Hormone Therapy and Dementia Risk: A Critical Window?

 Este artículo es interesante en cuanto al uso de Terapia Hormonal y la demencia. 





"A prospective cohort study reveals a decreased risk for dementia in women taking HT in midlife but an increased risk for those taking HT in later life. 


Several observational studies have demonstrated a reduced risk for dementia in women who use hormone therapy (HT). However, well-designed interventional trials of estrogen–progesterone combinations have revealed an increased risk for dementia, cancer, and vascular events associated with HT use. This prospective cohort study was designed to further investigate the critical window theory that estrogen is beneficial only immediately before and immediately after menopause and may have deleterious effects in later life. More than 5000 women without dementia at baseline had been screened between ages 40 and 55 and reported whether they used HT (i.e., midlife use). Thirty years later, the authors identified participants' HT use (i.e., later-life use) from pharmacy databases. Starting when the cohort reached a median age of 80, the authors identified dementia from ICD-9 coding of diagnoses by neurologists, neuropsychologists, and internists; dementia assessment lasted 7.5 years.
During dementia assessment, 27% of the cohort received a diagnosis of dementia. Women who reported taking HT at midlife but had no evidence of later-life HT use had a significantly decreased risk for dementia diagnosis (adjusted hazard ratio, 0.74). In contrast, those who did not report midlife HT use but had evidence of later-life use had a significant increase in risk (AHR, 1.48). Women who had used HT in both midlife and later life had similar risks to those of women who had no evidence of HT use.
Comment: This study is potentially confounded by self-report data in its early phase and by the limitations inherent in the accuracy of pharmacy records and diagnostic coding in its later phase. Nonetheless, the findings unify data from observational and interventional studies of women using hormone therapy. Moreover, the findings are consistent with animal modeling of a critical window of estrogen-related neuroprotection, which is reportedly associated with improved cerebral blood flow and glucose use and with reduced amyloid deposition in the brain. The bottom line clinically is that HT use around menopause may help protect against dementia, but later use may increase risk."

Link para leer más sobre este tema:  http://neurology.jwatch.org/cgi/content/full/2011/104/1?q=etoc_jwneuro

Saludos

Dr. Carlos Erazo