Cognitive health after menopause: Does menopausal hormone therapy affect it?

Area of Science:

• Neurology
• Gerontology
• Endocrinology

Background:

• Dementia, including Alzheimer's disease (AD), is a significant global health concern, particularly affecting women over 65.
• While age and genetics are risk factors, acquired factors also play a role in dementia development.
• Menopausal Hormone Therapy (MHT) is currently not recommended for dementia prevention.

Purpose of the Study:

• To systematically review the existing literature on the relationship between MHT and dementia risk.
• To evaluate the impact of MHT on cognitive performance in women already diagnosed with dementia.
• To synthesize recent findings for updating clinical guidelines.

Main Methods:

• A systematic literature search was conducted focusing on MHT's effects on dementia/AD risk and cognitive function in demented women.
• Two recent meta-analyses and eight additional original articles were identified and analyzed.
• Study designs, MHT types, and age at initiation were considered as variables.

Main Results:

• The majority of studies indicate that MHT reduces dementia risk by 11-33%.
• However, specific MHT formulations (e.g., conjugated equine estrogens with medroxyprogesterone acetate) initiated after age 65 in comorbid women showed an increased dementia risk (WHIMS study).
• MHT generally shows benefits for dementia risk factors and augments protective factors.

Conclusions:

• Clinicians can be reassured that MHT can be safely prescribed for cognitive health in women without dementia.
• MHT is not indicated for improving cognition in women already diagnosed with dementia.
• Current international guidelines on MHT and dementia should incorporate the latest research findings.