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Alzheimer's, Dementia & Mental Health
Dementia in Older Men Associated with High Levels of
Female Hormone
High estrogen may be consequence of, or early AD sign,
rather than cause
July 24, 2006 - A new study has found that higher
estrogen levels in older men are associated with an increased risk of
dementia. By contrast, levels of testosterone were not associated with
cognitive decline. An earlier study found that older women receiving
estrogen therapy had increased risk of dementia.
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Alzheimer's, Dementia & Mental Health |
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As our population ages, the impact of dementia will
grow. By the year 2050, some 13 million Americans could have Alzheimer's
disease, which is the most common cause of dementia. Researchers are
searching to understand risk factors and some studies have suggested
that sex hormones play a role.
One large study showed that women receiving
estrogen therapy had an increased risk of cognitive impairment and
dementia. However, the evidence for how testosterone levels affect men
is contradictory.
To better understand the role of sex hormones in
dementia, the researchers studied whether older men's levels of
testosterone and estrogen were associated with their risk of cognitive
decline and developing dementia, including Alzheimer's disease.
The researchers, led by Mirjam Geerlings, Ph.D. of
the University Medical Center Utrecht, examined data from the
prospectively studied population-based cohort of 2974 Japanese-American
men aged 70 to 91 who participated in the Honolulu-Asia Aging Study.
Participants showed no signs of dementia at
baseline in 1991-1993, at which time fasting blood samples were drawn.
The researchers measured the levels of testosterone and estradiol, the
major estrogen in humans, in the samples and the men were reexamined for
evidence of cognitive decline or dementia in 1994-1996 and 1997-1999
using the Cognitive Abilities Screening Instrument (CASI). At each exam,
researchers also collected physical, demographic and medical
information.
A total of 2,300 men completed the study and 223
were diagnosed with incident dementia during the follow-up period. 134
men developed Alzheimer's disease, and 44 developed vascular dementia.
The researchers used Cox regression analyses, adjusting for age and
other covariates, to see if hormone levels were associated with risk of
developing dementia
"Levels of bioavailable testosterone were not
associated with risk of cognitive decline and incident dementia," they
report. "In contrast, higher levels of bioavailable estradiol were
associated with an increased risk for cognitive decline and Alzheimer's
disease."
Note: "bioavailable" refers to the degree to which
a substance can be absorbed and utilized by those parts of the body on
which it is intended to have an effect.
For each standard deviation increase in estradiol
level, the risk for the disease went up by 25 percent. Furthermore,
compared with the lowest tertile of estradiol, men in the middle and
highest tertile had .24 and .28 points lower CASI scores, respectively,
for each year increase in age.
Note: "Estradiol" is an estrogenic hormone produced
in the ovaries and synthesized for use in treating estrogen deficiency
and breast cancer.
The researchers hypothesize that the estradiol
association could be explained by increased aromatase activity in the
brain, which may be associated with a neurodegenerative process. It is
then possible that the high levels of estradiol are a consequence or
early marker of Alzheimer's disease rather than a cause.
Some caution is needed when interpreting the
results, as, due to death or refusal, some men could not be given a
diagnosis of dementia or follow-up cognitive testing.
In conclusion, the authors report, "our findings of
an increased risk of cognitive decline and Alzheimer's disease
associated with higher estradiol are similar to recent findings in
postmenopausal women. Further studies are needed to examine whether
there are mechanisms by which estradiol may increase risk of cognitive
decline and dementia."
Notes:
The study is in the August issue of Annals of
Neurology, a journal published by John Wiley & Sons. (http://www.interscience.wiley.com/journal/ana).
Article: "Endogenous sex hormones, cognitive
decline and future dementia in old men." Geerlings, Mirjam; Strozyk,
Dorothea; Masaki, Kamal; Remaley, Alan; Petrovitch, Helen; Ross,
Webster; White, Lon; Launer, Lenore. Annals of Neurology; August 2006; (DOI:
10.1002/ana.20918).
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