Postmenopausal hormone therapy and cognitive outcomes: The Women's Health Initiative Memory Study (WHIMS) |
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| Authors: | Laura H Coker Mark A Espeland Stephen R Rapp Claudine Legault Susan M Resnick Patricia Hogan Sarah Gaussoin Maggie Dailey Sally A Shumaker |
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| Institution: | 1. Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA;2. Biostatistical Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA;3. Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA;4. Department of Psychiatry and Behavioral Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA;5. National Institute on Aging, Laboratory of Personality and Cognition, Biomedical Research Center, Room 04B317, 251 Bayview Blvd., Baltimore, MD 21224, USA;1. Laboratorio de Neurofisiología, Edificio P, Tercer piso, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco CP 44340, Mexico;1. Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA;2. University of Puerto Rico Carolina Campus, Department of Natural Sciences, Carolina, PR 00984, USA;3. Institute of Forensic Science, San Juan, PR, USA;4. Department of Biochemistry, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA;1. Center for Hormone Advanced Science and Education (CHASE), Roskamp Institute, Sarasota, FL 34243, United States;2. Center for Advanced Therapeutic Strategies for Brain Disorders (CATSBD), Roskamp Institute, Sarasota, FL 34243, United States |
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| Abstract: | This review discusses major findings from the Women's Health Initiative Memory Study (WHIMS). WHIMS reported hormone therapy (HT) – conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) – increased the risk for dementia (HR 1.76 95% CI, 1.19–2.60]; P = 0.005) and global cognitive decline, with a mean decrement relative to placebo of 0.21 points on the Modified Mini Mental State Examination (3MS) (P = 0.006) in women age 65 and older.A subset of WHIMS participants joined the ancillary WHI Study of Cognitive Aging (WHISCA) trials, in which domain-specific cognitive tests and mood were measured annually. Compared with placebo, CEE + MPA had a negative impact on verbal memory over time (P = 0.01); and CEE-Alone was associated with lower spatial rotational ability (P ≤ 0.01) at the initial assessment, but the difference diminished over time.The ancillary WHIMS-MRI study measured subclinical cerebrovascular disease to possibly explain the negative cognitive findings reported by WHIMS and the increased clinical stroke in older women reported by the WHI. WHIMS-MRI reported that while CEE + MPA and CEE-Alone were not associated with increased ischemic brain lesion volume relative to placebo; both CEE + MPA and CEE-Alone were associated with lower mean brain volumes in the hippocampus (P = 0.05); frontal lobe (P = 0.004); and total brain (P = 0.07). HT-associated reductions in hippocampal volumes were greatest in women with baseline 3MS scores ≤90. |
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