Alcohol, estrogen replacement therapy, and visuospatial processes in postmenopausal women

Sex difference in association between tardive dyskinesia and cognitive deficits in patients with chronic schizophrenia

BACKGROUND

Tardive dyskinesia (TD), a side effect due to long-term use of antipsychotic medication, is associated with cognitive impairment. Several studies have found sex differences in cognitive impairment in schizophrenia patients, while whether there are sex differences in cognitive performance in schizophrenia patients with TD has not been reported.

METHODS

A total of 496 schizophrenia inpatients and 362 healthy controls were recruited for this study. We used the Positive and Negative Syndrome Scale (PANSS) to assess patients' psychopathological symptoms and the Abnormal Involuntary Movement Scale (AIMS) to assess the severity of TD. Cognitive function was measured in 313 of these inpatients and 310 of healthy controls using the Repeatable Battery for Assessment of Neuropsychological Status (RBANS).

RESULTS

Patients with schizophrenia performed worse in all cognitive domains than healthy controls(all p < 0.001). Compared to patients without TD, patients with TD had higher PANSS total, PANSS negative symptom subscale and AIMS scores (all p < 0.001), while RBANS total, visuospatial/constructional and attention subscale scores were significantly lower (all p < 0.05). In addition, the visuospatial/constructional and attention indices remained significantly lower in male patients with TD than those without TD (both p < 0.05), but these results were not observed in female patients. Moreover, visuospatial/constructional and attention indices were negatively correlated with total AIMS scores only in male patients (both p < 0.05).

CONCLUSION

Our results suggest that there may be sex differences in cognitive impairment in schizophrenia patients with comorbid TD, indicating that female gender may have a protective effect on cognitive impairment in schizophrenia patients caused by TD.

Longer duration of hormonal contraceptive use predicts better cognitive outcomes later in life

BACKGROUND

The cognitive effects of postmenopausal hormone therapy (HT) have been studied extensively, but little is known about the relationship between premenopausal hormone use and cognition. Hormonal contraceptive use vs. nonuse may be a potential factor influencing cognitive processes in midlife. The aim of this study is to explore the effect of modification of hormone milieu through use of hormonal contraception in premenopausal women and midlife cognitive function.

METHODS

Subjects were 261 cognitively normal women, aged 40-65 (mean μ=52), enrolled in the Wisconsin Registry for Alzheimer's Prevention. All women completed the Women's Health History Questionnaire and a self-report health history questionnaire and were administered a battery of neuropsychologic tests. Cognitive results were analyzed using summary scores for the domains of Verbal Ability, Visuo-spatial Ability, Working Memory, Verbal Learning & Memory, and Speed & Flexibility derived using a confirmatory factor analysis.

RESULTS

Hormonal contraceptive ever users performed significantly better than never users in the domains of Visuo-spatial Ability (μ=0.75, 95% confidence interval [CI] 0.23-1.28, p=0.005) and Speed & Flexibility (μ=0.52, 95% CI -0.16-1.04, p=0.007), with duration-dependent increases in performance, especially in ever users with ≥ 15 years of use.

CONCLUSIONS

These data provide preliminary evidence that hormonal contraceptive use may influence cognitive outcomes, even years after use is discontinued. Hormonal contraceptive users scored better in domains of Visuo-spatial Ability and Speed & Flexibility than never users, with a duration-dependent trend. Further research is needed to explore the use of hormonal contraceptives to prevent or delay cognitive decline and to clarify the physiologic basis of this phenomenon.

Effects of alcohol- and cigarette-use disorders on global and specific measures of cognition in middle-age adults

OBJECTIVE

This study examined the effects of alcohol- and tobacco-use disorders on global and specific cognitive abilities in middle age.

METHOD

The sample consisted of 118 men and 169 women ranging in age from 31 to 60 years (M [SD] = 43.59 [6.58]). Lifetime diagnoses were determined from a semistructured interview. Information about current levels of alcohol and cigarette use was also collected. A comprehensive neurocognitive assessment measuring global cognition, memory, and executive-functioning abilities was administered. Baseline cognition was estimated from average composite scores of the Iowa Test of Basic Skills school-achievement tests administered from third through eighth grade. Repeated-measures analysis of variance was used. Covariates comprised baseline cognition, current depression symptoms, and medication use.

RESULTS

Lifetime alcohol- and tobacco-use disorders were not associated with cognition among men. Women having a diagnosis of tobacco dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) performed less well on measures of global cognition and executive functioning. A lifetime diagnosis of DSM-IV alcohol abuse or dependence was associated with higher working memory among women only.

CONCLUSIONS

These results demonstrate few negative effects of alcohol-use disorders on midlife cognition, especially if current consumption is light. Differential susceptibility to the effects of cigarette use on cognition was found with women showing greater deficits in visuospatial abilities, processing speed, and executive-functioning abilities.

Alcohol and estrogen replacement therapy in postmenopausal women. Direct and mediated effects on cognitive component processes

The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors. Postmenopausal women (n = 298) completed a battery of cognitive tests designed to assess speed and accuracy of episodic and knowledge-based cognitive processing. Potentially confounding variables were categorized and tested as mediators in hierarchical regression analyses. Moderate drinking was a weak predictor of episodic availability prior to removal of potential mediators. ERT use was a significant predictor of episodic and knowledge-based availability; no mediators were identified. Alcohol moderated ERT, as a combined alcohol/ERT variable was shown to be related to cognition. Neither moderate drinking nor ERT use was associated with cognitive speed. These findings suggest that positive relationships between alcohol and cognition are likely mediated by other variables, and should not be regarded as a benefit of drinking. Further, results support ERT as a predictor of knowledge-based and episodic availability, independent of mood stabilization or socioeconomic influences. Finally, alcohol and ERT appear to interact to impact both episodic and knowledge-based performance.

Association between alcohol intake and domain-specific cognitive function in older women

Moderate levels of alcohol intake may be associated with better cognitive function; however, this relationship may vary between cognitive domains. Women, aged 65-80 years, enrolled in the Women's Health Initiative (WHI) randomized clinical trials of hormone therapy, underwent annual standardized testing for global cognitive function through the ancillary WHI Memory Study (average follow-up of 4.5 years) and domain-specific cognitive function through the WHI Study of Cognitive Aging (average follow-up of 1.7 years). Compared to nondrinkers, women reporting moderate levels of alcohol intake (<or=3 drinks per day) performed better on a measure of global cognitive function. Women reporting any alcohol intake also performed better on tests of verbal knowledge, verbal fluency, figural memory, verbal memory, attention and working memory, and motor speed (all p < 0.05), but not spatial ability (p = 0.36). After covariate adjustment, mean scores were higher among women reporting >or=1 drink/day by 5.7% for verbal knowledge (p < 0.001) and by 5.7% for phonemic fluency (p = 0.004), compared to never-drinkers. Moderate levels of alcohol intake are associated with somewhat better cognition, which may be expressed most strongly in functions related to verbal knowledge and phonemic fluency. However, our observational study cannot rule out confounding associations with unmeasured factors.

Hormone replacement therapy and cognitive performance in postmenopausal women—a review by cognitive domain

Laboratory, animal and neuroimaging evidences suggest that hormone replacement therapy (HRT) may be beneficial to human cognition. This systematic review includes 26 studies on the association between HRT and cognition and 17 studies on HRT and risk of dementia. It was hypothesised that HRT would have a positive association with cognitive speed and verbal memory and possibly visual memory but not with executive functioning, and would be associated with a decreased risk of dementia. Evidence for HRT's neuroenhancing and neuroprotective properties was also evaluated. There was significant statistical and clinical heterogeneity among studies precluding meta-analysis. Results showed no consistent relationship between HRT and performance in any cognitive domain. Cross-sectional studies tended to report more positive results than longitudinal studies and randomised-controlled trials, particularly in the areas of verbal memory and executive functioning. HRT was associated with decreased risk of dementia in observational studies, but with increased risk in one randomised-controlled trial. Cognitive improvement or maintenance are not secondary benefits of HRT.

Does drinking have effects on mood and cognition in male and female students?

Self-ratings of mood and bodily symptoms were made by groups of IQ and education-matched male and female students [teetotal, low (2-9 units/week for both sexes; 1 UK unit=8 g alcohol) and moderate (12-34 units/week for males; 10-24 units/week for females) drinkers], before the start and at the end of cognitive testing. Multivariate analyses of variance (MANOVAs) showed that there were significant Alcohol x Time interactions, because the teetotal group responded to the cognitive tests with greater increases in the factors of somatic anxiety and aggressive mood than did the other two groups. Thus, the teetotallers had greater ratings of anxiety, sweating, palpitations, irritability, headache, feeling angry, quarrelsome, belligerent, resentful, hostile, spiteful and rebellious. No differences were found in immediate or delayed logical memory, in verbal fluency, trails, clock-drawing or mental flexibility tests. In tests of sustained attention [rapid visual information processing (RVIP)] and planning, males performed better than females. The moderate-alcohol group performed better than the low-alcohol group in RVIP and planning (completed significantly more tasks in the minimum moves), although in the hardest parts of the latter test, they took longer in planning the initial move. In conclusion, there was no evidence that the group drinking moderate levels of alcohol had any cognitive impairment and the teetotal group responded to the cognitive tests with the greatest increases in negative mood.