Hogervorst E, Boshuisen M, Riedel W, Willeken C, Jolles J
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
Psychoneuroendocrinology. 1999 Jan;24(1):43-68. doi: 10.1016/s0306-4530(98)00043-2.
Although evidence seems to indicate favorable effects of hormone replacement therapy (HRT) on cognitive functions and mood in elderly healthy and demented women, some questions remain. For instance, the nature of the long term effect of HRT, e.g. in preventing cognitive decline is still unclear. In this respect, the addition of progestagens in combined HRT has been mentioned to oppose some of the beneficial effects of estrogens. The present paper aims to illuminate these questions and presents two studies. In the first study, the long term effects of combined HRT in healthy postmenopausal women was investigated using a parallel groups (HRT-users vs. controls) design. HRT subjects were always tested during the estrogen-progestagen phase. Results indicated that after 6 and 12 months, women in the HRT-treatment group had higher scores on several indicators of the subjective feeling of well being (sleep, physical and psychological complaints) than matched controls, although at baseline both groups were not severely impaired. Effects of HRT on memory functions were seen when HRT treated subjects were compared with their own baseline functioning, but not when compared with controls. Hence, the addition of progestagen did not oppose the effects of estrogens on subjective feelings of well being or on memory. Our second (case-control) study involved women of middle-age who were unaware of the purpose of the experiment. No positive effects of HRT use on subjective scales of well being or on memory were found. However, women with HRT were faster on basic sensorimotor speed tasks as compared with controls. It should be kept in mind that double blind testing in an experimental study is difficult due to withdrawal bleeding and the reduction of flushes. Expectancy effects may have confounded the results of the first study. However, our findings indicate that the use of a particular design and type of memory test can explain the controversial results of studies into the effect of HRT on cognitive function. Furthermore, it was concluded that HRT has a global activating, instead of specific direct effect on cognitive functions.
尽管有证据表明激素替代疗法（HRT）对老年健康女性和患有痴呆症的女性的认知功能和情绪有积极影响，但仍存在一些问题。例如，HRT的长期影响的本质，如在预防认知衰退方面，仍不清楚。在这方面，有人提到在联合HRT中添加孕激素会抵消雌激素的一些有益作用。本文旨在阐明这些问题，并介绍两项研究。在第一项研究中，采用平行组设计（HRT使用者与对照组）对健康绝经后女性联合HRT的长期影响进行了调查。HRT受试者总是在雌激素 - 孕激素阶段接受测试。结果表明，在6个月和12个月后，HRT治疗组的女性在主观幸福感的几个指标（睡眠、身体和心理不适）上的得分高于匹配的对照组，尽管在基线时两组都没有严重受损。当将接受HRT治疗的受试者与其自身的基线功能进行比较时，可以看到HRT对记忆功能的影响，但与对照组比较时则没有。因此，添加孕激素并没有抵消雌激素对主观幸福感或记忆的影响。我们的第二项（病例对照）研究涉及中年女性，她们不知道实验的目的。未发现使用HRT对主观幸福感量表或记忆有积极影响。然而，与对照组相比，使用HRT的女性在基本感觉运动速度任务上更快。应该记住，由于撤退性出血和潮热减少，在实验研究中进行双盲测试很困难。期望效应可能混淆了第一项研究的结果。然而，我们的研究结果表明，使用特定的设计和记忆测试类型可以解释关于HRT对认知功能影响的研究中存在争议的结果。此外，得出的结论是，HRT对认知功能具有整体激活作用，而不是特定的直接作用
