Wong Gary R M, Lee Elina J A, Liaw Qian Yan, Rajaram Hrishikesh
University of Leeds, UK.
University of Glasgow, UK.
BJPsych Open. 2023 Oct 17;9(6):e194. doi: 10.1192/bjo.2023.579.
Studies have shown a relationship between oestrogen and Alzheimer's disease. However, there is neither clear nor strong evidence on the use of oestrogen-only therapy in reducing the risk of Alzheimer's disease.
To assess the effects of oestrogen-only therapy on reducing the risk of Alzheimer's disease.
Inclusion criteria was determined with the PICO framework. Outcome was cognitive function measured by neuropsychological tests and strict protocols. Exclusion criteria included non-Alzheimer's dementia, progesterone-only therapy and pre-menopausal women. Searches were conducted in nine electronic healthcare databases, last searched in July 2022. Quality assessments conducted on randomised controlled trials (RCTs) were performed with the GRADE assessment, and cohort studies and case-control studies were assessed with the Newcastle-Ottawa Scale. Extracted data were used to analyse participants, interventions and outcomes.
Twenty-four studies satisfied the search criteria (four RCTs, nine cohort studies, 11 case-control studies). Fifteen studies showed positive associations for oestrogen-only therapy reducing the risk of Alzheimer's disease, and the remaining nine found no evidence of association.
Fifteen studies showed that oestrogen-only therapy effectively reduced the risk of Alzheimer's disease, whereas nine showed no correlation. Studies also investigated oestrogen-related variables such as length of oestrogen exposure, being an apolipoprotein E ε4 carrier and concomitant use of non-steroidal anti-inflammatory drugs, and their role in neuroprotection. This review was limited by the limited ranges of duration of oestrogen treatment and type of oestrogen-only therapy used. In conclusion, oestrogen-only therapy has potential for use in preventing Alzheimer's disease, although current evidence is inconclusive and requires further study.
研究表明雌激素与阿尔茨海默病之间存在关联。然而，关于仅使用雌激素疗法降低阿尔茨海默病风险，既没有明确也没有有力的证据。
评估仅使用雌激素疗法在降低阿尔茨海默病风险方面的效果。
采用PICO框架确定纳入标准。结局指标为通过神经心理学测试和严格方案测量的认知功能。排除标准包括非阿尔茨海默病性痴呆、仅使用孕激素疗法以及绝经前女性。在九个电子医疗数据库中进行检索，最后一次检索时间为2022年7月。对随机对照试验（RCT）进行质量评估时采用GRADE评估法，对队列研究和病例对照研究采用纽卡斯尔-渥太华量表进行评估。提取的数据用于分析参与者、干预措施和结局。
24项研究符合检索标准（4项RCT、9项队列研究、11项病例对照研究）。15项研究表明仅使用雌激素疗法与降低阿尔茨海默病风险呈正相关，其余9项研究未发现相关证据。
15项研究表明仅使用雌激素疗法可有效降低阿尔茨海默病风险，而9项研究未显示出相关性。研究还调查了与雌激素相关的变量，如雌激素暴露时长、载脂蛋白Eε4携带者状态以及非甾体抗炎药的联合使用情况，及其在神经保护中的作用。本综述受到雌激素治疗持续时间范围有限以及所使用的仅雌激素疗法类型有限的限制。总之，仅使用雌激素疗法在预防阿尔茨海默病方面具有潜在应用价值，尽管目前证据尚无定论，需要进一步研究。
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