title: Enhanced cognitive performance with estrogen use in nondemented community-dwelling older women.
abstract: OBJECTIVE
  To examine the association between history of postmenopausal estrogen use and cognitive function in a large sample of nondemented community-dwelling older women.
  
  
  METHODS
  A community of older residents in Cache County, Utah.
  
  
  METHODS
  A total of 2338 nondemented women aged 65 and older.
  
  
  METHODS
  All subjects were administered the Modified Mini-Mental State Examination (3MSE). Self-reported information on current and past use of estrogen after menopause was also obtained using a structured interview. Estrogen use was trichotomized as: no use, past use, and current use. Apolipoprotein E (APOE) genotype was determined and was dichotomized by the presence of an epsilon4 allele. A series of variance/covariance models was conducted with the 3MSE score as the dependent variable, first considering estrogen use alone, then adding, sequentially as covariates, education, age, health status, APOE genotype, current depression status, and history of head injury.
  
  
  RESULTS
  In the simplest bivariate model, the 3MSE means (and confidence intervals) were 92.1 (91.7-92.4), 93.5 (93.1-93.9), and 94.4 (94.0-94.7) for never-, past-, and current users, respectively. In the final model (R2 = 0.28), no use of estrogen replacement therapy (P = .006), lower education (P < .001), poorer perceived health status (P = .035), current depression (P = .014), and presence of at least one APOE epsilon4 allele (P < .001) each independently predicted lower 3MSE score. Both current and past estrogen users had significantly higher 3MSE scores than never-users (P = .0063 and P = .0096, respectively).
  
  
  CONCLUSIONS
  In this large community study, women who had used estrogen after menopause scored higher on the 3MSE. This finding remained, even after controlling for the effects of age, education, APOE genotype, and other variables that may affect cognition. These data support studies reporting a beneficial role of estrogen on cognition in postmenopausal women, particularly among current estrogen users.
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Steffens
authors.forename: M C
authors.initials: MC
authors.lastname: Norton
authors.forename: B L
authors.initials: BL
authors.lastname: Plassman
authors.forename: J T
authors.initials: JT
authors.lastname: Tschanz
authors.forename: B W
authors.initials: BW
authors.lastname: Wyse
authors.forename: K A
authors.initials: KA
authors.lastname: Welsh-Bohmer
authors.forename: J C
authors.initials: JC
authors.lastname: Anthony
authors.forename: J C
authors.initials: JC
authors.lastname: Breitner
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001057:Apolipoproteins E / Q000235:genetics; D003071:Cognition / Q000187:drug effects / Q000502:physiology*; D015914:Estrogen Replacement Therapy; D005260:Female; D005838:Genotype; D006801:Humans; D007407:Interviews as Topic; D008609:Mental Status Schedule; D017698:Postmenopause / Q000523:psychology*; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001057:Apolipoproteins E