title: Postmenopausal hormone therapy and Alzheimer disease: A prospective cohort study.
abstract: OBJECTIVE
  To explore the association between postmenopausal hormone therapy (HT) and Alzheimer disease (AD).
  
  
  METHODS
  Twenty-year follow-up data from the Kuopio Osteoporosis Risk Factor and Prevention study cohort were used. Self-administered questionnaires were sent to all women aged 47-56 years, residing in Kuopio Province starting in 1989 until 2009, every 5th year. Register-based information on HT prescriptions was available since 1995. Probable AD cases, based on DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, were identified from the special reimbursement register (1999-2009). The study population included 8,195 women (227 cases of incident AD).
  
  
  RESULTS
  Postmenopausal estrogen use was not associated with AD risk in register-based or self-reported data (hazard ratio/95% confidence interval 0.92/0.68-1.2, 0.99/0.75-1.3, respectively). Long-term self-reported postmenopausal HT was associated with reduced AD risk (0.53/0.31-0.91). Similar results were obtained with any dementia diagnosis in the hospital discharge register as an outcome.
  
  
  CONCLUSIONS
  Our results do not provide strong evidence for a protective association between postmenopausal HT use and AD or dementia, although we observed a reduced AD risk among those with long-term self-reported HT use.
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. bushra.imtiaz@uef.fi.
authors.forename: Bushra
authors.initials: B
authors.lastname: Imtiaz
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Marjo
authors.initials: M
authors.lastname: Tuppurainen
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Toni
authors.initials: T
authors.lastname: Rikkonen
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Miia
authors.initials: M
authors.lastname: Kivipelto
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Soininen
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Heikki
authors.initials: H
authors.lastname: Kröger
authors.affiliation: From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tolppanen
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000139:chemically induced / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004967:Estrogens / Q000009:adverse effects; D015444:Exercise; D005260:Female; D005387:Finland; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017698:Postmenopause; D012042:Registries; D011795:Surveys and Questionnaires
chemical_list: D004967:Estrogens