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White matter hyperintensities, hot flushes and estrogen--are they related?
1a Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Abstract:
White matter hyperintensities (WMH) are areas of high intensity observed in brain MRI scans. They are usually seen in normal aging but also in a number of neurological and psychiatric disorders. One of the underlying mechanisms is ischemia, expressed as small vessel disease. Since the volume of WMH may correlate with cognition, and an ongoing debate links postmenopausal hormone therapy with stroke and a decline in certain cognitive domains, several MRI studies have addressed this potential association. Two major randomized, placebo-controlled trials - WHIMS and KEEPS, the first including elderly women and the second recruiting recently menopausal women, did not demonstrate any safety concerns in this respect in hormone users.
Insights
White matter hyperintensities (WMH) on MRI scans are linked to aging and neurological disorders. Hormone therapy did not show safety concerns regarding WMH in major trials for elderly and recently menopausal women.
Area of Science:
- Neuroimaging
- Neurology
- Vascular Dementia
Background:
- White matter hyperintensities (WMH) are visible on brain MRI and associated with aging, neurological, and psychiatric conditions.
- Ischemia, a manifestation of small vessel disease, is a key underlying mechanism contributing to WMH.
- WMH volume may correlate with cognitive function, prompting research into its relationship with various health interventions.
Discussion:
- The potential link between postmenopausal hormone therapy and stroke risk, alongside cognitive decline, has been a subject of ongoing research.
- Two significant randomized, placebo-controlled trials, WHIMS (elderly women) and KEEPS (recently menopausal women), specifically investigated this association.
- These trials provide crucial data on the safety of hormone therapy concerning WMH and related cognitive outcomes.
Key Insights:
- Major clinical trials (WHIMS, KEEPS) found no adverse safety concerns for hormone therapy users in relation to white matter hyperintensities.
- The studies did not demonstrate a negative impact of hormone therapy on cognitive domains potentially affected by WMH in the studied populations.
- Evidence from these trials suggests hormone therapy is not associated with increased risk of WMH or associated cognitive decline in postmenopausal women.
Outlook:
- Further research may explore nuanced effects of different hormone formulations or treatment durations on WMH and cognition.
- Long-term follow-up studies could provide deeper insights into the sustained impact of hormone therapy on brain health.
- Understanding the complex interplay between WMH, aging, cognition, and hormone therapy remains a critical area for neurological research.
