Department of Neurology, University of California Irvine, Irvine, CA, USA.
Department of Epidemiology, University of California Irvine, Irvine, CA, USA.
Climacteric. 2020 Jun;23(3):311-315. doi: 10.1080/13697137.2020.1727876. Epub 2020 Feb 28.
This study aimed to investigate the association of endogenous and exogenous estrogen exposure with risk of incident dementia in the oldest-old (age 90+ years). Participants were part of The 90+ Study, a longitudinal study begun in 2003 of aging and dementia among people aged 90+ years. Menstrual, reproductive, and menopausal data were collected in the 1980s as part of the population-based Leisure World Cohort Study. Cognitive status at baseline was determined from an in-person neurological evaluation with biannual follow-up through June 2019. Hazard ratios (HRs) of dementia associated with estrogen-related variables were estimated using Cox regression analysis. No adjustment was made for multiple comparisons. A total of 424 women without dementia at baseline had at least one follow-up evaluation. The mean age was 68.5 years at enrollment in the Leisure World Cohort Study, 93.2 years at enrollment in The 90+ Study, and 96.5 years at last follow-up. During follow-up (mean 3.4 years) dementia was diagnosed in 209 (49%) participants. No individual menstrual, reproductive, menopausal, or estrogen replacement variable was associated with risk of incident dementia after age 90 years. However, women with a high endogenous estrogen exposure index (summarizing exposure from menarche to menopause) had a non-significant 25% lower risk (HR = 0.75, 95% confidence interval 0.53-1.06). Prior exposure to estrogen, endogenous or exogenous, had little effect on risk of dementia in the 10th decade of life.
本研究旨在探讨内源性和外源性雌激素暴露与 90 岁以上老年人（年龄≥90 岁）发生痴呆的风险之间的关联。参与者属于“90+ 研究”的一部分，这是一项始于 2003 年的针对 90 岁以上人群的衰老和痴呆的纵向研究。在 20 世纪 80 年代，作为基于人群的“休闲世界队列研究”的一部分，收集了月经、生殖和绝经数据。在基线时通过面对面的神经学评估来确定认知状态，并通过截至 2019 年 6 月的每两年一次的随访来进行跟踪。使用 Cox 回归分析来估计与雌激素相关变量相关的痴呆风险的风险比（HR）。未对多次比较进行调整。共有 424 名在基线时无痴呆的女性至少接受了一次随访评估。在参加休闲世界队列研究时的平均年龄为 68.5 岁，在参加 90+ 研究时的平均年龄为 93.2 岁，在最后一次随访时的平均年龄为 96.5 岁。在随访期间（平均 3.4 年），有 209 名（49%）参与者被诊断为痴呆。在 90 岁以后，没有任何单个月经、生殖、绝经或雌激素替代变量与痴呆发生风险相关。然而，具有高内源性雌激素暴露指数（总结从初潮到绝经的暴露）的女性风险降低了 25%，但无统计学意义（HR=0.75，95%置信区间 0.53-1.06）。在生命的第十个十年，先前暴露于雌激素（内源性或外源性）对痴呆风险的影响很小。
