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17 beta Estriodiol Improves Memory Post Menopausal

Posted by Phillipa on September 20, 2011, at 21:38:11

17 beta estriadol vs equine estrogen in post menopausal cognition especially in those predisposed to cognitive decline. Phillipa so does this mean bioidentical?

From Medscape Medical News > Psychiatry
17β-Estradiol Improves Postmenopausal Memory Performance
Deborah Brauser

Authors and Disclosures
September 19, 2011 Hormone therapy compounds differ significantly when it comes to their effects on cognition in postmenopausal women, especially on verbal memory, new research suggests.

In a cohort study of almost 70 healthy women between the ages of 49 and 68 years who were at risk for Alzheimer's disease (AD), those receiving hormone therapy containing 17β-estradiol showed a significant improvement in verbal memory performance compared with those receiving compounds with conjugated equine estrogen (CEE).

"There is a differential effect of the type of hormone therapy on brain function," principal investigator Natalie Rasgon, MD, PhD, professor of psychiatry and of obstetrics and gynecology at Stanford School of Medicine in Palo Alto, California, and director of the Stanford Center for Neuroscience in Women's Health, told Medscape Medical News.

Dr. Natalie Rasgon

"We found consistently that [CEE] may not be good for the brain, at least in women with increased risk of dementia. And 17β-estradiol had better effects," said Dr. Rasgon.

The investigators note that the findings show that more studies are needed to determine whether hormone therapy has a role in helping these women beyond just treating their menopausal symptoms.

"Given the increasing age of the population, it is imperative for treatments that might prevent or slow the progress of neurodegenerative disorders...[to] be rigorously and thoroughly examined," they write.

The study is published in the September issue of the American Journal of Geriatric Psychiatry.

Addressing the Controversy

According to the researchers, "[m]uch controversy exists and many questions remain unanswered" about hormone therapy and its effects on slowing the progression of age-related cognitive decline in this patient population.

They note that growing evidence suggests that treatment with CEE often results in negative cognitive effects, whereas 17β-estradiol treatment has either positive or neutral effects.

In their own study, published in Psychoneuroendocrinology , of more than 6600 women from the Swedish Twin Registry, the investigators found a reduced risk for cognitive impairment in those receiving hormone therapy, which mostly included 17β-estradiol.

For this analysis, the investigators examined 68 healthy postmenopausal women with at least 1 risk factor for AD from a larger National Institute on Agingfunded longitudinal study on hormone therapy's effect on brain structure, function, and cognition.

Putative risk factors for AD included first-degree family history of the disorder, carriership of the apolipoprotein E ε4 gene, past (but not current) diagnosis of depression, history of bipolar disorder, and/or history of hypothyroidism, as long as it was treated and deemed medically stable.

The participants had been taking either CEE (n = 25; mean age, 58.8 years) or 17β-estradiol (n = 43; mean age, 57.5 years) for at least 1 year before the study's start. All participants were white except for 1 Asian participant.

The women underwent a number of neuropsychological tests for attention/working memory/processing speed, verbal memory, visual memory, and executive functioning.

"Declines in verbal memory are thought to be one of the early indications of AD, particularly when delayed word list and story recall measures are combined in verbal memory assessment, as in the case of the current study," write the researchers.

Verbal Memory Differences

Overall results showed that the women receiving CEE had significantly worse verbal memory performance than those receiving 17β-estradiol (P = .009).

The findings stayed consistent regardless of age, IQ, years of education, genetic risk for AD, and "duration of endogenous and exogenous estrogen exposure," report the investigators.

It was only after controlling for menopause-related variables that the women receiving 17β-estradiol showed significantly better executive function and attention/working memory/processing compared with the CEE-treated group.

The researchers note that the findings support their hypothesis that estrogen type influences cognition and may "help to explain some of the controversy that has taken place over the past several years in regards to the role of [hormone therapy] in the protection against neurodegeneration."

However, Dr. Rasgon added that because the patients in this study had such specific inclusion criteria, including heightened risk for AD, "the findings aren't easily extrapolated to the population at large."

"I think I would tell clinicians to stay tuned and keep open minded, and discuss with each individual patient her specific needs and reasons for being on estrogen. Also, there are some risk factors that can be easily assessed in general, ob-gyn, and psychiatric practice."

She reported that the investigative team is now working on "even more exciting data" that she hopes can be translated into clinical practice.

"For now, I'd say that people should be aware of our study's findings, but not necessarily use them as a new guideline."




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