Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, CA 92093, USA.
Clin Endocrinol (Oxf). 2010 Jan;72(1):99-106. doi: 10.1111/j.1365-2265.2009.03599.x. Epub 2009 Mar 30.
Despite overwhelming biological plausibility, evidence for a protective effect of oestrogen on cognitive function in postmenopausal women is inconsistent. This study examines the association between endogenous oestrogen levels and subsequent 4-year decline in cognitive function test performance in community-dwelling older women.
Longitudinal cohort study.
Three hundred and forty-three postmenopausal women (median age 70 years).
Between 1984 and 1987, serum for measurement of sex hormones was obtained along with relevant covariates. Cognitive function was assessed in 1988-1991 and again in 1992-1996 using the Category Fluency test, the Mini-Mental Status Exam (MMSE) and Trail Making Test B (Trails B).
Women in the highest tertile of oestrone and bioavailable oestradiol had respectively 1.75 (95% CI 1.02, 3.07) and 1.79 (95% CI 1.04, 3.10) higher odds of 4 year decline in Category Fluency, a test of frontal lobe function, compared to those in the lowest tertile, independent of age and education. The 20% of women with highest tertile levels of both oestrone and bioavailable oestradiol had a twofold higher odds of verbal fluency loss (OR = 2.17; 95% CI 1.21, 3.89). Adjustment for testosterone levels or for obesity-related factors associated with high endogenous oestrogens (higher body mass index, waist girth, and triglycerides and lower high-density lipoprotein cholesterol) did not alter results. Neither oestrogen was associated with change in MMSE or Trails B scores.
Higher endogenous oestrogen levels were associated with a greater decline in verbal fluency in postmenopausal women. This association was not explained by elevated androgens or by obesity or obesity-related factors.
尽管雌激素对绝经后妇女认知功能具有保护作用的生物学机制似乎合情合理，但相关证据并不一致。本研究旨在探讨内源性雌激素水平与社区居住的老年绝经后妇女认知功能测试表现 4 年内下降之间的关系。
纵向队列研究。
343 名绝经后妇女（中位年龄 70 岁）。
1984 年至 1987 年期间，采集血清以测量性激素及相关协变量。1988 年至 1991 年和 1992 年至 1996 年，使用类别流畅性测试、简易精神状态检查（MMSE）和连线测试 B（Trails B）评估认知功能。
与最低三分位数相比，雌酮和生物可利用雌二醇最高三分位数的女性，类别流畅性（测试额叶功能）分别在 4 年内下降的可能性高 1.75（95%可信区间 1.02，3.07）和 1.79（95%可信区间 1.04，3.10），独立于年龄和教育。雌酮和生物可利用雌二醇均处于最高三分位数的 20%女性，言语流畅性丧失的可能性高两倍（OR=2.17；95%可信区间 1.21，3.89）。调整睾酮水平或与高内源性雌激素相关的肥胖相关因素（较高的体重指数、腰围、甘油三酯和较低的高密度脂蛋白胆固醇）并未改变结果。两种雌激素与 MMSE 或 Trails B 评分的变化均无关。
较高的内源性雌激素水平与绝经后妇女言语流畅性下降幅度更大有关。这种关联不能用升高的雄激素或肥胖或肥胖相关因素来解释。
