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Alzheimer’s and HRT: Study suggests sweet spot to avoid dementia

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Alzheimer’s disease hits women harder than men — more than two-thirds of those who fall into the devastating twilight of dementia are female at birth. It is likely due to biological reasons and is not yet fully understood. Alzheimer’s Association.

One big part of the mystery: Women lose sex hormones such as estrogen during menopause. Or by surgical removal of the ovaries. However, it is also unclear how the loss of these hormones and the effects of hormone replacement therapy (HRT) affect the risk of dementia.

A new study may have revealed a piece or two of the puzzle.woman who received Early (40–45 years) or early (<40 years) Women who started hormone replacement therapy after menopause or more than five years after menopause had higher levels of tau in the brain, study found published on monday In the journal JAMA Neurology.

Tau tangles, along with plaques composed of beta-amyloid protein, are hallmark signs of Alzheimer’s disease.

“This is the first study to show that delayed use of hormone therapy appears to be associated with elevated levels of Alzheimer’s disease markers in the brain,” said lead author and neurologist at Massachusetts General Hospital in Boston. Researcher Gillian Coughlan said.

But these changes only occurred in women who already had high levels of beta-amyloid in their brain tissue, Coughlan told CNN.

“Most of the associations we’ve seen between menopause and tau protein occurred in the context of high amyloid,” Coughlan said. It’s not that uncommon.”

Hormone replacement therapy did not affect the risk of dementia unless it was started late, says a new study.

But tau deposits are rarer, she said, adding that both tau tangles and beta-amyloid are required to develop Alzheimer’s disease. Cognitive decline usually occurs within a few years,” Coughlan said.

“What we found is that women who go through menopause early or who use hormone therapy very late may be at higher risk, but that’s because they have elevated levels of amyloid and already have Alzheimer’s disease. “There was no such association in women with very low amyloid levels and early menopause.”

The study also found that “women who started hormone therapy at an appropriate time near menopause did not have higher or lower levels of tau protein in their brains.” It’s good because it means you may still be able to use hormone therapy to treat menopausal symptoms.”

Dr. Richard Isaacson, an Alzheimer’s disease prevention neurologist at the Institute for Neurodegenerative Diseases, thought the scientific paper was important.

“This isn’t the first time research has shown that early treatment with hormone replacement therapy may be more protective for the brain in women, but higher levels of tau protein may delay initiation of hormone therapy. It’s the first time it’s been suggested,” said Isaacson, who was not involved in the study.

“This study does not show that hormone therapy causes Alzheimer’s disease. I can’t confirm the statement.

“Hormone therapy has important benefits for many women and can help combat symptoms that menopause can bring,” said Imarisio, who was not involved in the study. These results should not deter women who have or are considering having it, and those who are concerned about the effects of this treatment should consult with their physician.”

The average age of menopause, defined as the absence of menstruation in a woman for 12 consecutive months, is 51, but women can enter menopause naturally between the ages of 40 and 58. North American Menopause SocietySymptoms such as hot flashes and night sweats can occur years earlier and are called peri-menopause.

Hormone replacement therapy has become a hot topic for many women since the early misleading results. 2002 issue From a study called Women’s Health Initiative Clinical TrialsA preliminary analysis found that combined estrogen and progestin therapy (a type of HRT prescribed at the time) increased the risk of heart disease, stroke, blood clots, dementia, and breast cancer. The study was stopped early due to hazards.

Fallout was dramatic.By the end of the year, the use of hormone therapy 30% less When analyzed by insurance claims. By 2009, claims for hormone therapy were down more than 70%.

Ten years later, the Women’s Health Initiative found that exposed. Because the original analysis included women over the age of 65, who are already at high risk of heart attacks, blood clots, and stroke, the first results in 2002 did not consider women’s age at the start of replacement therapy. , there was an error.

But the damage was done. Even today, many doctors are uncomfortable with the use of hormone therapy, and many women are helpless and suffer devastating symptoms.

the current medical guidelines The benefits of hormone therapy for hot flashes, night sweats, vaginal pain and dryness, urinary problems, and bone loss suggest that the risks outweigh the risks for women under 60 years of age within 10 years of onset of menopause.History of breast cancer, blood clots, stroke, etc. taboo.

It’s a different story for women over the age of 60, or those who started hormone therapy more than 10 years after menopause. “Because of the high absolute risk of coronary heart disease, stroke, venous thromboembolism, and dementia, the benefit/risk ratio looks less favorable,” he said. 2022 Position Statement on Hormone Therapy of the North American Menopausal Society.

In the new JAMA Neurology study, a team of researchers from Boston-based Massachusetts General Hospital and Brigham and Women’s Hospital analyzed brain scans of 193 women and 99 men with normal cognition to identify beta-amyloid and We investigated the pathology of tau.

This may sound like a small study, but it’s not, Coughlan said.

The study found that women had higher accumulations of tau in some parts of the brain than men of the same age, said a professor of neurodegeneration and associate director of the Center for Discovery and Brain Sciences at the University of Edinburgh, Scotland. Tara Spiers-Jones said she was not involved in the study.

“Furthermore, women had a higher tau load than men when they had amyloid lesions in their brains,” Spires-Jones said in a statement.

The women in the new study all used the type of hormone therapy (a mix of estrogen and progestin) used by women in clinical trials for the Women’s Health Initiative, which has caused much controversy.

“If[our study]could be replicated, we might have discovered a potential biologic basis for the results of the Women’s Health Initiative clinical trial. therapy,” she said.

However, women today have many other options for hormone replacement, depending on their individual needs.

This study had several limitations. Most of the participants were white, and the study did not reveal who later developed dementia, experts say. What’s more, not enough people with a genetic risk for Alzheimer’s disease participated in the study, said Dr Liz Coulthard, an associate professor of dementia neurology at the University of Bristol in the UK. was not involved.

“Recently, we found that HRT may have different effects in people at high genetic risk (positive for the apoE4 gene), but this is beyond the scope of this article.

“The results here are of scientific interest,” she added. “However, research into the relationship between HRT, menopause, and Alzheimer’s disease is plagued by multiple small studies, all of which point to different reasons why people are prescribed HRT and the accuracy of menopausal memory. and the use of HRT.

“As a result, women receive conflicting or unjustified advice about whether HRT use will benefit their future brain health,” Coulthard said. “The only way to truly understand whether HRT is detrimental to brain health is through years of strong, balanced trials of HRT.”

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