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From Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System (Drs. Asthana, Baker, Craft, Veith, Raskind, and Plymate), Seattle/Tacoma, WA; Departments of Medicine (Drs. Asthana and Plymate) and Psychiatry and Behavioral Sciences (Drs. Baker, Craft, Veith and Raskind), University of Washington School of Medicine, Seattle; and Department of Obstetrics and Gynecology (Dr. Stanczyk), University of Southern California, Los Angeles.
Address correspondence and reprint requests to Dr. S. Asthana, MD, GRECC (A-182), VA Puget Sound Health Care System, American Lake Division, Tacoma, WA 98493; e-mail: sasthana{at}u.washington.edu
Objective:— To characterize the cognitive and neuroendocrine response to treatment with a high dose of estrogen for postmenopausal women with AD.
Methods:— Twenty postmenopausal women with AD were randomized to receive either 0.10 mg/day of 17ß-estradiol by skin patch or a placebo patch for 8 weeks. Subjects were evaluated at baseline, at weeks 3, 5, and 8 during treatment, and again 8 weeks after treatment termination. During each visit, cognition was assessed with a battery of neuropsychological tests, and blood samples were collected to measure plasma estradiol as well as several other neuroendocrine markers of interest.
Results:— Significant effects of estrogen treatment were observed on attention (Stroop Color Word Interference Test), verbal memory (Buschke Selective Reminding Test), and visual memory (Figure Copy/Memory). In addition, women treated with estrogen demonstrated improved performance on a test of semantic memory (Boston Naming Test) compared with subjects who received a placebo. Estrogen appeared to have a suppressive effect on the insulin-like growth factor (IGF) system such that plasma concentration of IGF binding protein-3 was significantly reduced and plasma levels of estradiol and IGF-I were negatively correlated during estrogen treatment.
Conclusions:— Administration of a higher dose of estrogen may enhance attention and memory for postmenopausal women with AD. Although these findings provide further clinical evidence to support a cognitive benefit of estrogen for women with AD, studies evaluating the effect of estradiol administration, in particular, using larger sample sizes and for longer treatment durations are warranted before the therapeutic potential of estrogen replacement for women with AD can be firmly established.
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