Sunday, May 2, 2010

Old ladies and verbal fluency

My last post covered data on the brain health of women abruptly plunged into menopause via bilateral oophorectomies (removal of ovaries), some of whom received post-op estrogen and some of whom did not. On average, those who did fared better in cognition as they motored on in life than those who did not.

So what about ladies who just fade into senescence in a non-surgical sort of way? Well, no paucity of info on that subject either. Consider the Research into Memory, Brain function and Estrogen Replacement study--more familiarly known as the REMEMBER study--where 428 Australian old ladies were enticed down to an Adelaide research center and put through their paces.(1)

How do you know which old Australian is still on her game? Among other things, you see who is fastest on the FAS test. This is a measure of verbal fluency which requires the subject to say as many words as they can think of that start with the letter F, then A, then S in 60 second testing intervals. The doctors down under tried this very task--among other tests-- on the subjects, comparing FAS scores amongst the ladies as associated with their early, late, or never use of estrogen through the golden years of menopause.

The old gals who gravitated to estrogen with that first hot flash bested the rest in FAS facility. Compared to these so-called "early initiators," the never users were not so FASt. But oy, the "late initiators," i.e. those Jills-come-lately to hormone therapy who decided to estrogen up after age 56 or five or more years post-oophorectomy; this group was slowest of all on the word retrieval thing.

These findings mirror those of the WHIMS study wherein women who were older than 67 at the onset of the Women's Health Initiative study were put on full dose Premarin and Provera many, many years post-menopause, thus qualifying as "late-late initiators". This sub-study of the WHI followed the group for the onset of cognitive troubles over the ensuing five years. When compared with a control group given look-alike placebo Premarin, this study group demonstrated significantly more problems retaining their marbles during follow-up.

All this research suggests again a 'window of opportunity' with respect to bolstering aging brains through the use of estrogen, the so-called timing hypothesis proposed by neuroscientists. If the brain, particularly the structures of the forebrain in charge of complex cognition, is full of estrogen receptors, why would it matter when hormone therapy is initiated?

More info to follow!
(1) MacLennan, AH, et al. Hormone therapy, timing of initiation, and cognition in women aged older than 60 years: the REMEMBER pilot study. Menopause. 2006 Jan-Feb;13(1):28-36.

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