Postmenopausal hormone therapy and cognitive outcomes: the Women's Health Initiative Memory Study (WHIMS).
This review discusses major findings from the Women's Health Initiative Memory Study (WHIMS). WHIMS reported hormone therapy (HT)--conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA)--increased the risk for dementia (HR 1.76 [95% CI, 1.19-2.60]; P=0.005) and global cognitive decline, with a mean decrement relative to placebo of 0.21 points on the Modified Mini Mental State Examination (3MS) (P=0.006) in women age 65 and older. A subset of WHIMS participants joined the ancillary WHI Study of Cognitive Aging (WHISCA) trials, in which domain-specific cognitive tests and mood were measured annually. Compared with placebo, CEE+MPA had a negative impact on verbal memory over time (P=0.01); and CEE-Alone was associated with lower spatial rotational ability (P < or = 0.01) at the initial assessment, but the difference diminished over time. The ancillary WHIMS-MRI study measured subclinical cerebrovascular disease to possibly explain the negative cognitive findings reported by WHIMS and the increased clinical stroke in older women reported by the WHI. WHIMS-MRI reported that while CEE+MPA and CEE-Alone were not associated with increased ischemic brain lesion volume relative to placebo; both CEE+MPA and CEE-Alone were associated with lower mean brain volumes in the hippocampus (P=0.05); frontal lobe (P=0.004); and total brain (P=0.07). HT-associated reductions in hippocampal volumes were greatest in women with baseline 3MS scores < or = 90.
Coker
Laura H
LH
Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA. lcoker@wfubmc.edu
Espeland
Mark A
MA
Rapp
Stephen R
SR
Legault
Claudine
C
Resnick
Susan M
SM
Hogan
Patricia
P
Gaussoin
Sarah
S
Dailey
Maggie
M
Shumaker
Sally A
SA
D000368:Aged; D000375:Aging / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008568:Memory / Q000187:drug effects*; D017698:Postmenopause
D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate