Endogenous oestrogens predict 4-year decline in verbal fluency in postmenopausal women: the Rancho Bernardo Study.
OBJECTIVE
Despite overwhelming biological plausibility, evidence for a protective effect of oestrogen on cognitive function in postmenopausal women is inconsistent. This study examines the association between endogenous oestrogen levels and subsequent 4-year decline in cognitive function test performance in community-dwelling older women.


METHODS
Longitudinal cohort study.


METHODS
Three hundred and forty-three postmenopausal women (median age 70 years).


METHODS
Between 1984 and 1987, serum for measurement of sex hormones was obtained along with relevant covariates. Cognitive function was assessed in 1988-1991 and again in 1992-1996 using the Category Fluency test, the Mini-Mental Status Exam (MMSE) and Trail Making Test B (Trails B).


RESULTS
Women in the highest tertile of oestrone and bioavailable oestradiol had respectively 1.75 (95% CI 1.02, 3.07) and 1.79 (95% CI 1.04, 3.10) higher odds of 4 year decline in Category Fluency, a test of frontal lobe function, compared to those in the lowest tertile, independent of age and education. The 20% of women with highest tertile levels of both oestrone and bioavailable oestradiol had a twofold higher odds of verbal fluency loss (OR = 2.17; 95% CI 1.21, 3.89). Adjustment for testosterone levels or for obesity-related factors associated with high endogenous oestrogens (higher body mass index, waist girth, and triglycerides and lower high-density lipoprotein cholesterol) did not alter results. Neither oestrogen was associated with change in MMSE or Trails B scores.


CONCLUSIONS
Higher endogenous oestrogen levels were associated with a greater decline in verbal fluency in postmenopausal women. This association was not explained by elevated androgens or by obesity or obesity-related factors.
Laughlin
Gail A
GA
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, CA 92093, USA. glaughlin@ucsd.edu
Kritz-Silverstein
Donna
D
Barrett-Connor
Elizabeth
E
D000368:Aged; D002140:California; D003071:Cognition / Q000502:physiology; D004967:Estrogens / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D012111:Residence Characteristics; D013060:Speech / Q000502:physiology; D013064:Speech Disorders / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors
D004967:Estrogens