Grady Deborah, Yaffe Kristine, Kristof Margaret, Lin Feng, Richards Cynthia, Barrett-Connor Elizabeth
Department of Epidemiology and Biostatistics, University of California-San Francisco, 1635 Divisidero Street, Suite 600, San Francisco, CA 94115, USA.
Am J Med. 2002 Nov;113(7):543-8. doi: 10.1016/s0002-9343(02)01270-6.
To determine if hormone therapy results in better cognitive function in older postmenopausal women.
The Heart and Estrogen/progestin Replacement Study (HERS) was a randomized, placebo-controlled trial involving 2763 women with coronary disease. Women were assigned randomly to conjugated estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) in one tablet daily or identical placebo; they were followed for a mean (+/- SD) of 4.2 +/- 0.4 years. Participants at 10 of the 20 HERS centers were invited to enroll in the cognitive function substudy. At the end of the trial, we measured cognitive function in 517 women in the hormone group and 546 in the placebo group using six standard tests: the modified Mini-Mental Status Examination, Verbal Fluency, Boston Naming, Word List Memory, Word List Recall, and Trails B. Cognitive function was not measured at baseline.
The mean age of participants at the time of cognitive function testing was 71 +/- 6 years. There were no differences in age-adjusted cognitive function test scores between the two treatment groups, except that women assigned to hormones scored worse on the Verbal Fluency test than women assigned to placebo (15.9 +/- 4.8 vs. 16.6 +/- 4.8, P = 0.02). Adjustment for other potential confounders and restriction of the analyses to women who had been adherent to study medication did not change the results.
Among older postmenopausal women with coronary disease, 4 years of treatment with postmenopausal hormone therapy did not result in better cognitive function as measured on six standardized tests. Whether these results also apply to elderly women without coronary disease cannot be determined from this study.
确定激素疗法是否能使绝经后老年女性获得更好的认知功能。
心脏和雌激素/孕激素替代研究（HERS）是一项随机、安慰剂对照试验，涉及2763名患有冠心病的女性。女性被随机分配至每日服用一片含结合雌激素（0.625毫克）加醋酸甲羟孕酮（2.5毫克）的药物或相同的安慰剂；她们被随访了平均（±标准差）4.2±0.4年。HERS的20个中心中有10个中心的参与者被邀请参加认知功能子研究。在试验结束时，我们使用六项标准测试对激素组的517名女性和安慰剂组的546名女性进行了认知功能测量：改良简易精神状态检查表、语言流畅性测试、波士顿命名测试、单词表记忆测试、单词表回忆测试和连线测验B。未在基线时测量认知功能。
进行认知功能测试时，参与者的平均年龄为71±6岁。两个治疗组之间经年龄调整的认知功能测试分数没有差异，但接受激素治疗的女性在语言流畅性测试中的得分低于接受安慰剂治疗的女性（15.9±4.8对16.6±4.8，P = 0.02）。对其他潜在混杂因素进行调整以及将分析限制在坚持服用研究药物的女性中，结果并未改变。
在患有冠心病的绝经后老年女性中，4年的绝经后激素治疗并未使六项标准化测试所测量的认知功能得到改善。这些结果是否也适用于无冠心病的老年女性，无法从本研究中确定。
