Alzheimer's Disease and Estrogen Replacement Therapy: Another Factor to Consider
Dahl, Deana E.
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Alzheimer's disease (AD) is rapidly becoming an important women's health issue based on recent epidemiological studies demonstrating the increased incidence among women. Several recent studies have shown a strong correlation between estrogen and the possible delay or prevention of Alzheimer's disease. This adds another factor for women and their health care providers to address when considering estrogen replacement therapy (ERT). ERT is already of great concern to women and remains a very controversial issue. The possibility of estrogen having a positive effect on cognition along with the cardioprotective effects and prevention of osteoporosis increase its benefits. Nurse practitioners play an important role in the prevention and early diagnosis of Alzheimer's disease. In the United States, Alzheimer's disease is the most common form of dementia. It is often misdiagnosed or unrecognized in the early stages. Practitioners are on the front-line and must sharpen their diagnostic skills to prevent the misdiagnosis of dementia, identifying patients at greater risk including women. A clear understanding of the pathophysiology of AD, and how estrogen may positively affect neuronal activity will be helpful in deciphering the latest information about diagnostic tests and new treatments. A review of the literature indicates a strong relationship between estrogen and cognition. Several observational studies have revealed epidemiologic data regarding the increased prevalence of AD among women, and the significantly lower incidence of AD among women taking HRT. Clinical trials to date are also demonstrating promising evidence but have been unable to account for confounding factors. Studies in progress, such as the Women's Health Initiative will provide more accurate data upon which practitioners can base clinical decisions and counseling about HRT. Meanwhile, leading researchers have suggested that patients be informed of the possible benefits of estrogen replacement for the prevention or delay of AD.