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Menopause Live - IMS Updates
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Date of release: 01 December, 2008

Lifetime exposure to estrogen and cognitive function


Joanne Ryan and colleagues report, in a recent issue of Psychoneuroendocrinology, the effects of ‘lifetime’ exposure to estrogen on various measures of cognitive function [1]. The study emanates from observations of the French ESPRIT cohort, and encompasses the follow-up of 996 French women, aged 65 and older over 4 years. Rather on focusing on the effects of hormonal therapy on various cognitive domains, they primarily focus on recalled events, such as age of menarche, first birth, and age of menopause, to suggest whether these events may influence cognitive activity and dementia prevalence. Their conclusions suggest a mild beneficial effect of lifetime exposure to estrogen on several domains of cognitive functioning, as well as some beneficial effect of hormone therapy, in those women who were users. Of interest, there was more of an effect on visual memory than on verbal memory, which is usually what has been reported to be benefited by estrogen in women.

Comment

This study adds some information to the field; there have been other studies attempting to look at lifetime exposure to estrogen with more inconsistent effects. Here too, however, multifactorial analyses and adjustments for baseline cognitive function weaken the data and render many parameters of borderline significance. Other concerns are the reliance on recall of life events, and the fact that the chosen events are only surrogates of how much exposure a woman actually has to estrogen. There are clearly many more variables that have to be considered. In addition, this is an extremely difficult area to study and, although several instruments of cognitive functioning have been studied, none is perfect in reflecting what the state of function really is. Although there was the intent in the study to assess the effect of estrogen on dementia, only 27 women had this diagnosed over the 4 years, and therefore there was insufficient power to assess this. However, these investigators will be continuing to follow this valuable cohort. Perhaps of greatest interest to this field, which this cohort may not be able to address, is whether hormonal use in the perimenopause and early postmenopausal period influences longer-term dementia risk.

Comentario

Roger A. Lobo
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, USA

    References

  1. Ryan J, Carriere I, Scali J, Ritchie K, Ancelin ML. Life-time estrogen exposure and cognitive functioning in later life. Psychoneuroendocrinology 2008 Oct 21. [Epub ahead of print].
    http://www.ncbi.nlm.nih.gov/pubmed/18947934