Skoog I, Gustafson D
University of Göteborg, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Sweden.
J Epidemiol Biostat. 1999;4(3):227-51; discussion 252.
The role of HRT and/or oestrogens in the aetiology, progression and prevention of neurodegenerative disorders is unclear. Various studies have been conducted in cells, animals and humans to better define these relationships. The following is a presentation of data on the role of oestrogens in the two most common dementia syndromes Alzheimer's Disease and vascular dementia. This review examines whether there is support for the hypothesis that the use of oestrogens reduces the risk for dementia and cognitive decline in a variety of experimental models. A literature search was performed using the following key words: oestrogen and dementia, oestrogen and Alzheimer, oestrogen and cognition, oestrogen and learning, and oestrogen and memory. The reference lists for the articles identified using these search strategies were examined. The strongest evidence for a beneficial effect comes from cell and animal studies. These suggest that treatment with oestrogens may influence the pathogenetic processes of AD, mainly by affecting the beta-amyloid metabolism, by promoting the activity of the cholinergic system, by reducing oxidative stress or cardiovascular risk. Observational studies give some support to the hypothesis that HRT may be protective for cognitive decline and dementia in the elderly, but the inherited methodological problems in these studies preclude any conclusions. The treatment trials published thus far have methodological problems that prohibit definite conclusions on the relationship between HRT and cognitive decline and dementia.
激素替代疗法（HRT）和/或雌激素在神经退行性疾病的病因、进展及预防中的作用尚不清楚。人们已在细胞、动物和人体上开展了各种研究，以更好地明确这些关系。以下介绍雌激素在两种最常见的痴呆综合征——阿尔茨海默病和血管性痴呆中的作用的数据。本综述探讨了在各种实验模型中，是否有证据支持使用雌激素可降低痴呆风险和认知能力下降这一假说。使用以下关键词进行了文献检索：雌激素与痴呆、雌激素与阿尔茨海默病、雌激素与认知、雌激素与学习以及雌激素与记忆。对通过这些检索策略确定的文章的参考文献列表进行了审查。最有力的有益作用证据来自细胞和动物研究。这些研究表明，雌激素治疗可能主要通过影响β-淀粉样蛋白代谢、促进胆碱能系统活性、降低氧化应激或心血管风险来影响阿尔茨海默病的发病过程。观察性研究为HRT可能对老年人认知能力下降和痴呆具有保护作用这一假说提供了一些支持，但这些研究中存在的固有方法学问题排除了得出任何结论的可能性。迄今为止发表的治疗试验存在方法学问题，无法就HRT与认知能力下降和痴呆之间的关系得出明确结论。
