Relative effects of tamoxifen, raloxifene, and conjugated equine estrogens on cognition.
OBJECTIVE
To compare the relative effects of conjugated equine estrogens (CEE), raloxifene, and tamoxifen therapies on cognition among women aged > or =65 years.


METHODS
Annual Modified Mini-Mental State (3MS) examinations were used to assess global cognitive function in the two randomized placebo-controlled clinical trials of CEE therapies of the Women's Health Initiative Memory Study (WHIMS) and the Cognition in the Study of Tamoxifen and Raloxifene (CoSTAR). Analyses were limited to women who had 3MS testing at baseline and the first 3 years of follow-up and, because of potential ethnic-related differences between studies, to Caucasian women (WHIMS n = 6211, CoSTAR n = 250). Covariate adjustment was used to compare the postrandomization mean 3MS scores among the three active therapies with placebo therapy while controlling for differences between groups with respect to dementia risk factors.


RESULTS
At baseline, the average (SD) 3MS scores by group were 95.24 (4.28) for placebo, 95.19 (4.33) for CEE, 94.60 (4.76) for raloxifene, and 95.02 (4.03) for tamoxifen. Compared with placebo, each active therapy was associated with a small mean relative deficit in 3MS scores of < or =0.5 units, which was fairly consistent between women with and without prior hysterectomy. Relative deficits were slightly greater for tamoxifen (p = 0.001) and less marked for raloxifene (p = 0.06) and CEE (p = 0.02) therapies. Relative deficits appeared to be greater among women with lower baseline 3MS scores: p = 0.009 (tamoxifen), p = 0.08 (raloxifene), and p = 0.03 (CEE).


CONCLUSIONS
Although unmeasured differences between trials may have confounded analyses, these findings raise the possibility that both tamoxifen and raloxifene adversely affect cognitive function in older women; however, the magnitude of the effect is small, and the long-term consequences are unknown.
Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. mespelan@wfubmc.edu
Mark A
MA
Espeland
Sally A
SA
Shumaker
Marian
M
Limacher
Stephen R
SR
Rapp
Therese B
TB
Bevers
David H
DH
Barad
Laura H
LH
Coker
Sarah A
SA
Gaussoin
Marcia L
ML
Stefanick
Dorothy S
DS
Lane
Pauline M
PM
Maki
Susan M
SM
Resnick
D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D003071:Cognition / Q000187:drug effects*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D020849:Raloxifene Hydrochloride / Q000009:adverse effects*; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects*; D013629:Tamoxifen / Q000009:adverse effects*
D004966:Estrogens, Conjugated (USP); D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride