Hormone therapy and risk for dementia: where do we go from here?

Prospective observational studies suggest that hormone therapy (HT) might confer protection against the development of Alzheimer's disease. In contrast, recent findings from the Women's Health Initiative Memory Study (WHIMS) indicated a doubling of the risk of all-cause dementia in women randomized to receive HT after age 64. The discrepancy between findings from observational studies and the WHIMS is commonly attributed to the lack of treatment bias in the randomized trial. However, there are other potentially important dfferences between the WHIMS and the observational studies. These include timing of initiation of HT and type of HT regimen used. The present review focuses on the clinical and basic science studies bearing on these clinically important issues. Additional clinical studies are needed to understand the external generalizability of the WHIMS results to populations of women for whom HT remains an indication.