Dementia is a concern for all of us as we age. Almost 2/3 of Alzheimer disease (AD) cases occur in women which indicates that this condition may be influenced by sex-specific factors. Researchers used data from a prospective cohort study (following a group of similar individuals over time who differ with respect to certain factors) looking at cognitive function and aging in Cache County, Utah. Investigators used data among 2114 women baseline age over 65, primarily white and an average 13 years of education. The factors they reviewed were estimated lifetime exposure to estrogen, both endogenous (years of ovulation) and exogenous (years of menopause hormone therapy) as well as timing of when hormone replacement was initiated.

Estrogen exposure was analyzed relative to cognitive status based on a modified Mini Mental State Exam conducted 3 times over 12 years of followup. Other variables that could influence the outcome included education level, APOE genotype, exercise, overall health. body mass index, depression status, type of hormone therapy, and age.

Longer exposure of estrogen exposure (both endogenous and hormone therapy use) were associated with prevention of age-related cognitive decline. Starting hormone therapy within 5 years of menopause onset was associated with better late-life cognitive function compared with delayed initiation of hormone therapy.

A prospective Finnish study also suggested that starting hormone therapy soon after menopause and continuing it long term reduced the risk for AD. This U.S. analysis now provides further support for this hypothesis that hormone therapy (initiated soon after menopause) can provide cognitive benefits.

Reference: Matyi, JM bet al. Lifetime estrogen exposure and cognition in late life: The Cache County Study. Menopause 2019
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Liu JH. Does estrogen provide “neuroprotection” for postmenopausal women? Menopause 2019 Dec; 26:1361.
Neurology 2017; 88:1062.