Can hormone therapy stave off Alzheimer's?

By Lindsey Konkel, MyHealthNewsDaily 

Women who carry a well-known genetic risk factor for Alzheimer's disease showed signs of more rapid aging in their body's cells than women who didn't have it, according to a new study.

The study, by researchers at Harvard and Stanford universities, may be a "critical link in our understanding of the role that APOE-e4 plays in the development of the disease," said Elizabeth Edgerly, chief program officer for the Northern California and Northern Nevada Chapter of The Alzheimer's Association. Edgerly was not involved in the study.

About 25 to 30 percent of the population carries at least one copy of APOE-e4 (each person inherits two copies, one from each parent). Forty percent of people with Alzheimer's disease are carriers.

Over the course of two years, researchers studied 63 post-menopausal women — their average age was 58 — who had been voluntarily taking hormone replacement therapy, either estrogen alone or estrogen plus progesterone, for at least one year. All the women were deemed at risk for Alzheimer's disease due to a family history of the condition. However, only 24 of the women were APOE-e4 carriers. All but one study participant was white.

At the study's start, baseline length measurements of each woman's telomeres were taken. A telomere is a "cap" on the end of each chromosome that protects the genes on the chromosome from deterioration. Every time a cell replicates, its telomeres shorten a little bit. That shortening has been associated with a number of aging-related diseases, including Alzheimer's.

Half of the women were then randomly assigned to stop taking hormone therapy while half stayed on it. After two years, the researchers measured the length of each woman's telomeres again.

The researchers found that women who were APOE-e4 carriers were six times more likely than non-carriers to exhibit obvious telomere shortening once they stopped taking hormones. In fact, APOE-e4 carriers experienced more rapid telomere shortening than non-carriers, suggesting that their cells had aged the equivalent of seven to 14 years over the course of the two-year study. But APOE-e4 carriers who remained on hormone replacement therapy showed no evidence of telomere shortening during that time.

"Our results suggest that for women with this genetic variant, hormone replacement therapy may reduce the risk for cellular aging, which may also reduce their risk of dementia," said Heather Kenna, a doctoral student in clinical psychology at Stanford University and one of the study authors. "However, we cannot make recommendations on hormone therapy from this one study alone or suggest that it will decrease risk of dementia."

It's unclear whether the protective effect the researchers saw was due to hormone replacement therapy or some other factor. For instance, there may be something different about women who chose to initiate hormone replacement therapy: they may live a healthier lifestyle or have a higher socioeconomic status, among other factors. Thus, they may not be representative of all women, Edgerly said.

"This is a promising first step, but future studies should focus on tracking larger numbers of women over a longer period of time," she said.

The current study was not designed to examine the differences between the two hormone therapy options — estrogen or estrogen plus progesterone, according to the study authors. The Women's Health Initiative, which started in 1991 and ended in 2010, found that estrogen plus progestin therapy offered no protection against mild cognitive impairment in women over age 65. In fact, women who took the hormones had an increased risk of dementia. Results from a study examining the effects of estrogen-only therapy on cognition are not yet available. The WHI involved more than 160,000 generally healthy postmenopausal women.

While genetic testing for the APOE-e4 gene type is commercially available, neither Kenna nor Edgerly recommend it for most people. Individuals with or without a family history of Alzheimer's who want to be tested for the gene must first undergo counseling so they are informed about the risks and benefits of finding out if they carry the gene.

"Knowing you have the e4 gene is a powerful piece of information — one that may have repercussions for employment and long-term-care insurance, not to mention the psychological burden of knowing you are at a much higher risk for a disease with no known cure," Edgerly said.

Also from MyHealthNewsDaily:

Discuss this post

First the article says that women were randomly assigned to take hormones or not, then it says, "there may be something different about women who chose to initiate hormone replacement therapy: they may live a healthier lifestyle or have a higher socioeconomic status, among other factors."

That makes no sense. Either the women in the study were randomly assigned to take hormones, or they chose on their own to take them -- it can't be both.

  • 2 votes
Reply#1 - Thu Feb 14, 2013 12:19 AM EST

The study participants were drawn from women already taking HRT. There may be bias introduced by the original choice of taking HRT. Half of the women in the study were then randomly assigned to go off taking HRT

I would guess that, given the studies linking higher breast cancer rates to the use of HRT, the researchers did not/could not ask women not taking HRT to begin.

It is notable that, unlike the Women's Health Inititave study, this study uses progesterone, not progestin, in as the hormone being evaluated.

    #1.2 - Thu Feb 14, 2013 10:03 AM EST
    Reply

    They call this "old timers disease" where I come from. (That's not meant in a mean way, in case anyone thinks it is)

    Its an awful affliction. I hope they find a treatment for it some day. To lose ones mind and memories, I cant think of anything worse. Basically losing who you are, and all your friends and family. It must be terrifying.

    I would rather be dead myself.. When your health goes, and everyone's does eventually. Your mind is all you have left. Except for these poor buggers..

    • 1 vote
    Reply#2 - Thu Feb 14, 2013 1:09 AM EST

    My husband is 57 and has this insidious disease. It has robbed him of everything he was and enjoyed doing. I am in the process of trying to find a home to put him in.

    In his case we believe it was caused by continued and prolonged exposure to lead and manganese as he was a welder of steel for 33 years.

    However it comes about - it is something that no one wants to endure. It's like watching an ice cube melt on a hot day, as little by little the person you knew and loved fades away.

    I think (hope?) he recognizes me when he sees me, but I'm not sure. I do believe he knows he knows me - but he doesn't know exactly who I am.

    Heartbreaking...gut wrenching...life altering...these are a few descriptions that convey the myriad of emotions I go through...every day.

      #2.1 - Thu Feb 14, 2013 10:39 AM EST

      one 25mg injection (by qualified neurologist between C6/C7 in neck to cerebral venous system) of the Natural biological compound Enbrel, Entanercept, our soluble receptor for our immflamatory Cytokine Tumor Necrosis Factor-alpha, Reverses Alzhiemer`s "Disease" in less than 30 minutes in 9 out of 10 diagnosed with such. ( Type this into youtube or National Library of Medicine- PUBMED)

      Find a Dr. NOW, That will Rx off label, or Neurosciene Institute (Proffessor Tobinik -Arcoss from UCLA & in Orange county)

      or Contact NIH Clinical Trials & "Angel Flight" Can provide free air transport.

      Also Life Extention Foundation in Florida is VERY helpful, may still have clinical Tral going on.

      Nutrtional sups also target this gene -respounce will take weeks to months but is nessesary to mantain Reversal

        #2.2 - Fri Feb 15, 2013 1:44 PM EST
        Reply
        Marlene17Deleted

        Estrogen therapy (estrogen alone) has a direct causage link to uterine cancer in women. The report didn't state which of the therapies (or both) were used in the final tally. Just that the therapy was stopped for a group of women.

        It would be interesting if the colleges involved in the study would add men over the age of 58 that were currently taking estrogen for their prostate cancer. Then it would truly prove the benefit of the estrogen treatments. If it works for both sexes.

        • 2 votes
        Reply#4 - Thu Feb 14, 2013 7:33 AM EST

        Studies do indicate a relationship between uterine cancer and estrogen. Some of the risk is related to normal differences in estrogen levels in women, such as the number of children a woman has - hormone levels change during pregnancy. The same is true of breast cancer. The risks may therefore be different depending on the nature of the hormone replacement therapy. for instance, some HRT regimes just prescribe a standard estrogen dosage for women. Pills like Premarin contain estrogens, but do not mimic the level of estrogens normall found in premenopausal women. Other HRT regimes on blood tests to determine a levels of all three estrogens and then HRT is individualized so that each of the estrogens (there are 3) are in the appropriate balance for a given woman. Whether that level of control decreases risk has not been systematically and widely studied, although there are some results that would support that hypothesis. I would guess that this is the protocol used in this study, although it isn't specified, as the study also uses progesterone, as opposed to the syntethic hormone Progestin. Many studies have shown that Progestin can increase side effectss and risks.

        There is a lot to be learned; women have complex endocrine systems and a lot of research needs to be done. I am much more afraid of Alzheimer's than I am of breast cancer, and I had to have a complete hysterectomy when I was in my 40s, so I have no risk of ovarian or uterine cancer.

        • 1 vote
        #4.1 - Thu Feb 14, 2013 10:13 AM EST

        Thanks for the info KG!

          #4.2 - Thu Feb 14, 2013 10:32 AM EST
          Reply

          This makes me want to find out whether I carry the higher risk gene not run out and get hormone replacement treatment

          • 1 vote
          Reply#5 - Thu Feb 14, 2013 7:40 AM EST

          J. Sarayda, the answer is in the post hoc analysis. They subjects could have been randomly assigned prior to the study. AFTER the study, researchers were told which took the hormones and which didn't. Then they can draw some inferences and conclusions.

            Reply#6 - Thu Feb 14, 2013 8:08 AM EST

            The researchers knew, and the answer is NOT in the post hoc analysis. They STARTED with women who were ALL on HRT. Then half were randomly assigned to go off HRT. So the initial group that was recruited to do the study was women who were all taking HRT. That choice of women taking HRT as a starting point for the research may have introduced bias as those women had some reason to have initially elected to take HRT - especially given the numbers of women that have discontinued HRT after the findings of the Women's Health Initiative that HRT leads to higher incidence of breast cancer. So these women may have had more severe post-menepausal symptoms. The article does not specify, but given it uses progeterone rather than progestin, which is synthetic and the more common drug used in HRT, these women may have been on waht is called bio-identical HRT, whereby the drugs taken are compouded and specific to a woman's own blood/body chemistry. If that is true, most insurance plans cover a very small part of that, and it can be expensive, so these women may also be from a higher socio-economic group. There may also be differences in initial health. This study does not generalize easily to women who were not or have never taken HRT.

              #6.1 - Thu Feb 14, 2013 10:21 AM EST
              Reply

              Testosterone replacement has also been linked to improved cognitive abilities in men.

                Reply#7 - Thu Feb 14, 2013 8:56 AM EST

                "Knowing you have the e4 gene is a powerful piece of information — one that may have repercussions for employment and long-term-care insurance, not to mention the psychological burden of knowing you are at a much higher risk for a disease with no known cure,"

                Yet another reason to create laws against discrimination of workers. And we all wonder why we have entitlement programs to take care of the tossed out.

                  Reply#8 - Thu Feb 14, 2013 9:27 AM EST
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