title: Distinct cognitive effects of estrogen and progesterone in menopausal women.
abstract: The effects of postmenopausal hormone treatment on cognitive outcomes are inconsistent in the literature. Emerging evidence suggests that cognitive effects are influenced by specific hormone formulations, and that progesterone is more likely to be associated with positive outcomes than synthetic progestin. There are very few studies of unopposed progesterone in postmenopausal women, and none that use functional neuroimaging, a sensitive measure of neurobiological function. In this study of 29 recently postmenopausal women, we used functional MRI and neuropsychological measures to separately assess the effects of estrogen or progesterone treatment on visual and verbal cognitive function. Women were randomized to receive 90 days of either estradiol or progesterone counterbalanced with placebo. After each treatment arm, women were given a battery of verbal and visual cognitive function and working memory tests, and underwent functional MRI including verbal processing and visual working memory tasks. We found that both estradiol and progesterone were associated with changes in activation patterns during verbal processing. Compared to placebo, women receiving estradiol treatment had greater activation in the left prefrontal cortex, a region associated with verbal processing and encoding. Progesterone was associated with changes in regional brain activation patterns during a visual memory task, with greater activation in the left prefrontal cortex and right hippocampus compared to placebo. Both treatments were associated with a statistically non-significant increase in number of words remembered following the verbal task performed during the fMRI scanning session, while only progesterone was associated with improved neuropsychological measures of verbal working memory compared to placebo. These results point to potential cognitive benefits of both estrogen and progesterone.
authors.affiliation: University of Michigan, Psychiatry Department, MBNI, 205 Zina Pitcher Place, Ann Arbor, MI 48109, USA. Electronic address: berent@umich.edu.
authors.forename: Alison
authors.initials: A
authors.lastname: Berent-Spillson
authors.affiliation: University of Michigan, Psychiatry Department, Neuropsychology Division, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105, USA. Electronic address: emilande@umich.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Briceno
authors.affiliation: University of Michigan Medical School, 1301 Catherine, Ann Arbor, MI, 48109, USA. Electronic address: apinksy@umich.edu.
authors.forename: Alana
authors.initials: A
authors.lastname: Pinsky
authors.affiliation: University of Michigan, Obstetrics and Gynecology Department, L4000 Womens SPC, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. Electronic address: asimmen@med.umich.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Simmen
authors.affiliation: University of Michigan, Psychiatry Department, Neuropsychology Division, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105, USA. Electronic address: cpersad@umich.edu.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Persad
authors.affiliation: University of Michigan, Psychiatry Department, MBNI, 205 Zina Pitcher Place, Ann Arbor, MI 48109, USA. Electronic address: zubieta@umich.edu.
authors.forename: Jon-Kar
authors.initials: JK
authors.lastname: Zubieta
authors.affiliation: University of Michigan, Obstetrics and Gynecology Department, L4000 Womens SPC, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. Electronic address: ysmith@umich.edu.
authors.forename: Yolanda R
authors.initials: YR
authors.lastname: Smith
mesh_terms: D000368:Aged; D003071:Cognition / Q000187:drug effects*; D015914:Estrogen Replacement Therapy / Q000379:methods; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008570:Memory, Short-Term / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D010919:Placebos; D017698:Postmenopause / Q000187:drug effects* / Q000378:metabolism; D011374:Progesterone / Q000494:pharmacology*
chemical_list: D004967:Estrogens; D010919:Placebos; D011374:Progesterone
keywords: Cognition; Functional MRI; Menopause; Postmenopausal hormone treatment; Progesterone