December 18 2022
Hormone Replacement for Prevention of Cognitive Decline
Women consist of approximately two-thirds of people living with Alzheimer’s Disease. In fact, being a woman is considered one of the major risk factors. Researchers have come to characterize Alzheimer’s as not primarily a disease of the old, rather a progressive disease starting years prior to the clinical diagnosis. How does this relate to women being at increased risk? Well, a major difference in the aging process women experience in comparison to men is the menopausal transition. This stage of life is characterized by a drastic drop in estrogen – a hormone which plays a part in how our brains use energy. Pre-clinical studies have shown the this drop in estrogen characteristic of the menopausal transition induces a neurological hypometabolic state that may be the beginnings of a potential Alzheimer’s Diagnosis decades down the road. This working theory has led to researchers investigating whether estrogen replacement therapy has any effect on preventing the cognitive decline typical of Alzheimer’s Disease.
An insightful and well-respected study referred to as the Cache County Memory Study provides some level of reassurance hormone replacement may actually play a role in preventing cognitive decline. In this study, researchers followed a large group of women living in Utah where they documented an Alzheimer’s diagnosis and whether these women used hormone replacement in the years prior. Here’s what was found:
- Women who used hormone replacement had a reduced risk of Alzheimer’s Disease compared with non-users.
- With more than 10 years of hormone replacement, the sex related increase in risk disappeared.
- No decreased risk unless hormone replacement was used for 10 years.
So, great news, right? Well, yes, but there’s a few things to point out about the nature of this study. Though, it’s a well-designed study, due to its epidemiologic design, it doesn’t test a treatment, but observes a past treatment (hormone replacement) for its influence on an outcome (Alzheimer’s diagnosis). In other words, it only shows correlation not causation.
Many healthcare providers are hesitant to make treatment decisions based on this type of information, though it does come down a provider’s practice philosophy and how much of the entirety of the medical evidence a provider is aware of or willing to consider as valid. For example, many providers may consider the above takeaways in respect to the pre-clinical information mentioned in the first paragraph. In addition, a provider aware of other trials may also recognize that hormone replacement therapy shows little risk when used in the early years following menopause. Furthermore, a provider may consider the lack of effective treatment options to manage Alzheimer’s Disease and the toll this diagnosis has on an individual and the individual’s family. Given this information in its entirety one can start to see how a treatment decision may be made on a patient-by-patient basis.
Hormone replacement during the years following menopause may be an opportunity to prevent cognitive decline later in life in women. Is more research needed to confirm this? Absolutely. However, considering the entirety of available evidence from pre-clinical to clinical trials, and the dismal landscape of current treatment options for Alzheimer’s Disease, in addition to more research, conversations can be had between women and their healthcare providers about the safe and effective use of hormone replacement. Our consulting pharmacists are happy to discuss personalized treatment options. Schedule a complimentary consult to learn more about estrogen replacement therapy.
Angelo Maida, PharmD
Compounding Pharmacist at Maida Pharmacy Compounding and Wellness