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Postmenopausal HT, diabetes may increase dementia, cognitive impairment risk
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Higher levels of estrogen may worsen the effects of type 2 diabetes on the risk for cognitive impairment among older women, according to recent study findings published in Diabetes Care.
According to the researchers, the interaction may be explained by the role estrogen plays in suppressing nonglucose-based energy sources in the brain.
Mark A. Espeland, PhD, professor of public health sciences at Wake Forest Baptist Medical Center, and colleagues evaluated data from the Women’s Health Initiative on 7,223 women aged 65 to 80 years to determine whether the effect of postmenopausal hormone therapy on cognitive impairment incidence differed with type 2 diabetes status. Follow-up was conducted for a maximum of 18 years.
Mark A. Espeland
Participants were divided into groups based on their use of postmenopausal HT and diabetes status: HT and diabetes (n = 274), placebo and diabetes (n = 264), HT without diabetes (n = 3,282) and placebo without diabetes (n = 3,413).
Conversion to probable dementia was highest in participants with diabetes assigned to HT (11.7%), followed by participants without diabetes assigned to HT (8.4%), placebo without diabetes (7.9%) and placebo with diabetes (7.2%). Rates of cognitive impairment were highest among the HT with diabetes group (23.4%), followed by the placebo with diabetes group (17.4%) and the two nondiabetes groups (14.4% for both).
Throughout follow-up, the risks for probable dementia (HR = 1.54; 95% CI, 1.16-2.06) and cognitive impairment (HR = 1.83; 95% CI, 1.5-2.23) were increased among participants with diabetes.
The risks for dementia (HR = 2.12; 95% CI, 1.47-3.06) and cognitive impairment (HR = 2.2; 95% CI, 1.7-2.87) were increased among participants with diabetes who were assigned to HT compared with participants without diabetes who were not assigned to HT.
“The adverse effects of diabetes on the cognitive function of older women appear to be accentuated by unopposed [conjugated equine estrogen] therapy,” the researchers wrote. “Whether these results apply to younger women is unknown, and the question of whether [HT] prior to menopause will yield comparable outcomes warrants further study.” – by Amber Cox
Disclosure: Espeland reports no relevant financial disclosures.
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