HRT may prevent Alzheimer's disease in menopausal women

  • In Health
  • 2023-01-14 06:00:00Z
  • By The Telegraph
HRT hormone replacement therapy menopause women Alzheimer’s disease - BSIP/UIG/Getty Images
HRT hormone replacement therapy menopause women Alzheimer’s disease - BSIP/UIG/Getty Images  

Hormone replacement therapy (HRT) may help prevent Alzheimer's disease, new research suggested.

Researchers from the University of East Anglia found that HRT, which helps control symptoms of the menopause, is associated with better memory, cognitive function and larger brain volumes in later life in women carrying a gene called APOE4.

About a quarter of women in the UK are thought to carry the APOE4 gene and Alzheimer's is more common in women than men.

Previous research found APOE4 to be a significant risk factor gene for Alzheimer's disease, although inheriting the gene does not mean that someone will definitely develop the condition.

In this latest study, published in the journal Alzheimer's Research & Therapy, the team found that HRT was most effective when given during perimenopause, where symptoms build up months or years before periods actually stop.

Alzheimer's disease is most common in people over the age of 65.

The risk of Alzheimer's and other types of dementia increases with age, affecting an estimated one in 14 people over the age of 65 and one in every six over the age of 80.

Hope amid HRT supply issues

Access to HRT has become more prominent over the past year following issues with supply.

The Government appointed a tsar to tackle the shortages after thousands of women struggled to access the key medication.

NHS figures released last year show that the number of prescriptions for HRT in England had doubled in the past five years, to more than 500,000 a month.

In this latest research, experts studied data from 1,178 women taking part in the European Prevention of Alzheimer's Dementia initiative, which was set up to study participants' brain health over time.

The project, which involved 10 countries, tracked the brains of 1,906 people over 50, who did not have dementia at the start of the study.

Prof Anne-Marie Minihane, from the UEA's Norwich Medical School, led the study with Prof Craig Ritchie from the University of Edinburgh. They looked at the results of cognitive tests and brain volumes as recorded by MRI scans.

The results showed that APOE4 carriers who also used HRT had better cognition and higher brain volumes than people not on HRT and non-APOE4 carriers.

Previous research by scientists at the Mayo Clinic in the US found oestrogen, one of the two main hormones in HRT, may have a protective effect on the brain against diseases such as Parkinson's and dementia.

Dr Rasha Saleh, a senior research associate from the Norwich Medical School, said: "We found that HRT use is associated with better memory and larger brain volumes among at-risk APOE4 gene carriers.

"The associations were particularly evident when HRT was introduced early during the transition to menopause, known as perimenopause.

"This is really important because there have been very limited drug options for Alzheimer's disease for 20 years and there is an urgent need for new treatments.

"The effects of HRT in this observation study, if confirmed in an intervention trial, would equate to a brain age that is several years younger."

Prof Minihane said that the team did not look at dementia cases, but that cognitive performance and lower brain volumes are predictive of future dementia risk.

Michael Hornberger, a professor of applied dementia research from the Norwich Medical School, said: "It's too early to say for sure that HRT reduces dementia risk in women. But our results highlight the potential importance of HRT and personalised medicine in reducing Alzheimer's risk.

"The next stage of this research will be to carry out an intervention trial to confirm the impact of starting HRT early on cognition and brain health. It will also be important to analyse which types of HRT are most beneficial."

Prof Ritchie said the study "highlights the need to challenge many assumptions about early Alzheimer's disease and its treatment, especially when considering women's brain health".

He said: "An effect on both cognition and brain changes on MRI supports the notion that HRT has tangible benefit. These initial findings need replication, however, in other populations."

Other researchers have called for HRT to be prescribed to women earlier after they found menopause "reshapes the brain".

Academics at Weill Cornell Medical College, New York, and the University of Arizona found that the menopause has a significant impact on the brain, including the reduction of grey matter and changes in blood flow.


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