title: Cognitive Effects of Hormone Therapy Continuation or Discontinuation in a Sample of Women at Risk for Alzheimer Disease.
abstract: OBJECTIVE
  Use of estrogen-based hormone therapy (HT) as a protection from cognitive decline and Alzheimer disease (AD) is controversial, although cumulative data support HT use when initiated close to menopause onset with estrogen formulations containing 17β-estradiol preferable to conjugated equine estrogen formulations. Little is known regarding specific populations of women who may derive benefit from HT.
  
  
  METHODS
  Women with heightened risk for AD (aged 49-69), all of whom were taking HT for at least 1 year and most of whom initiated HT close to menopause onset, underwent cognitive assessment followed by randomization to continue or discontinue HT. Assessments were repeated at 2 years after randomization.
  
  
  RESULTS
  Women who continued HT performed better on cognitive domains composed of measures of verbal memory and combined attention, working memory, and processing speed measures. Women who used 17β-estradiol versus conjugated equine estrogen, whether randomized to continue or discontinue HT, showed better verbal memory performance at the 2-year follow-up assessment. An interaction was also found with HT randomization and family history of AD in a first-degree relative. All female offspring of patients with AD declined in verbal memory; however, women who continued HT declined less than women who discontinued HT. Women without a first-degree relative with AD showed verbal memory improvement (likely because of practice effects) with continuance and declined with discontinuance of HT.
  
  
  CONCLUSIONS
  Continuation of HT use appears to protect cognition in women with heightened risk for AD when initiated close to menopause onset.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA.
authors.forename: Tonita E
authors.initials: TE
authors.lastname: Wroolie
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Kenna
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Williams
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford Center for Neuroscience in Women's Health, Stanford University School of Medicine, Stanford, CA. Electronic address: nrasgon@stanford.edu.
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Rasgon
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000517:prevention & control*; D003071:Cognition / Q000187:drug effects*; D004958:Estradiol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D004958:Estradiol
keywords: Alzheimer disease; Hormone therapy; cognition; postmenopausal women