Summary: A new randomized, placebo-controlled pilot study suggests that combining transdermal estradiol gel with oral micronized progesterone may help preserve or improve cognitive function in postmenopausal women diagnosed with mild cognitive impairment (MCI).
Source: NAMS
Hormones play a central role in many aspects of a woman’s health, influencing reproductive function, libido, body composition, mood, and metabolic processes. Emerging research also indicates that, when given in specific doses and combinations, hormone therapy may affect brain health and slow cognitive decline in some postmenopausal women. Results from a recent clinical trial are published in the journal Menopause.
Age-related changes in cognition are common and can range from mild forgetfulness to more significant problems. Mild cognitive impairment (MCI) describes a measurable decline in cognitive abilities that is greater than expected for an individual’s age but not severe enough to meet criteria for dementia. People with MCI have an elevated risk of progressing to Alzheimer disease or other forms of dementia; studies estimate that about 20% of persons with MCI progress to a more severe cognitive disorder each year. To date, pharmacologic treatment options for MCI are limited and no definitive therapy has been shown to reliably prevent progression to dementia.
The article titled “Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial” reports on a recent Korean clinical trial that assessed the cognitive effects of hormone therapy in women diagnosed with MCI. Participants were postmenopausal women receiving donepezil, a cholinesterase inhibitor commonly prescribed to support cognition. Over a 24-month follow-up, women randomized to receive a combination of transdermal estradiol gel and oral micronized progesterone showed statistically significant improvements in cognitive test scores compared with those receiving placebo.
Although the trial involved a relatively small number of participants and should be regarded as preliminary, its findings are noteworthy because this is the first known randomized, placebo-controlled study specifically evaluating hormone therapy in women with established MCI. The observed benefit was most apparent in measures of global cognitive function, with improvement documented in two of three key evaluation criteria used by the investigators.
“This encouraging, small pilot trial suggests a possible benefit of hormone therapy when given to women diagnosed with MCI who are also taking donepezil, a cholinesterase inhibitor,” said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society (NAMS). “Higher global cognition was seen in two of the three key evaluation criteria in those women using estradiol gel plus an oral micronized progesterone compared with those in the placebo group. Larger trials are needed to evaluate the effect of hormone therapy use before the full onset of Alzheimer disease.”
Clinical implications and limitations: The study raises the possibility that specific hormone regimens may have neuroprotective or cognition-supporting effects in postmenopausal women with early cognitive decline. However, because the trial was small and adjunctive therapy with donepezil was concurrent, these results should be interpreted with caution. Important questions remain regarding optimal timing of therapy, dose, formulation, duration, and patient selection, as well as safety considerations and long-term outcomes. Replication in larger, well-powered randomized trials is needed before changes to clinical practice can be recommended.
For clinicians and patients, the current findings underscore the value of individualized care and informed discussion about potential benefits and risks of hormone therapy. For researchers, the trial provides a rationale for further investigation into targeted hormone strategies as part of a broader approach to preventing or slowing the progression of cognitive impairment in postmenopausal women.
Source: Eileen Petridis – NAMS
Publisher: Organized by NeuroscienceNews.com
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Original Research: Abstract for “Concern about US Preventive Services Task Force recommendation on hormone therapy for the primary prevention of chronic conditions in postmenopausal women” by Pinkerton, JoAnn V.; Kaunitz, Andrew M.; and Manson, JoAnn E., published in Menopause, May 29, 2018.
doi: 10.1097/GME.0000000000001100
MLA: NAMS. “Hormone Therapy May Lead to Improved Cognitive Function.” NeuroscienceNews. NeuroscienceNews, 30 May 2018.
APA: NAMS (2018, May 30). Hormone Therapy May Lead to Improved Cognitive Function. NeuroscienceNews.
Chicago: NAMS. “Hormone Therapy May Lead to Improved Cognitive Function.” NeuroscienceNews. Accessed May 30, 2018.