Estrogen for Dementia-Related Aggression in Elderly Men

Abstract

As with previous reports, these cases suggest that conjugated estrogens may be used to reduce physical and sexual aggression associated with dementia in elderly men. Additional study is needed to determine the exact role of this alternative pharmacologic intervention.

The Role of Alcohol and Steroid Hormones in Human Aggression

“…In a study of men suffering from dementiarelated aggression, the subjects receiving transdermatal estradiol treatment decreased their physical and sexual aggressiveness but verbal aggression remained unchanged (Kay et al, 1996). In another small case study, conjugated estrogens reduced physical and sexual aggression in elderly demented men (Shelton and Brooks, 1999). Bulimia, which has been associated with increased aggressiveness in women, was found in one study of 33 women to be related to decreased levels of 17 beta-estradiol and increased concentrations of cortisol and testosterone (Cotrufo et al, 2000).…”

“…Earlier studies indicated that estrogens decreased physical and sexual aggression in demented men (Kay et al, 1996;Shelton and Brooks, 1999) while the effect on verbal aggression remained unchanged in men suffering from dementia-related aggression (Kay et al, 1996). Estrogens may reduce androgenic effects by suppressing the anterior pituitary gonadotrophic function in men (Barfield, 1984).…”

“…Although a few intervention studies have reported that the administration of the female steroid hormone, estradiol, attenuates dementia-related aggression in elderly men (Kyomen et al, 1991;Shelton and Brooks, 1999), almost nothing beyond this is known about the possible role of estradiol in human male aggression. In the subtle balance of hormones, cortisol may also play an important part as a regulator in the occurrence and expression of aggressiveness.…”

Recognition and Management of Behavioral Disturbances in Dementia

“…Short-term estrogen therapy has been found to be beneficial in a small randomized, double-blind study 148 for management of aggressive behaviors in elderly patients with moderate-to-severe dementia. Case reports have indicated potential benefits of estrogen, 149 medroxyprogesterone, 150 and cimetidine 151 for treatment of sexual aggression associated with dementia in the elderly.…”

Apolipoprotein E ε4 Status Modifies the Effects of Sex Hormones on Neuropsychiatric Symptoms of Alzheimer’s Disease

“…Therefore, sex hormone replacement is regarded as a potential treatment for aggression and depression among dementia patients. Some intervention studies have supported the beneficial effects of estrogen replacement therapy on aggression in elderly men with dementia [9,10,11] and on depression in female AD patients [12]. Estrogen and testosterone levels were reported to be associated with other neuropsychiatric symptoms, such as hallucinations, apathy and anxiety [13,14,15,16].…”