Neuropsychiatric Institute, MC 913, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL 60612, USA.
Hum Reprod Update. 2009 Nov-Dec;15(6):667-81. doi: 10.1093/humupd/dmp022. Epub 2009 May 25.
Clinical trials yield discrepant information about the impact of hormone therapy on verbal memory and executive function. This issue is clinically relevant because declines in verbal memory are the earliest predictor of Alzheimer's disease and declines in executive function are central to some theories of normal, age-related changes in cognition.
We conducted a systematic review of randomized clinical trials of hormone therapy (i.e. oral, transdermal, i.m.) and verbal memory, distinguishing studies in younger (i.e. <or=65 years of age; n = 9) versus older (i.e. >65 years; n = 7) women and studies involving estrogen alone versus estrogen plus progestogen. Out of 32 placebo-controlled trials, 17 were included (13 had no verbal memory measures and 2 involved cholinergic manipulations). We also provide a narrative review of 25 studies of executive function (two trials), since there are insufficient clinical trial data for systematic review.
There is some evidence for a beneficial effect of estrogen alone on verbal memory in younger naturally post-menopausal women and more consistent evidence from small-n studies of surgically post-menopausal women. There is stronger evidence of a detrimental effect of conjugated equine estrogen plus medroxyprogesterone acetate on verbal memory in younger and older post-menopausal women. Observational studies and pharmacological models of menopause provide initial evidence of improvements in executive function with hormone therapy.
Future studies should include measures of executive function and should address pressing clinical questions; including what formulation of combination hormone therapy is cognitively neutral/beneficial, yet effective in treating hot flashes in the early post-menopause.
临床试验对激素治疗对言语记忆和执行功能的影响提供了不一致的信息。这个问题在临床上很重要，因为言语记忆的下降是阿尔茨海默病的最早预测指标，而执行功能的下降是某些正常、与年龄相关的认知变化理论的核心。
我们对激素治疗（即口服、透皮、肌内）和言语记忆的随机临床试验进行了系统回顾，区分了年轻（即<或=65 岁；n=9）和老年（即>65 岁；n=7）女性的研究以及仅涉及雌激素与雌激素加孕激素的研究。在 32 项安慰剂对照试验中，有 17 项被纳入（13 项没有言语记忆测量，2 项涉及胆碱能操作）。我们还对 25 项执行功能研究进行了叙述性综述（两项试验），因为系统综述的临床试验数据不足。
有一些证据表明，单独使用雌激素对年轻的自然绝经后女性的言语记忆有益，而对接受手术绝经后的小样本研究则有更一致的证据。共轭马雌激素加醋酸甲羟孕酮对年轻和老年绝经后女性的言语记忆有更强的有害影响。观察性研究和绝经的药理学模型为激素治疗改善执行功能提供了初步证据。
未来的研究应包括执行功能的测量，并应解决紧迫的临床问题；包括什么配方的联合激素治疗在认知上是中性/有益的，但在绝经早期有效治疗热潮红。
