Hormone replacement therapy could prevent Alzheimer’s in genetically at-risk women

NORWICH, United Kingdom — Hormone replacement therapy (HRT) could help prevent the onset of Alzheimer’s in women who carry a gene which makes them more likely to develop the most common form of dementia. A team from the University of East Anglia says this type of treatment can bolster both memory and cognition among women with the APOE4 gene.

“We know that 25 percent of women in the UK are carriers of the APOE4 gene and that almost two thirds of Alzheimer’s patients are women. In addition to living longer, the reason behind the higher female prevalence is thought to be related to the effects of menopause and the impact of the APOE4 genetic risk factor being greater in women,” says Professor Anne-Marie Minihane from UEA’s Norwich Medical School, the director of the Norwich Institute for Healthy Aging, in a university release.

To determine if HRT could put a stop to cognitive decline, the research team used data on 1,178 women participating in the European Prevention of Alzheimer’s Dementia initiative, which was designed to follow brain health. Eligible participants were over the age of 50 and did not have dementia, allowing the team to study brain activity as it changed from a healthy state to a dementia state over time.

Why do women opt for HRT?

Hormone replacement therapy is a medication and procedure containing female hormones. Patients take this medication in order to replace estrogen that the body stops making during menopause. HRT is a common treatment for women dealing with common menopausal symptoms, including hot flashes and vaginal discomfort.

“We found that HRT use is associated with better memory and larger brain volumes among at-risk APOE4 gene carriers. The associations were particularly evident when HRT was introduced early – during the transition to menopause, known as perimenopause. This is really important because there have been very limited drug options for Alzheimer’s disease for 20 years and there is an urgent need for new treatments,” says Dr. Rasha Saleh, also from UEA’s Norwich Medical School. “The effects of HRT in this observation study, if confirmed in an intervention trial, would equate to a brain age that is several years younger.”

Minihane clarifies that they specifically examined cognition and brain volume, which is a relationship that is closely related to predicting dementia but doesn’t directly correlate. As such, this work can’t quite say with certainty that HRT reduces dementia risk in women.

Nonetheless, there is a connection worth exploring further, the researchers say. This work challenges what’s already known about Alzheimer’s and the level of care possible to prevent it. Now, the team plans to conduct treatment-based research in order to explore how HRT implementation into clinical care can improve brain health outcomes.

“The next stage of this research will be to carry out an intervention trial to confirm the impact of starting HRT early on cognition and brain health. It will also be important to analyze which types of HRT are most beneficial,” says Prof. Michael Hornberger from UEA’s Norwich Medical School.

The findings are published in the journal Alzheimer’s Research and Therapy.

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About the Author

Shyla Cadogan

Shyla Cadogan is a recent graduate from the University of Maryland, College Park with a Bachelor’s of Science in Nutrition and Food Science. She is on her way to becoming a Registered Dietitian, with next steps being completion of a dietetic internship at the University of Maryland Medical Center where she currently is gaining experience with various populations and areas of medical nutrition such as Pediatrics, Oncology, GI surgery, and liver and renal transplant. Shyla also has extensive research experience in food composition analysis and food resource management.

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