with a decline in cognitive function, underscoring the importance of endogenous ovarian function in maintenance of cognition. In addition to this Utah study, a prospective Finnish study suggested that initiating HT soon after menopause and continuing it long-term reduces risk for Alzheimer disease.

This Utah study provides additional support for the hypothesis that in women, exposure to endogenous as well as exogenous sex steroids is important for cognitive health.

Thank you for the honor of your time. I am Andrew Kaunitz.

Dr Andrew Kaunitz is a tenured University of Florida term professor and Associate Chair, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine-Jacksonville. Dr Kaunitz has published more than 240 articles in peer-reviewed journals, including the New England Journal of Medicine, JAMA, and Obstetrics and Gynecology.

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