Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition
IntroductionDespite evidence from preclinical studies suggesting estrogen’s neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial.MethodsWe used random-effect meta-analysis and multi-level meta-regression to derive pooled standardize...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-03-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1350318/full |
| _version_ | 1797279235121872896 |
|---|---|
| author | Caroline Andy Matilde Nerattini Steven Jett Caroline Carlton Camila Zarate Camila Boneu Francesca Fauci Trisha Ajila Michael Battista Silky Pahlajani Silky Pahlajani Paul Christos Matthew E. Fink Schantel Williams Roberta Diaz Brinton Lisa Mosconi Lisa Mosconi |
| author_facet | Caroline Andy Matilde Nerattini Steven Jett Caroline Carlton Camila Zarate Camila Boneu Francesca Fauci Trisha Ajila Michael Battista Silky Pahlajani Silky Pahlajani Paul Christos Matthew E. Fink Schantel Williams Roberta Diaz Brinton Lisa Mosconi Lisa Mosconi |
| author_sort | Caroline Andy |
| collection | DOAJ |
| description | IntroductionDespite evidence from preclinical studies suggesting estrogen’s neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial.MethodsWe used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants.ResultsAssociations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT.DiscussionThese findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs. |
| first_indexed | 2024-03-07T16:21:21Z |
| format | Article |
| id | doaj.art-09c67cec818f437db119942f3f7e5e33 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-07T16:21:21Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-09c67cec818f437db119942f3f7e5e332024-03-04T04:51:34ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922024-03-011510.3389/fendo.2024.13503181350318Systematic review and meta-analysis of the effects of menopause hormone therapy on cognitionCaroline Andy0Matilde Nerattini1Steven Jett2Caroline Carlton3Camila Zarate4Camila Boneu5Francesca Fauci6Trisha Ajila7Michael Battista8Silky Pahlajani9Silky Pahlajani10Paul Christos11Matthew E. Fink12Schantel Williams13Roberta Diaz Brinton14Lisa Mosconi15Lisa Mosconi16Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Radiology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Population Health Sciences, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United StatesDepartment of Neurology, Weill Cornell Medicine, New York, NY, United StatesDepartment of Radiology, Weill Cornell Medicine, New York, NY, United StatesIntroductionDespite evidence from preclinical studies suggesting estrogen’s neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial.MethodsWe used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants.ResultsAssociations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT.DiscussionThese findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs.https://www.frontiersin.org/articles/10.3389/fendo.2024.1350318/fullHRT (hormone replacement therapy)Alzheimer diseasecognitionmeta-analysismenopause |
| spellingShingle | Caroline Andy Matilde Nerattini Steven Jett Caroline Carlton Camila Zarate Camila Boneu Francesca Fauci Trisha Ajila Michael Battista Silky Pahlajani Silky Pahlajani Paul Christos Matthew E. Fink Schantel Williams Roberta Diaz Brinton Lisa Mosconi Lisa Mosconi Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition Frontiers in Endocrinology HRT (hormone replacement therapy) Alzheimer disease cognition meta-analysis menopause |
| title | Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition |
| title_full | Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition |
| title_fullStr | Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition |
| title_full_unstemmed | Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition |
| title_short | Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition |
| title_sort | systematic review and meta analysis of the effects of menopause hormone therapy on cognition |
| topic | HRT (hormone replacement therapy) Alzheimer disease cognition meta-analysis menopause |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1350318/full |
| work_keys_str_mv | AT carolineandy systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT matildenerattini systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT stevenjett systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT carolinecarlton systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT camilazarate systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT camilaboneu systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT francescafauci systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT trishaajila systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT michaelbattista systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT silkypahlajani systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT silkypahlajani systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT paulchristos systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT matthewefink systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT schantelwilliams systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT robertadiazbrinton systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT lisamosconi systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition AT lisamosconi systematicreviewandmetaanalysisoftheeffectsofmenopausehormonetherapyoncognition |