Department of Psychiatry, University of Illinois at Chicago College of Medicine, 912 South Wood Street, Chicago Illinois 60612, USA.
Endocrinology. 2012 Aug;153(8):3564-70. doi: 10.1210/en.2012-1175. Epub 2012 Jun 6.
Evidence from preclinical studies, randomized clinical trials (RCT), and observational studies underscores the importance of distinguishing among the different forms of estrogen and progestogens when evaluating the cognitive effects of hormone therapy (HT) in women. Despite this evidence, there is a lack of direct comparisons of different HT regimens. To provide insights into the effects of different HT formulations on cognition, this minireview focuses on RCT of verbal memory because evidence indicates that HT affects this cognitive domain more than others and because declines in verbal memory predict later development of Alzheimer's disease. Some observational studies indicate that estradiol confers benefits to verbal memory, whereas conjugated equine estrogens (CEE) confer risks. RCT to date show no negative impact of CEE on verbal memory, including the Women's Health Initiative Study of Cognitive Aging. Similarly, the Women's Health Initiative Memory Study showed no negative impact of CEE on dementia. Transdermal estradiol in younger postmenopausal women improved verbal memory in one small RCT but had no effect in another RCT. RCT of oral estradiol in younger and older postmenopausal women had neutral effects on cognitive function. In contrast, RCT show a negative impact of CEE plus medroxyprogesterone acetate on verbal memory in younger and older postmenopausal women. Small RCT show neutral or beneficial effects of other progestins on memory. Overall, RCT indicate that type of progestogen is a more important determinant of the effects of HT on memory than type of estrogen.
来自临床前研究、随机临床试验 (RCT) 和观察性研究的证据强调，在评估激素治疗 (HT) 对女性认知影响时，区分雌激素和孕激素的不同形式非常重要。尽管有这些证据，但缺乏对不同 HT 方案的直接比较。为了深入了解不同 HT 配方对认知的影响，本篇综述重点关注口头记忆的 RCT，因为有证据表明 HT 对这一认知领域的影响大于其他领域，而且口头记忆的下降预示着阿尔茨海默病的后期发展。一些观察性研究表明，雌二醇对口头记忆有益，而结合马雌激素 (CEE) 则有风险。迄今为止的 RCT 表明 CEE 对口头记忆没有负面影响，包括妇女健康倡议认知老化研究。同样，妇女健康倡议记忆研究也表明 CEE 对痴呆没有负面影响。在较年轻的绝经后妇女中，经皮雌二醇在一项小型 RCT 中改善了口头记忆，但在另一项 RCT 中没有效果。在较年轻和较年长的绝经后妇女中，口服雌二醇的 RCT 对认知功能没有影响。相比之下，RCT 表明 CEE 加醋酸甲羟孕酮对较年轻和较年长的绝经后妇女的口头记忆有负面影响。小型 RCT 表明其他孕激素对记忆有中性或有益的影响。总的来说，RCT 表明孕激素的类型是 HT 对记忆影响的一个更重要的决定因素，而不是雌激素的类型。
