A randomized clinical trial of estrogen therapy in younger postmenopausal women, aged 50–55, has found no long-term risk or benefit to cognitive function. The National Institutes of Health-supported study, reported in JAMA Internal Medicine on June 24, 2013, looked at women taking conjugated equine estrogens, the most common type of postmenopausal hormone therapy in the United States.

The earlier Women’s Health Initiative Memory Study (WHIMS) linked the same type of hormone therapy to cognitive decline and dementia in older postmenopausal women.

The new findings come from the Women’s Health Initiative Memory Study of Younger Women (WHIMSY) trial and were reported by Mark A. Espeland, Ph.D., Wake Forest School of Medicine, Winston-Salem, N.C., on behalf of the academic research centers involved in the study. The study was funded primarily by the National Institute on Aging (NIA), along with the National Heart, Lung, and Blood Institute (NHLBI), both components of the NIH.

“The WHIMS study found that estrogen-based postmenopausal hormone therapy produced deficits in cognitive function and increased risk for dementia when prescribed to women 65 and older,” said NIA Director Richard J. Hodes, M.D. “Researchers leading the WHIMSY study wanted to expand on those results by exploring the possibility of a window of opportunity whereby hormone therapy might promote or preserve brain health when given to younger women.”

“In contrast to findings in older postmenopausal women, this study tells women that taking these types of estrogen-based hormone therapies for a relatively short period of time in their early postmenopausal years may not put them at increased risk for cognitive decline over the long term,” said Susan Resnick, Ph.D., chief of the Laboratory of Behavioral Neuroscience, in NIA’s Intramural Research Program and a co-author of the study. “Further, it is important to note that we did not find any cognitive benefit after long-term follow-up.”

Neither WHIMSY nor WHIMS was designed to assess the reasons that hormone treatments had different effects on cognition in older and younger postmenopausal women.

WHIMSY is an extension of WHIMS, which was conducted as part of the Women’s Health Initiative (WHI). WHI enrollment took place from 1993–1998 at 40 academic research centers. Participants were randomized to one of two groups: women who had had a hysterectomy received conjugated equine estrogens alone; women with a uterus received estrogens plus a synthetic progestin (medroxyprogesterone acetate). There were companion control groups which received placebos. WHIMSY enrolled 1,326 women who started WHI treatment when they were between 50 and 55 and continued it for an average of seven years. The women were approached to participate in a telephone assessment of cognition an average of seven years after that.

Phone interviews on cognitive function were conducted with 1,168 women. The primary outcome was global cognitive function, which includes measures of memory, problem-solving skills and other cognitive abilities. The researchers also measured specific cognitive functions—verbal memory, attention, executive function, verbal fluency and working memory. The first cognitive assessment was performed when participants’ average age was 67.2 years and the second at an average age of 68.1 years.

The researchers found no meaningful difference in the average global cognitive function scores between women who had been assigned to hormone therapy vs. placebo. This finding applied to women regardless of whether their treatment included the synthetic progestin.

The WHIMSY research team will continue to follow the women in the study with annual telephone interviews to learn whether previous hormone therapy has longer term effects on how cognitive function changes over time. Women considering hormone therapy should consult their physician about how best to treat or prevent menopause symptoms or diseases for which they are at risk.

In addition to NIH support for the study, the hormone therapy used in the WHI hormone trials was provided by Wyeth-Ayerst Laboratories, now part of Pfizer, Inc.

Citation

Adapted from the National Institute on Aging

http://www.brightfocus.org/alzheimers/newsupdates/estrogen-therapy-no-long-term-effect-cognition.html?utm_source=eAlert&utm_medium=email&utm_campaign=ADR_eAlert

© 2000 - 2013 BrightFocus Foundation.

A Mediterranean diet with added extra virgin olive oil or mixed nuts seems to improve the brain power of older people better than advising them to follow a low-fat diet, indicates research published online in the Journal of Neurology Neurosurgery and Psychiatry.

The authors from the University of Navarra in Spain base their findings on 522 men and women aged between 55 and 80 without cardiovascular disease but at high vascular risk because of underlying disease/conditions.

These included either type 2 diabetes or three of the following: high blood pressure; an unfavorable blood fat profile; overweight; a family history of early cardiovascular disease; and being a smoker.

Participants, who were all taking part in the PREDIMED trial looking at how best to ward off cardiovascular disease, were randomly allocated to a Mediterranean diet with added olive oil or mixed nuts or a control group receiving advice to follow the low-fat diet typically recommended to prevent heart attack and stroke

A Mediterranean diet is characterized by the use of virgin olive oil as the main culinary fat; high consumption of fruits, nuts, vegetables and pulses; moderate to high consumption of fish and seafood; low consumption of dairy products and red meat; and moderate intake of red wine.

Participants had regular check-ups with their family doctor and quarterly checks on their compliance with their prescribed diet.

After an average of 6.5 years, they were tested for signs of cognitive decline using a Mini Mental State Exam and a clock drawing test, which assess higher brain functions, including orientation, memory, language, visuo-spatial and visuo-constrution abilities and executive functions such as working memory, attention span, and abstract thinking.

At the end of the study period, 60 participants had developed mild cognitive impairment: 18 on the olive oil supplemented Mediterranean diet; 19 on the diet with added mixed nuts; and 23 on the control group.

A further 35 people developed dementia: 12 on the added olive oil diet; six on the added nut diet; and 17 on the low fat diet.

The average scores on both tests were significantly higher for those following either of the Mediterranean diets compared with those on the low fat option.

These findings held true irrespective of other influential factors, including age, family history of cognitive impairment or dementia, the presence of ApoE protein-associated with Alzheimer’s disease-educational attainment, exercise levels, vascular risk factors; energy intake and depression.

The authors acknowledge that their sample size was relatively small, and that because the study involved a group at high vascular risk, it doesn’t necessarily follow that their findings are applicable to the general population.

But they say, theirs is the first long term trial to look at the impact of the Mediterranean diet on brain power, and that it adds to the increasing body of evidence suggesting that a high quality dietary pattern seems to protect cognitive function in the ageing brain.

Citation

“Mediterranean diet improves cognition@ the PREDIMED-NAVARRA randomised trial”,
Martínez-Lapiscina EH, et al. J Neurol Neurosurg Psychiatry 2013;00:1-8. doi:10.1136/jnnp-2012-304792

Journal of Neurology Neurosurgery and Psychiatry. (2013, May 21). “Mediterranean Diet Seems To Boost Ageing Brain Power.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/260761.php.

MediLexicon International Ltd © 2004-2013

Persons with Alzheimer’s disease are able to manage their everyday activities longer and they suffer from less psychological and behavioral symptoms if the diagnosis is made and treatment begun at a very early phase of the disease, indicates a recent study conducted at the University of Eastern Finland.

The study followed persons with Alzheimer’s disease over a course of three years. The study participants were diagnosed either at the very mild or mild phase of the disease and treated within the standard healthcare system.

According to the study, persons with a very mild Alzheimer’s disease at the time of the diagnosis and start of the Alzheimer’s disease targeted therapy are better able to manage their everyday activities than persons diagnosed at a more advanced phase of the disease. In addition, in relation to the stage of the disease, they also had less psychological and behavioral symptoms during the follow-up.

According to the researchers, Psychologist Ilona Hallikainen and Adjunct Professor, Psychologist Tuomo Hänninen, the results show that an early detection of the disease is important. Persons with Alzheimer’s disease may be able to live at home longer if they are able to manage their daily activities and have less psychological and behavioral symptoms.

In addition, the study enhanced knowledge about the use of common diagnostic tests during a follow-up. The results have been accepted for publication in the journal International Psychogeriatrics. Ms. Hallikainen presented the results at the Alzheimer’s Association International Conference (AAIC) in Boston on 17 July.

Citation

The above story is reprinted from materials provided by University of Eastern Finland, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

1. Ilona Hallikainen, Tuomo Hänninen, Mikael Fraunberg, Kristiina Hongisto, Tarja Välimäki, Asta Hiltunen, Pertti Karppi, Juhani Sivenius, Hilkka Soininen, Anne M. Koivisto.Progression of Alzheimer’s disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study. International Psychogeriatrics, 2013; 25 (08): 1335 DOI: 10.1017/S1041610213000653

University of Eastern Finland (2013, July 18). Early detection and treatment of Alzheimer’s disease prevents psychological and behavioural symptoms. ScienceDaily. Retrieved July 19, 2013, from http://www.sciencedaily.com­/releases/2013/07/130718100931.htm