Clinical Analysis of Ovarian Insufficiency and Effects of Hormone Replacement Therapy in Korean Women with Alzheimer's Disease

ABSTRACT

BACKGROUND: Estrogen deficiency is linked to cardiovascular disease (CVD) and osteoporosis in women. Ovarian hormones are also presumed to play a key role in Alzheimer's disease (AD). This study was designed to investigate the clinical evidences of estrogen deficiency and therapeutic efficacy of hormone replacement (HRT) in women with AD. METHODS: Clinical tests indicative of ovarian insufficiency were performed in 44 female patients with AD (age 49-81 68.0+1.2, Mean+SEM). Out of 40 patients treated with HRT, 16 completed one-year follow-ups. Modification of risk factors for CVD and changes in bone mineral density with HRT were assessed. Periodic MMSE was performed to evaluate changes in cognitive function under HRT. RESULTS: All the patients except two were postmenopausal, and years since menopause were 18.2+1.8. Six patients had early menopause. Hypertension was detected in 9 patients, and one had history of CVD. Prevalence of osteoporosis at lumbar vertebrae or femur neck and that of fragility fracture were 57% and 39%, respectively. Sixteen patiens who completed one-year HRT were analyzed separately HRT reduced significantly blood levels of total cholesterol, Lp(a), and glucose and increased HDL-cholesterol. HRT also prevented bone loss at both lumbar spine and femur neck. MMSE scores at 3, 6, and 12 months of HRT revealed no significant decline compared with baseline score. CONCLUSIONS: Female AD is late problem after menopause, and frequently associated with osteoporosis. In addition to beneficial modification of risk factors for CVD and prevention of further bone loss, HRT might inhibit cognitive decline assessed by MMSE in AD.