Context: Women seem to be more vulnerable to dementia, particularly Alzheimer's disease (AD), than men. There is controversy among studies correlating estrogen deficit to cognitive impairment. Because of the sudden drop of estrogens in menopause, this hormonal deficit could represent one of the risk factors for the larger incidence and prevalence of AD in postmenopausal women. Rationale: We therefore wanted to find out if post-menopausal women with dementia, or even in a prior stage, mild cognitive impairment (MCI), would have a more significant deficit of estrogens than post-menopausal women without dementia, or any other type of cognitive problem. Objectives: The aim of this study was to detect possible differences of the sex hormone levels among post-menopausal women, simultaneously affected by MCI or dementia, in comparison with a control group without cognitive impairment. Design, setting, and participants: A small, multicenter, prospective study was performed on 82 post-menopausal women (41 cases, 41 controls), aged 45-81 years, to investigate their sex hormone balance. The diagnosis of dementia was made according to ICD 9 or 10 and DSM III-R or IV appropriate to the time interval. The diagnosis of probable AD followed the NINCDS-ADRDA criteria. MCI met the Paquid-study criteria. Blood was analyzed in qualified centers for LH, FSH, and 17-β-estradiol. All women went through a thorough psychiatric examination and those with a suspected hormonal impairment were examined by a gynecologist. Results: 15 cases (36.6%) had impaired hormonal function, compared with 8 controls (19.5%). Of the 15 cases with hormonal impairment, 9 had MCI. Conclusions: These preliminary data stress a considerable difference between the sex hormone status of these two populations, showing a tendency towards a more accentuated estrogen deficit linked to cognitive deficit. Enlarging the sample and following the evolution could bring more interesting data. Keywords: dementia, cognitive impairment, post menopause, estrogens BackgroundThe intriguing fact that women are far more affected with Alzheimer's disease (AD) than men (Buckwalter et al 1993;Lamberts et al 1997;Hofman and Launer 1998;Gelfand et al 2001) led us to think about risk factors specifically linked to gender (Henderson 2000). Again women seem to have their own protective factors, which give them a longer life expectancy then men, with a prevalence of 5%-7% more over the age of 65 years and of up to 50% more over the age of 85 (Evans 1989;Jorm 1998 Hormones and dementia -a comparative study of hormonal impairment in post-menopausal women, with and without dementia
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