Hormone replacement therapy in postmenopausal women with Alzheimer’s disease: a randomized, prospective study
Presented at the 11th Annual Meeting of the North American Menopause Society, Orlando, Florida, September 7–9, 2000.
Received 14 January 2002; received in revised form 10 June 2002; accepted 10 June 2002.
Abstract
Objective
To compare the therapeutic efficacy of hormone replacement therapy (HRT) and tacrine in Alzheimer’s disease.
Design
Six-month, randomized, open-label study.
Setting
University hospital.
Patient(s)
Fifty-five women with mild to moderate Alzheimer’s disease were randomly assigned to tacrine (n = 26) or HRT (n = 29).
Intervention(s)
In the tacrine group, an initial dose of 40 mg/day was increased up to 160 mg/day. In the HRT group, conjugated equine estrogen was given to patients without uteri (n = 3) or together with micronized progesterone to patients with uteri (n = 26).
Main outcome measure(s)
Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test, Boston Naming Test, Controlled Oral Word Association Test, Geriatric Depression Scale, Hamilton Depression Scale (HDS), and Instrumental Activities of Daily Living (IADL).
Result(s)
Thirty-three patients who completed the outcome measures (tacrine, 17; HRT, 16) were included in an intent-to-treat analysis. The results did not differ between groups except for IADL, which rated more highly after HRT. Apolipoprotein E genotype effects were assessed. MMSE and HDS scores were improved after tacrine treatment in ε4-negative patients.
Conclusion(s)
Overall efficacy of estrogen plus progesterone combination was similar to tacrine for cognition and mood, but greater for ADL. In ε4-negative patients, tacrine is preferable for cognition and mood.
aDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
bDepartment of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
cDepartment of Clinical Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
dDepartment of Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
eDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
fDepartment of Psychology, Hallym University, Chunchon, South Korea
Reprint requests: Duk L. Na, M.D., Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea (FAX: 82-2-3410-0052).
ABSTRACT