Long-Term Estrogen Replacement Therapy in Female Patients with Dementia of the Alzheimer Type: 7 Case Reports

Abstract

Seven female patients with mild to moderate dementia of the Alzheimer type (DAT) were treated with long-term, low-dose estrogen replacement therapy (ERT) over a period of 5–45 months. Five of the 7 patients were cases who had responded well to short-term ERT with 1.25 mg/day of conjugated equine estrogens (CEE) for 6 weeks. The 7 patients from 56 to 77 years of age received 0.625 mg/day of CEE for 21 days, followed by a pause of 7 days. A28-day cycle of low-dose ERT was performed repeatedly. In 4 cases, these patients received 5 mg/day of medroxyprogesterone acetate (MPA) during the last 10–12 days of estrogen treatment. Therapeutic efficacy of estrogen was evaluated by psychometric assessments such as the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale (HDS) and a behavior rating scale of the Gottfries-Bråne-Steen geriatric rating scale (GBS). The MMSE and HDS evaluations were performed principally once in 2–4 weeks. In 4 out of the 7 patients, the MMSE and HDS scores were elevated above the pretreatment levels during ERT. The termination of ERT resulted in a decrease in both scores. Furthermore, the GBS scores and daily activities of the same 4 patients were improved during ERT. In these 4 patients cognitive functions were markedly improved throughout the treatment period, while the other 2 patients responded moderately well and another patient did not respond at all. These observations suggest that long-term, low-dose ERT improves cognitive functions, dementia symptoms and daily activities in women with mild to moderate DAT. However, the supplemental treatment with MPA seems to have an unfavorable effect on dementia symptoms and daily activities in the aged DAT patients.

Conjugated equine estrogen enhances rats' cognitive, anxiety, and social behavior

“…Among menopausal and postmenopausal women, CEE therapy improves memory in some [16][17][18], but not all, studies [9,10]. Although other behavioral studies in rodents are lacking, in-vitro studies provide additional proof-ofconcept evidence that CEE may have beneficial neural effects.…”

Skin and brain age together: The role of hormones in the ageing process

“…They enhance the outgrowth of neurites and promote the formation of dendrite spines and synapses (Lustig, 1994;Woolley and McEwen, 1994). In the brain, estrogens increase cerebral blood flow and glucose metabolism and modulate acetylcholine metabolism (Bishop and Simpkins, 1995;Luine, 1985;Ohkura et al, 1995). Furthermore, the beneficial effect of estrogens on the CNS may be mediated by cholesterol and apo E…”

Estrogen and Non-Feminizing Estrogen for Alzheimer's Disease

“…Many clinical studies have supported the therapeutic effect of estrogen on AD, since Fillit et al [20] first reported an open trial of estradiol-17b (E 2 ) therapy for AD (Table 2) [20][21][22][23][24][25][26][27][28][29][30][31][32]. However, the therapeutic effect was not established.…”