Hormone replacement therapy in postmenopausal women with Alzheimer's disease: a randomized, prospective study.
OBJECTIVE
To compare the therapeutic efficacy of hormone replacement therapy (HRT) and tacrine in Alzheimer's disease.


METHODS
Six-month, randomized, open-label study.


METHODS
University hospital.


METHODS
Fifty-five women with mild to moderate Alzheimer's disease were randomly assigned to tacrine (n = 26) or HRT (n = 29).


METHODS
In the tacrine group, an initial dose of 40 mg/day was increased up to 160 mg/day. In the HRT group, conjugated equine estrogen was given to patients without uteri (n = 3) or together with micronized progesterone to patients with uteri (n = 26).


METHODS
Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test, Boston Naming Test, Controlled Oral Word Association Test, Geriatric Depression Scale, Hamilton Depression Scale (HDS), and Instrumental Activities of Daily Living (IADL).


RESULTS
Thirty-three patients who completed the outcome measures (tacrine, 17; HRT, 16) were included in an intent-to-treat analysis. The results did not differ between groups except for IADL, which rated more highly after HRT. Apolipoprotein E genotype effects were assessed. MMSE and HDS scores were improved after tacrine treatment in epsilon 4-negative patients.


CONCLUSIONS
Overall efficacy of estrogen plus progesterone combination was similar to tacrine for cognition and mood, but greater for ADL. In epsilon 4-negative patients, tacrine is preferable for cognition and mood.
Yoon
Byung-Koo
BK
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Kim
Doh Kwan
DK
Kang
Yeonwook
Y
Kim
Jong-Won
JW
Shin
Myung-Hee
MH
Na
Duk L
DL
D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D001057:Apolipoproteins E / Q000235:genetics; D001824:Body Constitution; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D005838:Genotype; D006801:Humans; D008572:Menarche; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D011446:Prospective Studies; D013619:Tacrine / Q000627:therapeutic use*
D001057:Apolipoproteins E; D002800:Cholinesterase Inhibitors; D013619:Tacrine