Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bethesda, MD 20892-1277, USA.
Arch Womens Ment Health. 2013 Feb;16(1):47-58. doi: 10.1007/s00737-012-0316-9. Epub 2012 Nov 28.
Gynecology clinic-based studies have consistently demonstrated that induced hypogonadism is accompanied by a decline in cognitive test performance. However, a recent study in healthy asymptomatic controls observed that neither induced hypogonadism nor estradiol replacement influenced cognitive performance. Thus, the effects of induced hypogonadism on cognition might not be uniformly experienced across individual women. Moreover, discrepancies in the effects of hypogonadism on cognition also could suggest the existence of specific risk phenotypes that predict a woman's symptomatic experience during menopause. In this study, we examined the effects of induced hypogonadism and ovarian steroid replacement on cognitive performance in healthy premenopausal women. Ovarian suppression was induced with a GnRH agonist (Lupron) and then physiologic levels of estradiol and progesterone were reintroduced in 23 women. Cognitive tests were administered during each hormone condition. To evaluate possible practice effects arising during repeated testing, an identical battery of tests was administered at the same time intervals in 11 untreated women. With the exception of an improved performance on mental rotation during estradiol, we observed no significant effects of estradiol or progesterone on measures of attention, concentration, or memory compared with hypogonadism. In contrast to studies in which a decline in cognitive performance was observed in women receiving ovarian suppression therapy for an underlying gynecologic condition, we confirm a prior report demonstrating that short-term changes in gonadal steroids have a limited effect on cognition in young, healthy women. Differences in the clinical characteristics of the women receiving GnRH agonists could predict a risk for ovarian steroid-related changes in cognitive performance during induced, and possibly, natural menopause.
妇科临床研究一致表明，诱导性性腺功能减退伴随着认知测试表现的下降。然而，最近一项针对健康无症状对照者的研究观察到，诱导性性腺功能减退和雌二醇替代均不会影响认知表现。因此，诱导性性腺功能减退对认知的影响可能不会在个体女性中普遍存在。此外，性腺功能减退对认知的影响存在差异，这也可能表明存在特定的风险表型，可以预测女性在更年期的症状体验。在这项研究中，我们研究了诱导性性腺功能减退和卵巢类固醇替代对健康绝经前妇女认知表现的影响。使用 GnRH 激动剂（Lupron）诱导卵巢抑制，然后在 23 名女性中引入生理水平的雌二醇和孕酮。在每个激素条件下进行认知测试。为了评估在重复测试中可能出现的练习效应，在 11 名未经治疗的女性中以相同的时间间隔进行了相同的测试组合。除了在雌二醇期间精神旋转表现改善外，与性腺功能减退相比，我们没有观察到雌二醇或孕酮对注意力、集中力或记忆测量有任何显著影响。与在接受卵巢抑制治疗的女性中观察到认知表现下降的研究不同，我们证实了之前的一项报告，即短期性腺类固醇变化对年轻健康女性的认知有有限的影响。接受 GnRH 激动剂治疗的女性的临床特征差异可能预示着诱导性和可能自然绝经期间卵巢类固醇相关认知表现变化的风险。
