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Julie L. Mitchell, MD, MS; Karen J. Cruickshanks, PhD; Barbara E. K. Klein, MD; Mari Palta, PhD; David M. Nondahl, MS

Arch Intern Med. 2003;163:2485-2490.

Background  Cognitive impairment is a common and potentially debilitating medical problem in older women. Postmenopausal hormone therapy (HT) has been associated with better cognitive function, but the literature is conflicting. Results of recent trials suggest that HT is inappropriate for prevention of heart disease, and we sought to determine the role of HT in the risk of cognitive impairment.

Methods  We measured HT use and cognitive function in a population-based cohort of 1462 postmenopausal women participating in the 5-year follow-up examination for the Epidemiology of Hearing Loss Study in 1998-2000. The cohort was defined in 1987-1988 by residency in Beaver Dam, Wis, and an age of 43 to 84 years. Women had also participated in the Beaver Dam Eye Study baseline examination in 1988-1990. Use of HT was assessed at the Beaver Dam Eye Study baseline (1988-1990), 5-year follow-up (1993-1995), and 10-year follow-up (1998-2000) visits. Cognitive impairment was defined as a low Mini-Mental State Examination score or a reported diagnosis of Alzheimer disease.

Results  Six percent of participants (n = 94) were impaired; these women were significantly older and less educated than those who were unimpaired. In age- and education-adjusted analysis, current HT use was not significantly associated with cognitive impairment (odds ratio, 0.6; 95% confidence interval, 0.2-1.3). Similarly, cognitive impairment was not associated with past HT use or duration of HT use.

Conclusion  In this large population-based study, postmenopausal horomone therapy was not significantly associated with better cognitive function.

From the Department of Medicine, Medical College of Wisconsin, Milwaukee (Dr Mitchell); and the Departments of Population Health Sciences (Drs Cruickshanks and Palta) and Ophthalmology and Visual Sciences (Drs Cruickshanks and Klein and Mr Nondahl), University of Wisconsin–Madison. The authors have no relevant financial interest in this article.

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