Hormone replacement therapy could help prevent Alzheimer’s dementia in women at risk

Hormone replacement therapy (HTS) might help prevent Alzheimer’s dementia in women at risk of developing the disease – according to a study from the University of East Anglia.

The study shows that HRT use is associated with better memory, better cognition and larger brain volumes later in life in women who carry the APOE4 gene – the strongest risk factor gene for Alzheimer’s disease.

The research team found that HRT was most effective when introduced early in the menopausal journey during perimenopause.

Professor Anne-Marie Minihane, from UEA’s Norwich Medical School and director of UEA’s Norwich Institute for Healthy Aging, led the study together with Professor Craig Ritchie from the University of Edinburgh.

Professor Minihane said: “We know that 25% of women in the UK carry the APOE4 gene and that almost two-thirds of Alzheimer’s patients are female.

“In addition to living longer, the reason for the higher female prevalence is thought to be related to the effects of menopause and the impact of the genetic risk factor APOE4 being greater in women.

“We wanted to know if HRT might prevent cognitive decline in at-risk APOE4 carriers. »

The research team studied data from 1,178 women taking part in the European Alzheimer’s Dementia Prevention Initiative – which was set up to study participants’ brain health over time.

The project spanned 10 countries and tracked participants’ brains from “healthy” to diagnosed with dementia in some. Participants were included if they were over 50 and did not have dementia.

The research team studied their results to analyze the impact of HRT on women carrying the APOE4 genotype.

Dr Rasha Saleh, also from UEA’s Norwich Medical School, said: “We found that HRT use is associated with better memory and larger brain volumes in carriers of the at-risk APOE4 gene. . 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 few drug options for Alzheimer’s disease for 20 years and there is an urgent need for new treatments.

“The effects of HRT in this observational study, if confirmed in an intervention trial, would equate to years of younger brain age. »

Professor Minihane said: “Our research examined associations with cognition and brain volumes using MRI. We did not examine cases of dementia, but lower cognitive performance and brain volumes are predictive of future dementia risk.

Professor Michael Hornberger, from UEA’s Norwich Medical School, said: “It is too early to say with certainty that HRT reduces the risk of dementia in women, but our results highlight the potential importance of HRT and personalized medicine in reducing the risk of Alzheimer’s.

“The next step in this research will be to conduct an intervention trial to confirm the impact of early initiation of HRT on cognition and brain health. It will also be important to analyze which types of HRT are most beneficial,” he added.

Professor Craig Ritchie, University of Edinburgh, said: “This important finding from the EPAD cohort highlights the need to challenge many assumptions regarding early Alzheimer’s disease and its treatment, particularly when we consider women’s brain health. An effect on cognition and brain changes on MRI support the idea that HRT has tangible benefits. However, these initial results need to be replicated in other populations.

“Hormone replacement therapy is associated with better cognition and larger brain volumes in APOE4-at-risk women: results from the European Cohort for the Prevention of Alzheimer’s Disease (EPAD)” is published in the journal Alzheimer’s disease research and therapy.