Impact of Type 2 Diabetes and Postmenopausal Hormone Therapy on Incidence of Cognitive Impairment in Older Women
Authors
Espeland, Mark A.Brinton, Roberta Diaz.
Hugenschmidt, Christina
Manson, JoAnn E.
Craft, Suzanne
Yaffe, Kristine
Weitlauf, Julie
Vaughan, Leslie
Johnson, Karen C.
Padula, Claudia B.
Jackson, Rebecca D.
Resnick, Susan M.
WHIMS Study Group
Ockene, Judith K.
UMass Chan Affiliations
Department of Medicine, Division of Preventive and Behavioral MedicinePrevention Research Center
Document Type
Journal ArticlePublication Date
2015-12-01Keywords
Endocrinology, Diabetes, and MetabolismObstetrics and Gynecology
Psychiatry and Psychology
Women's Health
Metadata
Show full item recordAbstract
OBJECTIVE: In older women, higher levels of estrogen may exacerbate the increased risk for cognitive impairment conveyed by diabetes. We examined whether the effect of postmenopausal hormone therapy (HT) on cognitive impairment incidence differs depending on type 2 diabetes. RESEARCH DESIGN AND METHODS: The Women's Health Initiative (WHI) randomized clinical trials assigned women to HT (0.625 mg/day conjugated equine estrogens with or without [i.e., unopposed] 2.5 mg/day medroxyprogesterone acetate) or matching placebo for an average of 4.7-5.9 years. A total of 7,233 women, aged 65-80 years, were classified according to type 2 diabetes status and followed for probable dementia and cognitive impairment (mild cognitive impairment or dementia). RESULTS: Through a maximum of 18 years of follow-up, women with diabetes had increased risk of probable dementia (hazard ratio [HR] 1.54 [95% CI 1.16-2.06]) and cognitive impairment (HR 1.83 [1.50-2.23]). The combination of diabetes and random assignment to HT increased their risk of dementia (HR 2.12 [1.47-3.06]) and cognitive impairment (HR 2.20 [1.70-2.87]) compared with women without these conditions, interaction P = 0.09 and P = 0.08. These interactions appeared to be limited to women assigned to unopposed conjugated equine estrogens. CONCLUSIONS: These analyses provide additional support to a prior report that higher levels of estrogen may exacerbate risks that type 2 diabetes poses for cognitive function in older women. The role estrogen plays in suppressing non-glucose-based energy sources in the brain may explain this interaction. long as the work is properly cited, the use is educational and not for profit, and the work is not altered.Source
Diabetes Care. 2015 Dec;38(12):2316-24. doi: 10.2337/dc15-1385. Epub 2015 Oct 20. Link to article on publisher's siteDOI
10.2337/dc15-1385Permanent Link to this Item
http://hdl.handle.net/20.500.14038/44619PubMed ID
26486190Notes
Judith Ockene is a collaborator in the for the WHIMS Study Group. For full list of collaborators see article.
Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.2337/dc15-1385