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Clinical AdvisorCan Estrogen Prevent Alzheimer Disease in Women? A Window of Opportunity

New Insights into the Timing and Efficacy of Estrogen Replacement for Cognitive Decline

As Alzheimer’s disease (AD) continues to affect millions, particularly women, the medical community is exploring preventative measures like estrogen hormone therapy (EHT). This article digs into the complex relationship between estrogen levels, particularly around menopause, and the onset of AD, shedding light on the potential benefits and risks of EHT as a preventative measure.

HCN Medical Memo
The evolving research on EHT and Alzheimer’s disease offers a nuanced view of potential preventative measures, particularly for female patients. Although EHT is not yet endorsed as a primary prevention method for AD, understanding the timing and context could be crucial for future treatment protocols. Further research is needed, but the window around menopause may offer a unique opportunity for intervention.

Key Points
  • Approximately 6.5 million people aged 65 and older in the US have AD, nearly two-thirds of whom are women.
  • Estrogen facilitates cognitive function and declines during menopause, leading researchers to investigate its role in AD prevention.
  • The Women’s Health Initiative (WHI) study on postmenopausal EHT was controversial and based on incomplete statistics.
  • Recent studies suggest that EHT started near the onset of menopause is safe and could decrease all-cause mortality.

From 2000 to 2019, the mortality rate for AD increased by more than 145%, while the number of deaths from heart disease and stroke decreased

Additional Points
  • AD is the fifth-leading cause of death among people aged 65 years and older.
  • The presence of the APOE-e4 gene has been associated with an increased risk for AD.
  • Current guidelines do not support EHT as primary prevention for cognitive dysfunction, citing a lack of conclusive evidence.

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