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Reproductive Hormones and Dementia

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Reproductive Medicine for Clinical Practice

Part of the book series: Reproductive Medicine for Clinicians ((REMECL,volume 1))

Abstract

Dementia usually is a terminal outcome of diseases of the aging brain. It is so pervasive and fateful a condition that it demands the attention of the general and healthcare communities, so much so that it is itself often treated as a disease. This is confusing and takes the spotlight from dementia’s underlying causes. And, while the management of dementia is of immediate importance for the individual patient and the surrounding community, it has drawn attention from the necessity of understanding dementia’s underlying cause(s). In order to avoid the worldwide tsunami of demented, aging individuals that is bearing down on society, the focus must shift from treatment to identification and prevention of the underlying diseases that dementia represents.

This chapter focuses on the common coexistence of Alzheimer disease (leading to Alzheimer dementia, AD) and vascular insufficiency (leading to vascular dementia, VD) underlying dementia to drive home the need for discerning the presence and effect of AD and VD in studies that test the effects of hormones, especially estrogens, in prevention of dementia.

Presently available data confirm the common coexistence of AD and VD in cases of dementia and the prevalence of dementia in aging women over men. As well, studies have shown that the age-corrected predominance of demented women over men is prevented by menopausal hormone treatment (MHT)/estrogen treatment (ET), especially if the treatment is started around the time of menopause and continues for 5 or more years. Estrogen has been shown to be the active agent of this prevention.

Since clinical studies have shown that estrogen does not affect the rate of minimal cognitive impairment (a precursor of AD, MCI), or the course of established AD, AD may not be the clinical target for the salutary actions of estrogen/ET/MHT on dementia. Rather, since estrogen in MHT prevents atherogenesis and possibly amyloid vascular plaques, we propose that estrogen/MHT prevention of dementia is due to the prevention of VD. Testing of this hypothesis should be a high priority.

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Acknowledgements

Helpful discussions with Dr. Mony de Leon are gratefully acknowledged.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

    Frederick Naftolin & Amanda Orley

  2. Department of Gynecology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP/EPM, São Paulo, Brazil

    Ivaldo Silva

Authors
  1. Frederick Naftolin
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  2. Ivaldo Silva
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  3. Amanda Orley
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Corresponding author

Correspondence to Frederick Naftolin .

Editor information

Editors and Affiliations

  1. Department Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel

    Joseph G. Schenker

  2. Department of Obstetrics and Gynecology, Northwestern Medical Faculty Foundation, Chicago, USA

    John J. Sciarra

  3. Obstetrics and Gynaecology, University Hospital Schleswig-Holst, Kiel, Germany

    Liselotte Mettler

  4. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

  5. Professor emeritus of Gynaecological Endocrinology and Reproductive Medicine, University of Bern, Bern, Switzerland

    Martin Birkhaeuser

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Naftolin, F., Silva, I., Orley, A. (2018). Reproductive Hormones and Dementia. In: Schenker, J., Sciarra, J., Mettler, L., Genazzani, A., Birkhaeuser, M. (eds) Reproductive Medicine for Clinical Practice. Reproductive Medicine for Clinicians, vol 1. Springer, Cham. https://doi.org/10.1007/978-3-319-78009-2_16

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  • DOI: https://doi.org/10.1007/978-3-319-78009-2_16

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