Estrogen replacement therapy seemed a promising treatment for Alzheimer’s disease, or AD, after several small clinical trials. However, a recent study shows that estrogen replacement is not effective in slowing mental deterioration in Alzheimer’s patients. The report appears in the Feb. 23 issue of the Journal of the American Medical Association.
“Overall, the results of this study do not support the role of estrogen in the treatment of AD,” wrote study authors, led by Ruth A. Mulnard, R.N., D.N.Sc., of the Institute for Brain Aging and Dementia at the University of California, Irvine.
The study, the largest and longest of its kind, randomly divided 120 women with mild to moderate Alzheimer’s disease into three groups: one receiving a low dose of estrogen, another receiving a high dose of estrogen and a third receiving a placebo pill, which did not contain estrogen. Only women who had had a hysterectomy prior to enrollment were eligible for the trial. Ninety-seven women completed the study.
Researchers followed the progress of the patients for up to 15 months, regularly assessing their overall mental ability in addition to their mood, memory, attention, language skills, motor function and daily living activities.
Estrogen replacement therapy did not slow the mental decline of the Alzheimer’s patients studied. Eighty percent of the patients taking estrogen showed deterioration in their conditions compared to 74 percent of the patients taking a placebo. Low doses of estrogen were associated with some initial, short-term improvements in mental ability, consistent with earlier studies. This progress, however, was not sustained for the study’s duration.
In an interview with the American Council on Science and Health, Mulnard said she and her colleagues were surprised and disappointed by the findings. But, Mulnard added, “the results are very important to women. Positive or negative, the study is an important contribution.”
Alzheimer’s disease is estimated to affect more than 4 million people in the United States. The majority are women. The disease, which typically begins after age 60, is characterized by a progressive deterioration of memory, language ability, visuospatial skills and judgment. Currently, there is no cure for Alzheimer’s, although some medications are effective in easing certain symptoms.
While the latest study indicates that estrogen is not effective in treating existing AD, study authors remain optimistic that estrogen may still prove useful in preventing or retarding the start of AD.
“This is a definitive study for the kind of women we studied,” Mulnard said. “But, it does not answer questions for all women with Alzheimer’s disease.”
“One thing is very clear,” Mulnard stressed, “Estrogen could still play a very big role in preventing disease.” She noted that there are already several large studies underway examining whether estrogen may prevent AD.
In an editorial accompanying the latest report, Yale researchers emphasized that the findings could only be limitedly generalized. They also encouraged more research on estrogen and Alzheimer’s disease.
“The conclusions are valid only for a very specific population, women of advanced age (approximately 75 years) with AD of mild to moderate severity,” commented Bennett A. Shaywitz, M.D., and Sally E. Shaywitz, M.D. “It remains for future studies to determine the role of estrogen, if any, in preventing or delaying the onset of AD.”
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