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Konishi K, Jacobs EG, Aroner S, De Vivo I, Smith B, Scribner-Weiss B, Makris N, Seitz-Holland J, Remington A, Aizley H, Kubicki M, Goldstein JM. Leukocyte telomere length and memory circuitry and cognition in early aging: Impact of sex and menopausal status. Horm Behav 2024; 165:105631. [PMID: 39232410 DOI: 10.1016/j.yhbeh.2024.105631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
Telomere length (TL) is an important cellular marker of biological aging impacting the brain and heart. However, how it is related to the brain (e.g., cognitive function and neuroanatomic architecture), and how these relationships may vary by sex and reproductive status, is not well established. Here we assessed the association between leukocyte TL and memory circuitry regional brain volumes and memory performance in early midlife, in relation to sex and reproductive status. Participants (N = 198; 95 females, 103 males; ages 45-55) underwent structural MRI and neuropsychological assessments of verbal, associative, and working memory. Overall, shorter TL was associated with smaller white matter volume in the parahippocampal gyrus and dorsolateral prefrontal cortex. In males, shorter TL was associated with worse working memory performance and corresponding smaller white matter volumes in the parahippocampal gyrus, anterior cingulate cortex, and dorsolateral prefrontal cortex. In females, the impact of cellular aging was revealed over the menopausal transition. In postmenopausal females, shorter TL was associated with poor associative memory performance and smaller grey matter volume in the right hippocampus. In contrast, TL was not related to memory performance or grey and white matter volumes in any memory circuitry region in pre/perimenopausal females. Results demonstrated that shorter TL is associated with worse memory function and smaller volume in memory circuitry regions in early midlife, an association that differs by sex and reproductive status. Taken together, TL may serve as an early indicator of sex-dependent brain abnormalities in early midlife.
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Affiliation(s)
- Kyoko Konishi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America; Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Emily G Jacobs
- Department of Psychological and Brain Sciences, University of California, Santa Barbara 93111, United States of America
| | - Sarah Aroner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America; Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Immaculata De Vivo
- Department of Epidemiology, T.H. Chan School of Public Health, Boston, MA 02120, United States of America
| | - Brianna Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Blair Scribner-Weiss
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, United States of America
| | - Nikos Makris
- Harvard Medical School, Boston, MA 02120, United States of America; Athinoula A. Martinos Center, Massachusetts General Hospital, Charlestown, MA 02129, United States of America
| | - Johanna Seitz-Holland
- Harvard Medical School, Boston, MA 02120, United States of America; Athinoula A. Martinos Center, Massachusetts General Hospital, Charlestown, MA 02129, United States of America
| | - Anne Remington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America; Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Harlyn Aizley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America; Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Marek Kubicki
- Harvard Medical School, Boston, MA 02120, United States of America; Athinoula A. Martinos Center, Massachusetts General Hospital, Charlestown, MA 02129, United States of America
| | - Jill M Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America; Harvard Medical School, Boston, MA 02120, United States of America; Athinoula A. Martinos Center, Massachusetts General Hospital, Charlestown, MA 02129, United States of America; Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA 02114, United States of America; Department of Medicine, Harvard Medical School, Boston, MA 02115, United States of America.
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Andy C, Nerattini M, Jett S, Carlton C, Zarate C, Boneu C, Fauci F, Ajila T, Battista M, Pahlajani S, Christos P, Fink ME, Williams S, Brinton RD, Mosconi L. Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition. Front Endocrinol (Lausanne) 2024; 15:1350318. [PMID: 38501109 PMCID: PMC10944893 DOI: 10.3389/fendo.2024.1350318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Despite evidence from preclinical studies suggesting estrogen's neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial. Methods We used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants. Results Associations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT. Discussion These findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs.
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Affiliation(s)
- Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Francesca Fauci
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Trisha Ajila
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Calvo N, Einstein G. Steroid hormones: risk and resilience in women's Alzheimer disease. Front Aging Neurosci 2023; 15:1159435. [PMID: 37396653 PMCID: PMC10313425 DOI: 10.3389/fnagi.2023.1159435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying women's risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2's crucial role in women's brain reserve, (3) women's verbal memory advantage as a cognitive reserve factor, and (4) E2's potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.
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Affiliation(s)
- Noelia Calvo
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Women’s College Research Institute, Toronto, ON, Canada
- Centre for Life Course and Aging, University of Toronto, Toronto, ON, Canada
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Sharma A, Davies R, Kapoor A, Islam H, Webber L, Jayasena CN. The effect of hormone replacement therapy on cognition and mood. Clin Endocrinol (Oxf) 2023; 98:285-295. [PMID: 36447434 DOI: 10.1111/cen.14856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To summarise the available data regarding the effect of hormone replacement therapy (HRT) on cognition and mood in women. BACKGROUND Complaints of impaired cognition and mood are common in the peri-menopausal and menopausal period. There is debate as to whether HRT can ameliorate this phenomenon. DESIGN A literature search of studies using electronic databases was conducted. Both randomised control trials and observational studies were included. PATIENTS Perimenopausal and menopausal women. RESULTS Due to the heterogenicity of results it is challenging to draw firm conclusions. The preparations used in many of the studies are older regimes no longer routinely used clinically. The notion of a 'critical window' for HRT is compelling, suggesting HRT has a positive impact on cognition when administered in the peri-menopausal or early postmenopausal period but may have negative effects on cognition in the older, postmenopausal woman. The evidence would seem to suggest importance of hormonal replacement in woman undergoing a surgical menopause, especially when young. It remains unclear for how long they ought to continue HRT though until at least the natural age of the menopause seems reasonable. Evidence for a positive effect of HRT on mood is more convincing, though possibly more efficacious in the younger age group. The effect of HRT on anxiety is less clear. CONCLUSIONS Further study, particularly focusing on the more contemporaneous HRT preparations, is warranted before evidence-based conclusions can be drawn.
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Affiliation(s)
- Aditi Sharma
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rhianna Davies
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | | | - Lisa Webber
- Department of Gynaecology, St. Mary's Hospital, London, UK
| | - Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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5
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Is Hormone Replacement Therapy a Risk Factor or a Therapeutic Option for Alzheimer's Disease? Int J Mol Sci 2023; 24:ijms24043205. [PMID: 36834617 PMCID: PMC9964432 DOI: 10.3390/ijms24043205] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that accounts for more than half of all dementia cases in the elderly. Interestingly, the clinical manifestations of AD disproportionately affect women, comprising two thirds of all AD cases. Although the underlying mechanisms for these sex differences are not fully elucidated, evidence suggests a link between menopause and a higher risk of developing AD, highlighting the critical role of decreased estrogen levels in AD pathogenesis. The focus of this review is to evaluate clinical and observational studies in women, which have investigated the impact of estrogens on cognition or attempted to answer the prevailing question regarding the use of hormone replacement therapy (HRT) as a preventive or therapeutic option for AD. The articles were retrieved through a systematic review of the databases: OVID, SCOPUS, and PubMed (keywords "memory", "dementia," "cognition," "Alzheimer's disease", "estrogen", "estradiol", "hormone therapy" and "hormone replacement therapy" and by searching reference sections from identified studies and review articles). This review presents the relevant literature available on the topic and discusses the mechanisms, effects, and hypotheses that contribute to the conflicting findings of HRT in the prevention and treatment of age-related cognitive deficits and AD. The literature suggests that estrogens have a clear role in modulating dementia risk, with reliable evidence showing that HRT can have both a beneficial and a deleterious effect. Importantly, recommendation for the use of HRT should consider the age of initiation and baseline characteristics, such as genotype and cardiovascular health, as well as the dosage, formulation, and duration of treatment until the risk factors that modulate the effects of HRT can be more thoroughly investigated or progress in the development of alternative treatments can be made.
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6
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Hadisi N, Abedi H, Shokoohi M, Tasdemir S, Mamikhani SH, Meshgi SH, Zolfagharzadeh A, Roshangar L. COVID-19 and Endocrine System: A Cross-Sectional Study on 60 Patients with Endocrine Abnormality. CELL JOURNAL 2022; 24:182-187. [PMID: 35674019 PMCID: PMC9124443 DOI: 10.22074/cellj.2022.8079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Objective COVID-19 is an infectious disease that has become pandemic with a high mortality rate. This study aims to
provide new insight into the relations between SARS-CoV-2 and the Endocrine system.
Materials and Methods In this cross-sectional study, we have hospitalized 60 patients with a positive SARA-CoV-2 PCR
test. The information of complete blood count and endocrine hormones was obtained when the patients were admitted to the
hospital or for a maximum of 4 days onset the hospitalization.
Results Of 60 patients with COVID-19, forty-four (73.33%) had at least one abnormality mean item >×3. In total, 26 (43.33%),
21 (35%), 18 (30%), 13 (21.67%), 31 (51.67%), 12 (20%), 30 (50%), 25 (41.67%) patients having estradiol, follicle stimulating
hormone (FSH), luteinizing hormone (LH), prolactin, progesterone, testosterone, cortisol and thyroid stimulating hormone
(TSH) abnormal test results, respectively. There was no change in creatinine levels. FSH has shown drastic changes in both
sexes’ intensity (F: 769, P<0.0001). Although TSH had many abnormalities in women, analysis has shown no significant P
value (P=0.4558). Furthermore, prolactin and testosterone mean level in men and the estradiol mean level in women have
shown no significant P value (P=0.2077, P=0.1446, P=0.1351, respectively).
Conclusion Results suggest that COVID-19 affects directly or non-directly glands and related hormones.
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Affiliation(s)
- Negin Hadisi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Ahar Bagher-al-Olum General Hospital, Ahar, Iran
| | - Hadi Abedi
- Ahar Bagher-al-Olum General Hospital, Ahar, Iran
| | - Majid Shokoohi
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seval Tasdemir
- Fertijin IVF Center Nispetiye Cad Bebek Yokusu Sokak, Etiler, Istanbul, Turkey
| | | | - S Hahla Meshgi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leila Roshangar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Udeh-Momoh C, Watermeyer T. Female specific risk factors for the development of Alzheimer's disease neuropathology and cognitive impairment: Call for a precision medicine approach. Ageing Res Rev 2021; 71:101459. [PMID: 34508876 DOI: 10.1016/j.arr.2021.101459] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/13/2021] [Accepted: 09/06/2021] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) includes a long asymptomatic stage, which precedes the formal diagnosis of dementia. AD biomarker models provide a framework for precision medicine approaches during this stage. However, such approaches have ignored the possible influence of sex on cognition and brain health, despite female sex noted as a major risk factor. Since AD-related changes may emerge in midlife, intervention efforts are being redirected around this period. Midlife coincides with several endocrinological changes, such as the menopausal transition experienced by women. In this narrative review, we discuss evidence for sex-differences in AD neuropathological burden and outline key endocrinological mechanisms for both sexes, focussing on hormonal events throughout the lifespan that may influence female susceptibility to AD neuropathology and dementia onset. We further consider common non-modifiable (genetic) and modifiable (lifestyle and health) risk factors, highlighting possible sex-dependent differential effects for the AD disease course. Finally, we evaluate the studies selected for this review demonstrating sex-differences in cognitive, pathological and health factors, summarising the state of sex differences in AD risk factors. We further provide recommendations for targeted research on female-specific risk factors, to inform personalised strategies for AD-prevention and the promotion of female brain health.
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8
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Zhou HH, Yu Z, Luo L, Xie F, Wang Y, Wan Z. The effect of hormone replacement therapy on cognitive function in healthy postmenopausal women: a meta-analysis of 23 randomized controlled trials. Psychogeriatrics 2021; 21:926-938. [PMID: 34622524 DOI: 10.1111/psyg.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
To investigate how hormone replacement therapy (HRT) intervention affects cognitive function in randomized controlled trials of healthy postmenopausal women, the PubMed and Web of Science databases were searched for relevant publications up to 1 May 2020. Random-effects, subgroup analysis, sensitivity analysis and meta-regression analyses were conducted with 23 selected publications. HRT had a significant negative effect on global cognition (standardized mean difference (SMD): -0.04, 95% confidence interval (CI): -0.08 to -0.01). Via subgroup analysis, for those older than 60 years and with more than 6 months' intervention duration, HRT aggravated global cognition (SMD: -0.05, 95% CI: -0.08 to -0.01; SMD: -0.05, 95% CI: -0.08 to -0.01). The results of meta-regression demonstrated no significant association between HRT intervention and global cognition after adjusting for participants' age or intervention duration. In conclusion, HRT had a significant negative effect on global cognition, and this effect might be especially more visible for those aged more than 60 years and with more than 6 months' intervention. Further randomized controlled trials for postmenopausal women with a younger age and short-term HRT exposure are necessary to clarify the effects of HRT on global and domain-specific cognitive functions.
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Affiliation(s)
- Huan-Huan Zhou
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lan Luo
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Fangfei Xie
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yun Wang
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zhongxiao Wan
- School of Public Health, Medical College of Soochow University, Suzhou, China.,College of Public Health, Zhengzhou University, Zhengzhou, China
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9
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Eye-movements during number comparison: Associations to sex and sex hormones. Physiol Behav 2020; 227:113161. [PMID: 32861751 PMCID: PMC7610954 DOI: 10.1016/j.physbeh.2020.113161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
Abstract
Multi-digit numbers are of a hierarchical nature with whole number magnitudes depending on digit magnitudes. Processing of multi-digit numbers can occur in a holistic or decomposed fashion. The unit-decade compatibility effect during number comparison is often used as a measure of decomposed processing. It refers to the fact that performance is reduced when the larger number contains the smaller unit digit (e.g. 73 vs. 26). It has been demonstrated that women show a larger compatibility effect than men, which is in accordance with their general tendency towards focusing on stimulus details during processing of visual hierarchical stimuli (local processing style). Such a local processing style has been related to higher progesterone and lower testosterone levels. One method to study individual processing styles is eye-tracking. The aim of the present study was to examine whether sex and sex hormones (estradiol, progesterone, testosterone) relate to eye movement behavior in the number comparison task. Unlike previous studies we found no evidence for sex differences in the behavioral compatibility effect. Nevertheless, women look more often and longer at individual digits and show a stronger compatibility effect in fixation durations compared to men, while men show more saccades between numbers than women. Estradiol and progesterone were related to fewer fixations and shorter fixation durations and more saccades between numbers in men, but not in women. Furthermore, the compatibility effect in the number of fixations and fixation durations was negatively related to testosterone in women. In summary, this is the first study to demonstrate sex differences and sex hormone influences on eye gaze behavior during number comparison.
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Yare K, Woodward M. Hormone Therapy and Effects on Sporadic Alzheimer’s Disease in Postmenopausal Women: Importance of Nomenclature. J Alzheimers Dis 2020; 73:23-37. [DOI: 10.3233/jad-190896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Katrine Yare
- Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
| | - Michael Woodward
- Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
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11
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Konishi K, Cherkerzian S, Aroner S, Jacobs EG, Rentz DM, Remington A, Aizley H, Hornig M, Klibanski A, Goldstein JM. Impact of BDNF and sex on maintaining intact memory function in early midlife. Neurobiol Aging 2019; 88:137-149. [PMID: 31948671 DOI: 10.1016/j.neurobiolaging.2019.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/30/2019] [Accepted: 12/14/2019] [Indexed: 01/06/2023]
Abstract
Sex steroid hormones and neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), play a significant neuroprotective role in memory circuitry aging. Here, we present findings characterizing the neuroprotective effects of BDNF on memory performance, as a function of sex and reproductive status in women. Participants (N = 191; mean age = 50.03 ± 2.10) underwent clinical and cognitive testing, fMRI scanning, and hormonal assessments of menopausal staging. Memory performance was assessed with the 6-Trial Selective Reminding Test and the Face-Name Associative Memory Exam. Participants also performed a working memory (WM) N-back task during fMRI scanning. Results revealed significant interactions between menopausal status and BDNF levels. Only in postmenopausal women, lower plasma BDNF levels were associated with significantly worse memory performance and altered function in the WM circuitry. BDNF had no significant impact on memory performance or WM function in pre/perimenopausal women or men. These results suggest that in postmenopausal women, BDNF is associated with memory performance and memory circuitry function, thus providing evidence of potential sex-dependent factors of risk and resilience for early intervention.
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Affiliation(s)
- Kyoko Konishi
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Aroner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily G Jacobs
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| | - Dorene M Rentz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Remington
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harlyn Aizley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jill M Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Yoon BK, Chin J, Kim JW, Shin MH, Ahn S, Lee DY, Seo SW, Na DL. Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial. Menopause 2019; 25:870-876. [PMID: 29846283 DOI: 10.1097/gme.0000000000001140] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to explore the therapeutic potential of menopausal hormone therapy (MHT) in women with mild cognitive impairment (MCI). METHODS Thirty-seven postmenopausal women (age range: 57-82 y) with multiple-domain, amnestic subtype MCI were randomly assigned to either placebo (n = 18) or MHT (n = 19) for 24 months (percutaneous estradiol [E2] gel [0.1%, 2 mg/d] and oral micronized progesterone [MP4] [100 mg/d]). All participants received donepezil, and apolipoprotein E genotype was determined. The primary endpoint was general cognitive function: Alzheimer's disease Assessment Scale, cognitive subscale, the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of the Montreal Cognitive Assessment (MoCA_K) were performed in-person every 6 months. RESULTS Twenty-one participants (placebo 13, MHT 8) completed the trial (56.8%). Progression rates to dementia were 52.9% (9/17) in the placebo group and 44.4% (8/18) in the MHT group. Within-group analysis showed that all three tests significantly worsened during the trial in the placebo, but not the MHT groups. Analysis adjusted for ε4 allele demonstrated that MHT significantly reduced deterioration of MoCA_K score, a sensitive tool for assessing global cognition in MCI (P = 0.0261). Compared with the control group, both MoCA_K (P = 0.043; mean difference, 3.85; 95% CI, -0.46 to 8.16) and K-MMSE (P = 0.0319; mean difference, 3.26; 95% CI, 0.04-6.48) scores were significantly better at 24 months in the MHT group. CONCLUSIONS Long-term MHT using percutaneous E2 gel and oral MP4 might attenuate cognitive decline in postmenopausal women with MCI.
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Affiliation(s)
- Byung-Koo Yoon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soohyun Ahn
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
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13
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Impact of adrenal hormones, reproductive aging, and major depression on memory circuitry decline in early midlife. Brain Res 2019; 1721:146303. [PMID: 31279842 DOI: 10.1016/j.brainres.2019.146303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022]
Abstract
Dehydroepiandrosterone-sulfate (DHEAS) is an adrenal androgen that is, in part, aromatized to estradiol. It continues to be produced after menopause and provides estrogenicity after depletion of ovarian hormones. Estradiol depletion contributes to memory circuitry changes over menopause, including changes in hippocampal (HIPP) and dorsolateral- and ventrolateral-prefrontal cortex (DLPFC; VLPFC) function. Further, major depressive disorder (MDD) patients have, in general, lower levels of estradiol and lower DHEAS than healthy controls, thus potentially a higher risk of adverse menopausal outcomes. We investigated whether higher DHEAS levels after menopause is associated with better memory circuitry function, especially in women with MDD. 212 adults (ages 45-55, 50% women) underwent clinical and fMRI testing. Participants performed a working memory (WM) N-back task and an episodic memory verbal encoding (VE) task during fMRI scanning. DHEAS levels were significantly associated with memory circuitry function, specifically in MDD postmenopausal women. On the WM task, lower DHEAS levels were associated with increased HIPP activity. On the VE task, lower DHEAS levels were associated with decreased activity in the HIPP and VLPFC. In contrast, there was no association between DHEAS levels and memory circuitry function in MDD pre/perimenopausal women, men, and non-MDD participants regardless of sex and reproductive status. In fact, MDD postmenopausal women with higher levels of DHEAS were similar to MDD pre/perimenopausal women and men. Thus, memory circuitry deficits associated with MDD and a lower ability of the adrenal gland to produce DHEAS after menopause may contribute to a lower ability to maintain intact memory function with age.
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14
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Chen X, Li J, Zhang J, He X, Zhu C, Zhang L, Hu X, Wang K. Impairment of the executive attention network in premenopausal women with hormone receptor-positive breast cancer treated with tamoxifen. Psychoneuroendocrinology 2017; 75:116-123. [PMID: 27815995 DOI: 10.1016/j.psyneuen.2016.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 10/09/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023]
Abstract
Tamoxifen (TAM) is most commonly prescribed for patients with hormone-sensitive breast cancer and exerts agonistic/antagonistic effects on estrogen receptors throughout the body. Accumulating evidence has revealed that breast cancer patients receiving TAM manifest cognitive dysfunction. However, whether these patients have a global attention deficit or a more selective impairment of specific attention networks remains unknown. In the present study, we sought to explore the attention function of premenopausal women with hormone receptor-positive breast cancer treated with TAM using the attention network test (ANT). The subjects included breast cancer patients receiving TAM (TAM, N=43), breast cancer patients not receiving TAM (non-TAM, N=41), and matched healthy controls (HC, N=46). The subjects completed the ANT and neuropsychological tests, which measure three independent attention networks and executive function performance, respectively. Our results indicated that patients in the TAM group had significant deficits in their executive control component but not in the alerting or orienting components. Moreover, the patients showed poor executive function performance in the neuropsychological tests. Additionally, in the TAM group, significant correlations were found between the decreased efficiency of the executive control component and their reduced performance in executive function tests. This study demonstrates that premenopausal women with hormone receptor-positive breast cancer treated with TAM have impairment of the executive attention network and that this impairment was associated with differences in executive function performance.
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Affiliation(s)
- Xingui Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Jingjing Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjie Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoxuan He
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Chunyan Zhu
- Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Lei Zhang
- Department of Medical Psychology, Anhui Medical University, Hefei, China
| | | | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, Anhui Medical University, Hefei, China.
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15
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Braden BB, Dassel KB, Bimonte-Nelson HA, O'Rourke HP, Connor DJ, Moorhous S, Sabbagh MN, Caselli RJ, Baxter LC. Sex and post-menopause hormone therapy effects on hippocampal volume and verbal memory. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 24:227-246. [PMID: 27263667 DOI: 10.1080/13825585.2016.1182962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many studies suggest sex differences in memory and hippocampal size, and that hormone therapy (HT) may positively affect these measures in women; however, the parameters of HT use that most likely confer benefits are debated. We evaluated the impact of sex and postmenopausal HT use on verbal learning and memory and hippocampal size in 94 cognitively intact women and 49 men. Using analysis of covariance that controlled for age and education, women had better total word learning and delayed verbal memory performance than men. HT analyses showed that non-HT users performed similarly to men, while HT users performed better than men in Delayed Memory regardless of whether use was current or in the past. Women had larger hippocampal volumes than men regardless of whether they were HT users. Using univariate linear models, we assessed group differences in the predictive value of hippocampal volumes for verbal learning and memory. Hippocampal size significantly predicted memory performance for men and non-HT users, but not for HT users. This lack of relationship between hippocampal size and verbal learning and memory performance in HT users suggests HT use may impact memory through extra-hippocampal neural systems.
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Affiliation(s)
- B Blair Braden
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Kara B Dassel
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | | | - Holly P O'Rourke
- b Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Donald J Connor
- c The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Sallie Moorhous
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Marwan N Sabbagh
- c The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Richard J Caselli
- d Department of Neurology , Mayo Clinic Arizona , Scottsdale , AZ , USA
| | - Leslie C Baxter
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
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16
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Guerrieri GM, Wakim PG, Keenan PA, Schenkel LA, Berlin K, Gibson CJ, Rubinow DR, Schmidt PJ. Sex differences in visuospatial abilities persist during induced hypogonadism. Neuropsychologia 2015; 81:219-229. [PMID: 26719236 DOI: 10.1016/j.neuropsychologia.2015.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/04/2015] [Accepted: 12/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite well-established sex differences in the performance on tests of several cognitive domains (e.g., visuospatial ability), few studies in humans have evaluated if these sex differences are evident both in the presence of circulating sex hormones and during sex steroid hormonal suppression. Sex differences identified in the relative absence of circulating levels of estradiol and testosterone suggest that differences in brain structure or function exist independent of current hormonal environment and are more likely a reflection of differing developmental exposures and/or genetic substrates. OBJECTIVE To evaluate cognitive performance in healthy eugonadal men and women before and again during GnRH agonist-induced hypogonadism. METHODS Men (n=16) and women (n=15) without medical or psychiatric illness were matched for IQ. Cognitive tests were performed at baseline (when eugonadal) and after 6-8 weeks of GnRH agonist-induced gonadal suppression. The test batteries included measures of verbal and spatial memory, spatial ability, verbal fluency, motor speed/dexterity, and attention/concentration. Data were analyzed using repeated-measures models. RESULTS During both eugonadism and hypogonadism, men performed significantly better than women on several measures of visuospatial performance including mental rotation, line orientation, Money Road Map, Porteus maze, and complex figure drawing. Although some test performances showed an effect of hormone treatment, the majority of these differences reflected an improved performance during hypogonadism compared with baseline (and probably reflected practice effects). CONCLUSION The well-documented male advantage in visuospatial performance, which we observed during eugonadal conditions, was maintained in the context of short-term suppression of gonadal function in both men and women. These findings suggest that, in humans, sex differences in visuospatial performance are not merely dependent on differences in the current circulating sex steroid environment. Thus sex differences in visuospatial performance in adulthood could reflect early developmental effects of sex steroid exposure or other environmental exposures differing across the sexes as our data confirm that these differences are independent of circulating estradiol or testosterone levels in men and women.
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Affiliation(s)
- Gioia M Guerrieri
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bldg. 10-CRC, Room 25330, 10 Center Drive, MSC 1277, Bethesda, MD 20892-1277, United States
| | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD 20892, United States
| | - P A Keenan
- Cronos Clinical Consulting (formerly Wayne State University), 22 Tanglewood Drive, Titusville, NJ 08560, United States
| | - Linda A Schenkel
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bldg. 10-CRC, Room 25330, 10 Center Drive, MSC 1277, Bethesda, MD 20892-1277, United States
| | - Kate Berlin
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bldg. 10-CRC, Room 25330, 10 Center Drive, MSC 1277, Bethesda, MD 20892-1277, United States
| | - Carolyn J Gibson
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bldg. 10-CRC, Room 25330, 10 Center Drive, MSC 1277, Bethesda, MD 20892-1277, United States
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Peter J Schmidt
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bldg. 10-CRC, Room 25330, 10 Center Drive, MSC 1277, Bethesda, MD 20892-1277, United States.
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17
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Ycaza Herrera A, Mather M. Actions and interactions of estradiol and glucocorticoids in cognition and the brain: Implications for aging women. Neurosci Biobehav Rev 2015; 55:36-52. [PMID: 25929443 DOI: 10.1016/j.neubiorev.2015.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/30/2015] [Accepted: 04/17/2015] [Indexed: 02/03/2023]
Abstract
Menopause involves dramatic declines in estradiol production and levels. Importantly, estradiol and the class of stress hormones known as glucocorticoids exert countervailing effects throughout the body, with estradiol exerting positive effects on the brain and cognition, glucocorticoids exerting negative effects on the brain and cognition, and estradiol able to mitigate negative effects of glucocorticoids. Although the effects of these hormones in isolation have been extensively studied, the effects of estradiol on the stress response and the neuroprotection offered against glucocorticoid exposure in humans are less well known. Here we review evidence suggesting that estradiol-related protection against glucocorticoids mitigates stress-induced interference with cognitive processes. Animal and human research indicates that estradiol-related mitigation of glucocorticoid damage and interference is one benefit of estradiol supplementation during peri-menopause or soon after menopause. The evidence for estradiol-related protection against glucocorticoids suggests that maintaining estradiol levels in post-menopausal women could protect them from stress-induced declines in neural and cognitive integrity.
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Affiliation(s)
- Alexandra Ycaza Herrera
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA 90089, United States.
| | - Mara Mather
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA 90089, United States.
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18
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Luine VN. Estradiol and cognitive function: past, present and future. Horm Behav 2014; 66:602-18. [PMID: 25205317 PMCID: PMC4318702 DOI: 10.1016/j.yhbeh.2014.08.011] [Citation(s) in RCA: 294] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 12/13/2022]
Abstract
A historical perspective on estradiol's enhancement of cognitive function is presented, and research, primarily in animals, but also in humans, is reviewed. Data regarding the mechanisms underlying the enhancements are discussed. Newer studies showing rapid effects of estradiol on consolidation of memory through membrane interactions and activation of inter-cellular signaling pathways are reviewed as well as studies focused on traditional genomic mechanisms. Recent demonstrations of intra-neuronal estradiol synthesis and possible actions as a neurosteroid to promote memory are discussed. This information is applied to the critical issue of the current lack of effective hormonal (or other) treatments for cognitive decline associated with menopause and aging. Finally, the critical period hypothesis for estradiol effects is discussed along with novel strategies for hormone/drug development. Overall, the historical record documents that estradiol positively impacts some aspects of cognitive function, but effective therapeutic interventions using this hormone have yet to be realized.
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Affiliation(s)
- Victoria N Luine
- Department of Psychology, Hunter College of CUNY, New York, NY, USA.
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19
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Petersen N, Patihis L, Nielsen SE. Decreased susceptibility to false memories from misinformation in hormonal contraception users. Memory 2014; 23:1029-38. [PMID: 25142128 DOI: 10.1080/09658211.2014.949777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sex hormones are increasingly implicated in memory formation. Recent literature has documented a relationship between hormones and emotional memory and sex differences, which are likely related to hormones, have long been demonstrated in a variety of mnemonic domains, including false memories. Hormonal contraception (HC), which alters sex hormones, has been associated with a bias towards gist memory and away from detailed memory in women who use it during an emotional memory task. Here, we investigated whether HC was associated with changes in susceptibility to false memories, which may be related to the formation of gist memories. We tested false memory susceptibility using two well-validated false memory paradigms: the Deese-Roediger-McDermott (DRM) task, and a story-based misinformation task. We found that hormonal contraceptive users were less susceptible to false memories compared to non-users in the misinformation task, and no differences were seen between groups on the DRM task. We hypothesise that the differences in false memories from the misinformation task may be related to hormonal contraceptive users' memory bias away from details, towards gist memory.
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Affiliation(s)
- Nicole Petersen
- a Semel Institute , University of California , Los Angeles , CA , USA
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20
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Chen X, Li J, Chen J, Li D, Ye R, Zhang J, Zhu C, Tian Y, Wang K. Decision-making impairments in breast cancer patients treated with tamoxifen. Horm Behav 2014; 66:449-56. [PMID: 25036869 DOI: 10.1016/j.yhbeh.2014.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 07/02/2014] [Accepted: 07/09/2014] [Indexed: 01/16/2023]
Abstract
The selective estrogen receptor modulator tamoxifen (TAM) is most commonly prescribed for patients with hormone-sensitive breast cancer. Although TAM can bind to estrogen receptors in the nervous system, it is unknown whether it acts as an estrogen agonist or antagonist in the human brain. Several studies have reported the negative effects of TAM on cognitive function; however, its effects on decision-making function have not been previously explored. The present study aimed to investigate the decision-making function under ambiguity and risk in breast cancer patients treated with TAM. Participants included breast cancer patients taking TAM (TAM, n=47) and breast cancer patients not taking TAM (non-TAM, n=45) as well as their matched healthy controls (HC, n=50). All participants were given the Iowa Gambling Task (IGT) to assess their decision-making under conditions involving ambiguity, the Game of Dice Task (GDT) to assess their decision-making under conditions involving risk, and a battery of neuropsychological tests. Our results indicated that patients in the TAM group were significantly impaired as assessed by both the IGT and GDT and performed significantly worse on some aspects of various tasks involving memory and information processing. Furthermore, we found that decreased performance on verbal memory testing significantly correlated with IGT performance, and executive dysfunction was associated with poor GDT performance in breast cancer patients undergoing TAM treatment. This study demonstrates that breast cancer patients taking TAM have several decision-making impairments. These findings may support the idea that TAM resulting in cognitive changes plays an antagonistic role in the areas of the brain where estrogen receptors are present, including the prefrontal cortex, hippocampus and amygdala.
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Affiliation(s)
- Xingui Chen
- Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Oncology, The Second Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Juluo Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dandan Li
- Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rong Ye
- Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjie Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chunyan Zhu
- Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Persistent cognitive changes in breast cancer patients 1 year following completion of chemotherapy. J Int Neuropsychol Soc 2014; 20:370-9. [PMID: 24229809 DOI: 10.1017/s1355617713001215] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Numerous studies have shown that there are acute cognitive side-effects of chemotherapy for breast cancer. Presumably, patients are more concerned about chronic treatment effects. This report from a prospective longitudinal study compares cognitive functioning in 56 breast cancer patients 1 year after chemotherapy to that of 56 healthy individuals. Neuropsychological test scores were combined into verbal memory, visual memory, working memory, and processing speed scores, as well as an overall summary score, and analyzed using multi-level growth modeling. Frequency of cognitive decline was assessed using regression-based change scores. There was significant rebound in the overall summary score from end of treatment to 1-year follow-up as well as a substantial reduction in the frequency of cognitive decline. However, more than one-third of the breast cancer patients who showed cognitive decline immediately following completion of chemotherapy showed persistent cognitive decline 1 year later. Furthermore, recovery was not seen in all cognitive domains. In fact, the rebound was significant only for working memory. Longer multi-site studies are recommended to explore the risk factors for and the permanence of these longer-term cognitive effects.
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22
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Ball A, Wolf CC, Ocklenburg S, Brüne M, Wolf OT, Güntürkün O, Pinnow M. The type of implicit motive enactment is modulated by sex hormones in naturally cycling women. Physiol Behav 2014; 123:119-26. [DOI: 10.1016/j.physbeh.2013.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
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Abstract
AbstractStudies in both rodents and humans have made much progress in shedding light on how fluctuations in ovarian hormones can affect memory in women across the lifespan. Specifically, advances in neuroscience have identified multiple memory systems that are each mediated by different brain areas. Two memory systems used to navigate an environment are ‘place’ and ‘response’ memory. They are defined as either using an allocentric strategy: using a spatial or cognitive map of the surroundings, or an egocentric strategy: using habitual-turns/movements, respectively. Studies in neuroendocrinology have shown that estrogen levels can bias a female to use one memory system over another to solve a task, such that high estrogen levels are associated with using place memory and low levels with using response memory. Furthermore, recent advances in identifying and localizing estrogen receptors in the rodent brain are uncovering which brain regions are affected by estrogen and providing insight into how hormonal fluctuations during the menstrual cycle, pregnancy, and menopause might affect which memory system is facilitated or impaired in women at different life stages. These studies can help point the way to improving cognitive health in women.
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Letrozole Potentiates Mitochondrial and Dendritic Spine Impairments Induced by β Amyloid. J Aging Res 2013; 2013:538979. [PMID: 23956860 PMCID: PMC3730361 DOI: 10.1155/2013/538979] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022] Open
Abstract
Reduced estrogens, either through aging or postsurgery breast cancer treatment with the oral nonsteroidal aromatase inhibitor letrozole, are linked with declined cognitive abilities. However, a direct link between letrozole and neuronal deficits induced by pathogenic insults associated with aging such as beta amyloid (Aβ 1-42) has not been established. The objective of this study was to determine if letrozole aggravates synaptic deficits concurrent with Aβ 1-42 insult. We examined the effects of letrozole and oligomeric Aβ 1-42 treatment in dissociated and organotypic hippocampal slice cultures. Changes in glial cell morphology, neuronal mitochondria, and synaptic structures upon letrozole treatment were monitored by confocal microscopy, as they were shown to be affected by Aβ 1-42 oligomers. Oligomeric Aβ 1-42 or letrozole alone caused decreases in mitochondrial volume, dendritic spine density, synaptophysin (synaptic marker), and the postsynaptic protein, synaptopodin. Here, we demonstrated that mitochondrial and synaptic structural deficits were exacerbated when letrozole therapy was combined with Aβ 1-42 treatment. Our novel findings suggest that letrozole may increase neuronal susceptibility to pathological insults, such as oligomeric Aβ 1-42 in Alzheimer's disease (AD). These changes in dendritic spine number, synaptic protein expression, and mitochondrial morphology may, in part, explain the increased prevalence of cognitive decline associated with aromatase inhibitor use.
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Abstract
OBJECTIVE The critical window hypothesis of hormone therapy (HT) and cognitive function states that the effects of HT depend on timing of initiation with respect to age, the menopausal transition, or both, and that optimal effects are evident with early initiation. This article reviews clinical studies that bear on this hypothesis. METHODS Recognizing that the typical pattern of HT use is early HT initiation, this review describes findings from observational studies of ever use of HT and observational studies that looked specifically at the timing of HT on Alzheimer's disease (AD) and cognitive test performance. Randomized trials of HT and verbal memory are discussed, and neuroimaging studies bearing on the hypothesis are reviewed. RESULTS Observational data suggest that HT generally reduces the risk of AD. Three of three observational studies that specifically examined the timing of initiation in relation to AD risk each provide support for the window, whereas three of five observational studies of HT timing and cognitive test performance do. Randomized clinical trials of estrogen therapy in younger women find support for the hypothesis. Conjugated equine estrogens/medroxyprogesterone acetate increases risks regardless of timing. Little is known about the cognitive effects of other combination HT formulations. CONCLUSIONS A definitive trial to test the critical window hypothesis is not feasible. Evidence drawn from other sources provides initial support for the hypothesis. Although these findings are relevant to women who use HT to treat vasomotor symptoms, HT is currently not indicated for the treatment of cognitive complaints or for dementia prevention.
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Affiliation(s)
- Pauline M Maki
- Department of Psychiatry , University of Illinois at Chicago, Chicago, IL 60612, USA.
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26
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Yesufu A, Bandelow S, Hogervorst E. Meta-analyses of the effect of hormone treatment on cognitive function in postmenopausal women. ACTA ACUST UNITED AC 2012; 3:173-94. [PMID: 19803851 DOI: 10.2217/17455057.3.2.173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As we age, most of us experience a certain degree of cognitive decline. In most cases, this decline is gradual. However, in some cases, cognitive impairment is so severe that it can be classified as dementia and this impacts greatly on activities of daily living. Alzheimer's disease, the most common form of dementia, has been linked to the reduction in estrogen levels that comes with aging. More specifically, many researchers have hypothesized that estrogen, and hence estrogen replacement via hormone therapy, could protect against cognitive decline in women. However, recent randomized, controlled trials did not reflect this. In fact, some reports showed that hormone therapy could have detrimental effects on cognitive function in older postmenopausal women. The most publicized of these has been the Women's Health Initiative Memory Study. Studies have thus yielded conflicting results and conclusions. The reasons for this may be due to a number of factors, such as the age of participants, the time of hormone therapy onset ('window of opportunity' theory), type of treatment, type of menopause (surgical or natural) and, possibly, genetic risk factors. We performed quantitative and qualitative meta-analyses and reviewed each of these factors in detail. The future may lie in combining these factors in order to fully understand the potential mechanisms behind estrogen and its effect on cognition.
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Affiliation(s)
- Amina Yesufu
- Department of Human Sciences, Loughborough University, LE11 3TU, UK.
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Frick KM. Building a better hormone therapy? How understanding the rapid effects of sex steroid hormones could lead to new therapeutics for age-related memory decline. Behav Neurosci 2012; 126:29-53. [PMID: 22289043 DOI: 10.1037/a0026660] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A wealth of data collected in recent decades has demonstrated that ovarian sex-steroid hormones, particularly 17β-estradiol (E2), are important trophic factors that regulate the function of cognitive regions of the brain such as the hippocampus. The loss of hormone cycling at menopause is associated with cognitive decline and dementia in women, and the onset of memory decline in animal models. However, hormone therapy is not currently recommended to prevent or treat cognitive decline, in part because of its detrimental side effects. In this article, it is proposed that investigations of the rapid effects of E2 on hippocampal function be used to further the design of new drugs that mimic the beneficial effects of E2 on memory without the side effects of current therapies. A conceptual model is presented for elucidating the molecular and biochemical mechanisms through which sex-steroid hormones modulate memory, and a specific hypothesis is proposed to account for the rapid memory-enhancing effects of E2. Empirical support for this hypothesis is discussed as a means of stimulating the consideration of new directions for the development of hormone-based therapies to preserve memory function in menopausal women.
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Affiliation(s)
- Karyn M Frick
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA.
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Differences in verbal memory performance in postmenopausal women receiving hormone therapy: 17β-estradiol versus conjugated equine estrogens. Am J Geriatr Psychiatry 2011; 19:792-802. [PMID: 21873835 PMCID: PMC3164805 DOI: 10.1097/jgp.0b013e3181ff678a] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Much controversy exists and many questions remain unanswered about the effects of hormone therapy (HT) on cognition in postmenopausal women. There is growing evidence suggesting that HT compounds containing conjugated equine estrogen (CEE) have negative effects on cognition whereas 17β-estradiol (17β-E) either has positive or neutral effects. The present study sought to further examine this issue in a sample of postmenopausal women with risk factors for Alzheimer's disease (AD). DESIGN Cross-sectional neuropsychological evaluation. SETTING Academic research clinic. PARTICIPANTS 68 healthy postmenopausal women (aged 49-68) receiving either 17β-E or CEE for at least one year with increased risk for AD. MEASUREMENTS Neuropsychological test battery of the cognitive domains of attention/working memory/processing speed, verbal memory, visual memory, and executive functioning. RESULTS Multivariate analyses of variance (MANOVA) showed significantly better verbal memory performance in women receiving 17β-E compared to women receiving CEE regardless of age, IQ, years of education, risk factors for AD (including APOE-ε4 carriership), duration of endogenous and exogenous estrogen exposure, concurrent progesterone use, or natural versus surgical menopause status. CONCLUSIONS Verbal memory performance was better in postmenopausal women receiving 17β-E compared to CEE in a sample population of women with risk factors for AD. Genetic risk for AD as well as other confounds did not affect this finding. The results suggest a differential effect of HT type on verbal memory, with 17β-E being a preferential compound. Further evaluation of HT types, regimens and duration of use on cognitive performance in postmenopausal women in a controlled longitudinal design is warranted.
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Bailey ME, Wang ACJ, Hao J, Janssen WGM, Hara Y, Dumitriu D, Hof PR, Morrison JH. Interactive effects of age and estrogen on cortical neurons: implications for cognitive aging. Neuroscience 2011; 191:148-58. [PMID: 21664255 DOI: 10.1016/j.neuroscience.2011.05.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/12/2011] [Accepted: 05/14/2011] [Indexed: 12/21/2022]
Abstract
In the past few decades it has become clear that estrogen signaling plays a much larger role in modulating the cognitive centers of the brain than previously thought possible. We have developed a nonhuman primate (NHP) model to investigate the relationships between estradiol (E) and cognitive aging. Our studies of cyclical E treatment in ovariectomized (OVX) young and aged rhesus monkeys have revealed compelling cognitive and synaptic effects of E in the context of aging. Delayed response (DR), a task that is particularly dependent on integrity of dorsolateral prefrontal cortex (dlPFC) area 46 revealed the following: (1) that young OVX rhesus monkeys perform equally well whether treated with E or vehicle (V), and (2) that aged OVX animals given E perform as well as young adults with or without E, whereas OVX V-treated aged animals display significant DR impairment. We have analyzed the structure of layer III pyramidal cells in area 46 in these same monkeys. We found both age and treatment effects on these neurons that are consistent with behavioral data. Briefly, reconstructions of pyramidal neurons in area 46 from these monkeys showed that cyclical E increased the density of small, thin spines in both young and aged monkeys. However, this effect of E was against a background of age-related loss of small, thin spines, leaving aged V-treated monkeys with a particularly low density of these highly plastic spines, and vulnerable to cognitive decline. Our current interpretation is that E not only plays a critically important role in maintaining spine number, but also enables synaptic plasticity through a cyclical increase in small highly plastic spines that may be stabilized in the context of learning. Interestingly, recent studies demonstrate that chronic E is less effective at inducing spinogenesis than cyclical E. We have begun to link certain molecular attributes of excitatory synapses in area 46 to E effects and cognitive performance in these monkeys. Given the importance of synaptic estrogen receptor α (ER-α) in rat hippocampus, we focused our initial studies on synaptic ER-α in area 46. Three key findings have emerged from these studies: (1) synaptic ER-α is present in axospinous synapses in area 46; (2) it is stable across treatment and age groups (which is not the case in rat hippocampus); and (3) the abundance and distribution of synaptic ER-α is a key correlate of individual variation in cognitive performance in certain age and treatment groups. These findings have important implications for the design of hormone treatment strategies for both surgically and naturally menopausal women. This article is part of a Special Issue entitled: Neuroactive Steroids: Focus on Human Brain.
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Affiliation(s)
- M E Bailey
- Department of Neuroscience, Mount Sinai School of Medicine, New York, NY 10029, USA
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Boulware MI, Kent BA, Frick KM. The impact of age-related ovarian hormone loss on cognitive and neural function. Curr Top Behav Neurosci 2011; 10:165-84. [PMID: 21533680 DOI: 10.1007/7854_2011_122] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
On average, women now live one-third of their lives after menopause. Because menopause has been associated with an elevated risk of dementia, an increasing body of research has studied the effects of reproductive senescence on cognitive function. Compelling evidence from humans, nonhuman primates, and rodents suggests that ovarian sex-steroid hormones can have rapid and profound effects on memory, attention, and executive function, and on regions of the brain that mediate these processes, such as the hippocampus and prefrontal cortex. This chapter will provide an overview of studies in humans, nonhuman primates, and rodents that examine the effects of ovarian hormone loss and hormone replacement on cognitive functions mediated by the hippocampus and prefrontal cortex. For humans and each animal model, we outline the effects of aging on reproductive function, describe how ovarian hormones (primarily estrogens) modulate hippocampal and prefrontal physiology, and discuss the effects of both reproductive aging and hormone treatment on cognitive function. Although this review will show that much has been learned about the effects of reproductive senescence on cognition, many critical questions remain for future investigation.
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Affiliation(s)
- Marissa I Boulware
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 E. Hartford Ave, Milwaukee, WI 53211, USA
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Abstract
Previous studies in postmenopausal women have reported that estrogen treatment (ET) modulates the risk for developing Alzheimer's disease (AD). It has recently been hypothesized that there may be a "critical period" around the time of menopause during which the prescription of ET may reduce the risk of developing AD in later life. This effect may be most significant in women under 49 years old. Furthermore, prescription of ET after this point may have a neutral or negative effect, particularly when initiated in women over 60-65 years old. In this paper, we review recent studies that use in vivo techniques to analyze the neurobiological mechanisms that might underpin estrogen's effects on the brain postmenopause. Consistent with the "critical period" hypothesis, these studies suggest that the positive effects of estrogen are most robust in young women and in older women who had initiated ET around the time of menopause.
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Affiliation(s)
- Michael C Craig
- Centre for Female Health and Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Kings College London, London, United Kingdom.
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Is systemic anti-cancer therapy neurotoxic? Does chemo brain exist? And should we rename it? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 678:86-95. [PMID: 20738010 DOI: 10.1007/978-1-4419-6306-2_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The existence of chemo brain has become almost universally accepted, although many details of the concept are controversial. Data about the different types of cognitive impairment and their duration are not always consistent in the literature. We still do not know which cytotoxic agents are responsible, which characteristics make patients vulnerableand which biologic mechanisms are involved. This chapter reviews the recent literature and provides an actualized definition of chemo brain, including recent functional imaging data and discusses its controversial aspects. Potential underlying mechanisms and their future possible clinical applications in the prevention and treatment of chemo brain are also discussed. These issues are of clinical importance given the prevalence of breast carcinoma, the increased use of chemotherapy as adjuvant therapy, the increasing use of more aggressive dosing schedules and the increasing survival rates. Better-designed future trials should lead to a better definition and understanding of chemo brain and to future therapies.
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Abstract
Research increasingly suggests that changes in estrogen levels during aging may increase the risk of Alzheimer's disease, the most common type of dementia. This update reviews the newest information about estrogen and cognitive aging, including information regarding the role of bioavailable estrogen in older women and men, use of selective estrogen receptor modulators to improve cognition, and studies of genetic risk factors to elucidate the effects of endogenous estrogen on aging and cognition. Future trials are needed to determine whether alternate timing, dosage, formulation, or method of administration of hormone replacement can reduce the risk of dementia.
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Affiliation(s)
- Sarah C Janicki
- G. H. Sergievsky Center, Columbia University Medical Center, 622 West 168th Street, PH-19, New York, NY 10019, USA.
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Hogervorst E, Bandelow S. Sex steroids to maintain cognitive function in women after the menopause: A meta-analyses of treatment trials. Maturitas 2010; 66:56-71. [DOI: 10.1016/j.maturitas.2010.02.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
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Abstract
The pros and cons of estrogen therapy for use in postmenopausal women continue to be a major topic of debate in women's health. Much of this debate focuses on the potential benefits vs. harm of estrogen therapy on the brain and the risks for cognitive impairment associated with aging and Alzheimer's disease. Many animal and human studies suggest that estrogens can have significant beneficial effects on brain aging and cognition and reduce the risk of Alzheimer's-related dementia; however, others disagree. Important discoveries have been made, and hypotheses have emerged that may explain some of the inconsistencies. This review focuses on the cholinergic hypothesis, specifically on evidence that beneficial effects of estrogens on brain aging and cognition are related to interactions with cholinergic projections emanating from the basal forebrain. These cholinergic projections play an important role in learning and attentional processes, and their function is known to decline with advanced age and in association with Alzheimer's disease. Evidence suggests that many of the effects of estrogens on neuronal plasticity and function and cognitive performance are related to or rely upon interactions with these cholinergic projections; however, studies also suggest that the effectiveness of estrogen therapy decreases with age and time after loss of ovarian function. We propose a model in which deficits in basal forebrain cholinergic function contribute to age-related changes in the response to estrogen therapy. Based on this model, we propose that cholinergic-enhancing drugs, used in combination with an appropriate estrogen-containing drug regimen, may be a viable therapeutic strategy for use in older postmenopausal women with early evidence of mild cognitive decline.
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Affiliation(s)
- Robert B Gibbs
- University of Pittsburgh School of Pharmacy, 1004 Salk Hall, Pittsburgh, Pennsylvania 15261, USA.
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36
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Lejbak L, Vrbancic M, Crossley M. Endocrine therapy is associated with low performance on some estrogen-sensitive cognitive tasks in postmenopausal women with breast cancer. J Clin Exp Neuropsychol 2010; 32:836-46. [DOI: 10.1080/13803391003596389] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lisa Lejbak
- a University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - Mirna Vrbancic
- a University of Saskatchewan , Saskatoon, Saskatchewan, Canada
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Braden BB, Talboom JS, Crain ID, Simard AR, Lukas RJ, Prokai L, Scheldrup MR, Bowman BL, Bimonte-Nelson HA. Medroxyprogesterone acetate impairs memory and alters the GABAergic system in aged surgically menopausal rats. Neurobiol Learn Mem 2010; 93:444-53. [PMID: 20074654 DOI: 10.1016/j.nlm.2010.01.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 12/16/2009] [Accepted: 01/06/2010] [Indexed: 11/16/2022]
Abstract
In women, medroxyprogesterone acetate (MPA) is the most commonly used progestin component of hormone therapy (HT). In vitro, MPA negatively impacts markers of neuronal health and exacerbates experimentally-induced neurotoxicity. There is in vitro evidence that these factors are driven by GABAergic and neurotrophic systems. Whether these effects translate to a negative impact on brain function has not been tested in vivo, clinically or preclinically. Here we evaluate the mnemonic and neurobiological effects of MPA in the surgically menopausal rat. Aged ovariectomized (OVX) rats were given subcutaneous vehicle, natural progesterone, low-dose MPA or high-dose MPA. Multiple cognitive domains were analyzed via the water radial-arm maze (WRAM) and Morris maze (MM). Cognitive brain regions were assayed for changes in the GABAergic system by evaluating GAD protein, the synthesizing enzyme for GABA, and neurotrophins. On the WRAM, both progestin types impaired learning. Further, high-dose MPA impaired delayed memory retention on the WRAM, and exacerbated overnight forgetting on the MM. While neurotrophins were not affected by progesterone or MPA treatment, both progestin types altered GAD levels. MPA significantly and progesterone marginally decreased GAD levels in the hippocampus, and both MPA and progesterone significantly increased GAD levels in the entorhinal cortex. These findings suggest that MPA, the most commonly used progestin in HT, is detrimental to learning and two types of memory, and modulates the GABAergic system in cognitive brain regions, in aged surgically menopausal rats. These findings, combined with in vitro evidence that MPA is detrimental to neuronal health, indicates that MPA has negative effects for brain health and function.
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Affiliation(s)
- B Blair Braden
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
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38
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Abstract
According to the 'critical period' hypothesis, which attempts to explain the observed discrepancies in the studies on estrogen and cognition, estrogen therapy effectively decreases cognitive decline in aging women when it is initiated around the time of menopause but not when it is started decades later. Here, I review studies in which the timing of the initiation of estrogen therapy was provided, to determine whether their findings support the 'critical period' hypothesis. The vast majority of the reviewed studies support the idea that early but not late initiation of estrogen therapy might prevent or delay cognitive decline in aging women. Nevertheless, numerous design issues, such as the specific drugs and doses that were used, the possible effects of progestins on cognition, and the failure to administer neuropsychological tests of specific cognitive domains that are sensitive to estrogen therapy confound the extant literature. In view of the reanalyzes of the Women's Health Initiative's data that show a beneficial effect of estrogen therapy on cardiac and breast diseases in women aged 50-59 years, more definitive evidence is needed to confirm that the early initiation of estrogen therapy that is continued for a few years provides enduring protection against cognitive aging 15-20 years later.
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Clifford A, Yesufu Udechuku A, Edwards L, Bandelow S, Hogervorst E. Maintaining cognitive health in elderly women. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ahe.09.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review indicates that possible preventative activities and lifestyle changes undertaken to maintain cognitive health and prevent dementia in old age may be particularly important in middle age. Risk factors for cardiovascular disease are the same as those for dementia, including its most common form, Alzheimer’s disease. Treating high blood pressure, high cholesterol and thyroid hormone deficiency, maintaining a normal weight, having a healthy diet and engaging in resistance or aerobic exercise can all potentially help to sustain cognitive health. Long-term treatment with estrogenic compounds (> 1 year) does not seem to be indicated and may actually confer risks for dementia in older women over the age of 65 years. The same may be the case for phytoestrogens. The possibility that folate can offset some of the negative effects of phytoestrogens merits more research in this area. Whether there is an optimum age to engage with these types of lifestyle behaviors is currently unclear and also requires additional research.
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Affiliation(s)
- Angela Clifford
- Department of Human Sciences, Brockington building, Loughborough LE11 3TU, UK
| | | | - Louisa Edwards
- Department of Human Sciences, Brockington building, Loughborough LE11 3TU, UK
| | - Stephan Bandelow
- Department of Human Sciences, Brockington building, Loughborough LE11 3TU, UK
| | - Eef Hogervorst
- Department of Human Sciences, Brockington building, Loughborough LE11 3TU, UK
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Collins B, Mackenzie J, Stewart A, Bielajew C, Verma S. Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective study. Psychooncology 2009; 18:811-21. [DOI: 10.1002/pon.1453] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Zec RF, Trivedi MA. Effects of hormone replacement therapy on cognitive aging and dementia risk in postmenopausal women: a review of ongoing large-scale, long-term clinical trials. Climacteric 2009. [DOI: 10.1080/cmt.5.2.122.134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Clinical trials yield discrepant information about the impact of hormone therapy on verbal memory and executive function. This issue is clinically relevant because declines in verbal memory are the earliest predictor of Alzheimer's disease and declines in executive function are central to some theories of normal, age-related changes in cognition. METHODS We conducted a systematic review of randomized clinical trials of hormone therapy (i.e. oral, transdermal, i.m.) and verbal memory, distinguishing studies in younger (i.e. <or=65 years of age; n = 9) versus older (i.e. >65 years; n = 7) women and studies involving estrogen alone versus estrogen plus progestogen. Out of 32 placebo-controlled trials, 17 were included (13 had no verbal memory measures and 2 involved cholinergic manipulations). We also provide a narrative review of 25 studies of executive function (two trials), since there are insufficient clinical trial data for systematic review. RESULTS There is some evidence for a beneficial effect of estrogen alone on verbal memory in younger naturally post-menopausal women and more consistent evidence from small-n studies of surgically post-menopausal women. There is stronger evidence of a detrimental effect of conjugated equine estrogen plus medroxyprogesterone acetate on verbal memory in younger and older post-menopausal women. Observational studies and pharmacological models of menopause provide initial evidence of improvements in executive function with hormone therapy. CONCLUSIONS Future studies should include measures of executive function and should address pressing clinical questions; including what formulation of combination hormone therapy is cognitively neutral/beneficial, yet effective in treating hot flashes in the early post-menopause.
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Affiliation(s)
- Pauline M Maki
- Neuropsychiatric Institute, MC 913, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL 60612, USA.
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Lacreuse A, Wilson ME, Herndon JG. No effect of different estrogen receptor ligands on cognition in adult female monkeys. Physiol Behav 2008; 96:448-56. [PMID: 19101578 DOI: 10.1016/j.physbeh.2008.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 10/30/2008] [Accepted: 11/21/2008] [Indexed: 11/16/2022]
Abstract
Many studies in women and animal models suggest that estrogens affect cognitive function. Yet, the mechanisms by which estrogens may impact cognition remain unclear. The goal of the present study was to assess the effects of different estrogen receptor (ER) ligands on cognitive function in adult ovariectomized female rhesus monkeys. The monkeys were tested for 6 weeks on a battery of memory and attentional tasks administered on a touchscreen: the object, face, and spatial versions of the Delayed Recognition Span Test (DRST) and a Visual Search task. Following a 2-week baseline period with oil vehicle treatment, monkeys were randomly assigned to one of 3 treatment groups: estradiol benzoate (EB), selective ERbeta agonist (diarylpropionitrile DPN) or selective ER modulator tamoxifen (TAM). In each treatment group, monkeys received oil vehicle for 2 weeks and the drug for 2 weeks, in a cross-over design. After a 4-week washout, a subset of monkeys was re-tested on the battery when treated with a selective ERalpha agonist (propyl-pyrazole-triol, PPT) or oil vehicle. Overall, drug treatments had no or negligible effects on cognitive performance. These results support the contention that exogenous estrogens and selective estrogen receptor modulators (SERMS) do not significantly affect cognition in young adult female macaques. Additional studies are needed to determine whether the cognitive effects of estrogens in monkeys of more advanced age are mediated by ERbeta, ERalpha or complex interactions between the two receptors.
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Affiliation(s)
- Agnès Lacreuse
- Department of Psychology, University of Massachusetts, Amherst, MA 01003, United States.
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Bergström LS, Lynöe N. Enhancing concentration, mood and memory in healthy individuals: An empirical study of attitudes among general practitioners and the general population. Scand J Public Health 2008; 36:532-7. [DOI: 10.1177/1403494807087558] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To study attitudes towards enhancing concentration, mood and memory in healthy individuals among the general public and general practitioners (GPs). Methods: A questionnaire consisting of vignettes including three cases dealing with enhancement of concentration, mood and memory was sent during 2006 to 1000 randomly selected people from Stockholm and 300 GPs. We asked about the use of pharmaceuticals for healthy individuals for the benefit of others and the benefit to oneself; we also asked whether or not society should pay the cost. Finally, we asked about enhancement of healthy people's concentration, mood and memory through the use of natural remedies. Results: Fifty-two per cent of the general public and 39% of the GPs responded. While the use of natural remedies was perceived as fairly acceptable, majorities in both groups were negative with regard to the use of pharmaceuticals to enhance concentration, mood and memory in a healthy individual. The general public tended to be less negative than the GPs. There was a significant difference between the reasons for providing enhancement; altruistic reasons seem to be more acceptable than egoistic ones. For both groups, enhancing mood was more controversial than enhancing memory. Conclusions: Despite the large dropout rate, the study indicates that enhancement by means of natural remedies of different human capacities is acceptable to the general public, while only small minorities of both groups are inclined to allow the use of pharmaceuticals. When compared to the egoistic reason, the altruistic one for enhancing concentration, mood and memory with pharmaceuticals seems to influence the general public's inclination to support prescriptions; this was also the case among the GPs, but only as regards mood enhancement.
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Affiliation(s)
- Lena Strand Bergström
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Niels Lynöe
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden,
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Lethaby A, Hogervorst E, Richards M, Yesufu A, Yaffe K. Hormone replacement therapy for cognitive function in postmenopausal women. Cochrane Database Syst Rev 2008; 2008:CD003122. [PMID: 18254016 PMCID: PMC6599876 DOI: 10.1002/14651858.cd003122.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND As estrogens have been found in animal models to be associated with the maintenance and protection of brain structures, it is biologically plausible that maintaining high levels of estrogens in postmenopausal women by medication could be protective against cognitive decline. OBJECTIVES To investigate the effect of ERT (estrogens only) or HRT (estrogens combined with a progestagen) in comparison with placebo in RCTs on cognitive function in postmenopausal women. SEARCH STRATEGY The CDCIG Specialized Register was searched 7 March 2006. Additional searches were made of MEDLINE (1966-2006/02); EMBASE (1985-2006/02); PsycINFO (1967-2006/02) and CINAHL (1982-2006/01). SELECTION CRITERIA All double-blind RCTs trials of the effect of ERT or HRT on cognitive function over a treatment period of at least two weeks in postmenopausal women. DATA COLLECTION AND ANALYSIS Selection of studies, assessment of quality and extraction of data were undertaken independently by three reviewers with disagreements resolved by discussion. MAIN RESULTS In total, 24 trials were included, but only 16 (10,114 women) had analysable data. Meta-analyses showed no effects of either ERT or HRT on prevention of cognitive impairment after five and four years of treatment, respectively (odds ratio 1.34, 95% CI 0.95 to 1.9; odds ratio 1.05, 95% CI 0.72 to 1.54 respectively) (trend favouring control in both instances). Analyses assessing the effects of treatment over time found that both ERT and HRT did not maintain or improve cognitive function and may even adversely affect this outcome (WMD = -0.45, 95% CI -0.99 to 0.09; WMD = -0.16, 95% CI -0.58 to 0.26, respectively at maximum follow up). Negative effects were found for ERT after one year and HRT after three and four years of therapy. Results from smaller trials assessing effects on individual cognitive domains mostly reported no evidence of benefit. AUTHORS' CONCLUSIONS There is good evidence that both ERT and HRT do not prevent cognitive decline in older postmenopausal women when given as short term or longer term (up to five years) therapy. It is not known whether either specific types of ERT or HRT have specific effects in subgroups of women, although there was evidence that combined hormone therapy in similarly aged women was associated with a decrement in a number of verbal memory tests and a small improvement in a test of figural memory. There is insufficient evidence to determine whether subgroups of women using specific types of hormone therapy could benefit from treatment. It remains to be determined whether factors such as younger age (< 60 years of age), type of menopause (surgical or natural) and type of treatment (type of estrogen with or without a progestagen), mode of delivery (transdermal, oral or intramuscular) and dosage have positive effects at a clinically relevant level. In addition, whether the absence or presence of menopausal symptoms can modify treatment effects should be investigated in more detail. Large RCTs currently underway in the USA may be able to provide answers to these uncertainties by the year 2010. In the meantime, based on the available evidence, ERT or HRT cannot be recommended for overall cognitive improvement or maintenance in older postmenopausal women without cognitive impairment.
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Affiliation(s)
- A Lethaby
- University of Auckland, O&G FMHS, Grafton Rd, Private Bag 92019, Auckland, New Zealand, 1142.
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Effects of letrozole on hippocampal and cortical catecholaminergic neurotransmitter levels, neural cell adhesion molecule expression and spatial learning and memory in female rats. Neuroscience 2008; 151:186-94. [DOI: 10.1016/j.neuroscience.2007.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 09/09/2007] [Accepted: 10/03/2007] [Indexed: 11/22/2022]
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Compton J, Travis MJ, Norbury R, Erlandsson K, van Amelsvoort T, Daly E, Waddington W, Matthiasson P, Eersels JLH, Whitehead M, Kerwin RW, Ell PJ, Murphy DGM. Long-term estrogen therapy and 5-HT(2A) receptor binding in postmenopausal women; a single photon emission tomography (SPET) study. Horm Behav 2008; 53:61-8. [PMID: 17956758 DOI: 10.1016/j.yhbeh.2007.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 08/20/2007] [Accepted: 08/21/2007] [Indexed: 11/23/2022]
Abstract
Variation in estrogen level is reported by some to affect brain maturation and memory. The neurobiological basis for this may include modulation of the serotonergic system. No neuroimaging studies have directly examined the effect of extended estrogen therapy (ET), on the 5-HT(2A) receptor in human brain. We investigated the effect of long-term ET on cortical 5-HT(2A) receptor availability in postmenopausal women. In a cross-sectional study, we compared cortical 5-HT(2A) receptor availability in 17 postmenopausal ERT-naive women and 17 long-term oophorectomised estrogen-users, age- and IQ-matched using single photon emission tomography and the selective 5-HT(2A) receptor ligand (123)I-5-I-R91150. Also, we used the Revised Wechsler Memory Scale to relate memory function to 5-HT(2A) receptor availability. Never-users had significantly higher 5-HT(2A) receptor availability than estrogen-users in hippocampus (1.17 vs. 1.11, respectively, p=0.02), although this did not remain significant after correction for multiple comparisons. Hippocampal 5-HT(2A) receptor availability correlated negatively with verbal and general memory and delayed recall (r=-0.45, p=0.01; r=-0.40, p=0.02; r=-0.36, p=0.04). Right superior temporal 5-HT(2A) receptor availability correlated negatively with verbal memory (r=-0.36, p=0.04). In estrogen-users, receptor availability correlated negatively with verbal and general memory (r=-0.70, p=0.002; r=-0.69, p=0.002); and in never-users, receptor availability negatively correlated with attention and concentration (r=-0.54, p=0.02). Long-term ET may be associated with lower 5-HT(2A) receptor availability in hippocampus. This may reflect increased activity within the serotonergic pathway leading to down-regulation of post-synaptic receptor. Also, increased availability of the 5-HT(2A) receptor in hippocampus is associated with poorer memory function.
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Affiliation(s)
- J Compton
- Department of Psychological Medicine, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK.
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Grigorova M, Sherwin BB. No differences in performance on test of working memory and executive functioning between healthy elderly postmenopausal women using or not using hormone therapy. Climacteric 2007; 9:181-94. [PMID: 16766432 DOI: 10.1080/13697130600727107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND On average, ovarian function ceases at the age of 52 years so that estrogen (E) levels are chronically low following the menopause. Numerous studies have found that hormone therapy (HT) helps to protect verbal memory, a hippocampal function. Estrogen receptors are also found in the prefrontal cortex (PFC), suggesting that estrogen may modulate executive and working memory functions, both mediated by the PFC. The possible role of progesterone (P) on executive functions and working memory is unknown. OBJECTIVE To examine the relationship between neuropsychological performance, age of initiation of HT, and duration of HT use. METHOD In this cross-sectional study, the neuropsychological performance of 37 postmenopausal women (mean age, 65 years) who used either estrogen-only or sequential E + P (E-alone group)(n = 22) or E + P continuously (n = 15) was compared to that of 28 healthy postmenopausal women matched for age and education who had never used HT. It was hypothesized that the E-only users would perform better then the E + P and the never-users on neuropsychological tests of verbal memory, executive function and working memory. RESULTS Results showed only minor between-group differences on working memory scores such that the E + P users were slowest to generate a response on the N-Back test of working memory. No group differences on tests of executive functions were found. CONCLUSION There was no relationship between neuropsychological performance, age of initiation of HT, or duration of HT use.
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Affiliation(s)
- M Grigorova
- Department of Psychology, McGill University, Montreal, Canada
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Abstract
Randomized controlled trials (RCTs) and observational and longitudinal studies provide positive, albeit, inconsistent evidence that estrogen might protect against cognitive decline in postmenopausal women. The fact that the Women's Health Initiative Memory Study (WHIMS), the largest RCT to date, failed to find that estrogen therapy (ET) had a protective effect against cognitive aging led to the formulation of the critical period hypothesis which holds that ET will effectively protect against memory decline when it is initiated around the time of menopause but not when considerable time has elapsed since the menopause. Evidence from basic neuroscience, and from rodent, nonhuman primate, and human studies that supports this theory is presented. Although much work remains to be done on the timing of initiation of treatment, on the most effective hormonal compounds and on their routes of administration, the hope is that, eventually, hormonal treatments may be able to attenuate or prevent the decline in aspects of cognition that occur with normal aging.
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