Marks Stephen J, Batra Reema R, Frishman William H
Department of Neurology, New York Medical College, Valhalla, 10595, USA.
Heart Dis. 2002 Jan-Feb;4(1):26-32. doi: 10.1097/00132580-200201000-00005.
The perceived benefits of estrogen on cognitive function are one of the few remaining potential roles for estrogen replacement therapy. The justification for such a role has a strong biologic basis and is easily shown in animal models. Purported benefits for estrogen on cognitive function include neuroprotective, neurostimulating, and neurotrophic effects. The objective of this study was to review the literature and to evaluate the role of estrogen replacement therapy in improving cognition in Alzheimer disease, vascular dementia, premenopausal women, and postmenopausal women without dementia. Additionally, the authors separately looked at the neuroprotective effects of estrogen replacement therapy on the subsequent risk of dementia. The available data fail to show a therapeutic benefit of estrogen replacement therapy in Alzheimer disease. Surprisingly, limited data allow consideration of a possible role of estrogen in the management of vascular dementia. Additionally, younger females with low estrogen levels secondary to primary ovarian failure and Turner syndrome benefit from estrogen replacement therapy. Despite the limited role of estrogen replacement therapy in cognitive enhancement, neuroprotective properties are likely because several prospective studies indicate a reduced risk of Alzheimer disease. A critical window of opportunity seems to exist for this protective effect in Alzheimer disease because once established, the course of the disease is not affected by concomitant estrogen replacement therapy. The authors conclude that the use of estrogen replacement therapy is not substantiated for the treatment of patients with Alzheimer disease. Alternatively, because of the evidence for a possible neuroprotective effect, women at high risk for the development of Alzheimer disease may be appropriate candidates for estrogen replacement therapy. Such a decision should be made on a case-by-case basis, after careful consideration of the risks and benefits.
雌激素对认知功能的潜在益处是雌激素替代疗法仅存的少数潜在作用之一。这一作用的依据有坚实的生物学基础，且在动物模型中很容易得到证明。雌激素对认知功能的所谓益处包括神经保护、神经刺激和神经营养作用。本研究的目的是回顾文献，并评估雌激素替代疗法在改善阿尔茨海默病、血管性痴呆、绝经前女性以及无痴呆的绝经后女性认知功能方面的作用。此外，作者还分别研究了雌激素替代疗法对后续痴呆风险的神经保护作用。现有数据未能显示雌激素替代疗法对阿尔茨海默病有治疗益处。令人惊讶的是，仅有有限的数据支持雌激素在血管性痴呆管理中可能发挥的作用。此外，因原发性卵巢功能衰竭和特纳综合征导致雌激素水平低的年轻女性可从雌激素替代疗法中获益。尽管雌激素替代疗法在认知增强方面作用有限，但由于多项前瞻性研究表明其可降低患阿尔茨海默病的风险，所以其可能具有神经保护特性。在阿尔茨海默病中，这种保护作用似乎存在一个关键的机会窗口，因为一旦疾病确立，其病程不受同时进行的雌激素替代疗法影响。作者得出结论，雌激素替代疗法用于治疗阿尔茨海默病患者缺乏依据。另外，鉴于有证据表明可能存在神经保护作用，阿尔茨海默病高危女性可能是雌激素替代疗法的合适候选者。这样的决定应在仔细权衡风险和益处后逐案做出。
