Petitti Diana B, Crooks Valerie C, Chiu Vicki, Buckwalter J Galen, Chui Helena C
Department of Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA.
Am J Epidemiol. 2008 Mar 15;167(6):692-700. doi: 10.1093/aje/kwm362. Epub 2008 Jan 23.
Results from epidemiologic studies of postmenopausal hormone use and dementia have been conflicting. Investigators from the Women's Health Initiative Memory Study reported that the incidence of dementia in women aged >/=65 years assigned to hormone use was increased. Here the authors report results from a prospective cohort study of 2,906 dementia-free women (1,519 hormone users and 1,387 hormone nonusers) aged > or =75 years who were recruited from a Southern California health plan in 1999 and followed through 2003. Cognitive status was assessed annually using the Telephone Interview of Cognitive Status-modified, supplemented by the Telephone Dementia Questionnaire and medical record review. The mean self-reported age at initiation of hormone use was 48.3 years for users of estrogen alone (n = 1,072) and 54.9 years for users of estrogen plus progestin (n = 447); self-reported mean durations of hormone use were 30.5 years and 23.2 years, respectively. There were 283 incident dementia cases identified during follow-up. After adjustment for age, education, and medical history, hazard ratios for incident dementia were 1.34 (95% confidence interval: 0.95, 1.89) in estrogen/progestin users and 1.23 (95% confidence interval: 0.94, 1.59) in estrogen users. These findings do not provide support for an effect of estrogen or estrogen/progestin use in preventing dementia.
绝经后激素使用与痴呆症的流行病学研究结果一直存在矛盾。妇女健康倡议记忆研究的调查人员报告称，被分配使用激素的65岁及以上女性患痴呆症的发病率有所增加。本文作者报告了一项前瞻性队列研究的结果，该研究对1999年从南加州健康计划招募的2906名75岁及以上无痴呆症女性（1519名激素使用者和1387名非激素使用者）进行了跟踪，随访至2003年。每年使用改良的认知状态电话访谈评估认知状态，并辅以电话痴呆问卷和病历审查。单独使用雌激素的使用者（n = 1072）开始使用激素时自我报告的平均年龄为48.3岁，使用雌激素加孕激素的使用者（n = 447）为54.9岁；自我报告的激素使用平均持续时间分别为30.5年和23.2年。随访期间共确定了283例新发痴呆病例。在对年龄、教育程度和病史进行调整后，雌激素/孕激素使用者发生痴呆的风险比为1.34（95%置信区间：0.95，1.89），雌激素使用者为1.23（95%置信区间：0.94，1.59）。这些发现不支持使用雌激素或雌激素/孕激素预防痴呆症的作用。
