Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause
| Autor: | Demetrius M. Maraganore, Brandon R. Grossardt, Walter A. Rocca, J. E. Ahlskog, M. De Andrade, James H. Bower, Lee J. Melton |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Aging medicine.medical_specialty medicine.drug_class Ovariectomy medicine.medical_treatment Population Menopause Premature Prophylactic Oophorectomy Cohort Studies Interviews as Topic Risk Factors Surveys and Questionnaires Epidemiology medicine Humans Dementia Risk factor education Aged Gynecology education.field_of_study Obstetrics business.industry Cognitive disorder Hazard ratio Age Factors Obstetrics and Gynecology Oophorectomy Estrogens Unilateral Oophorectomy General Medicine Middle Aged medicine.disease Causality Menopause Neuroprotective Agents Estrogen Female Neurology (clinical) Cognition Disorders business |
| Zdroj: | Neurology. 69:1074-1083 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/01.wnl.0000276984.19542.e6 |
| Popis: | There is increasing laboratory evidence that estrogen has neuroprotective effects that may include improved synapse formation, increased cerebral blood flow and glucose metabolism, antioxidant activity, and reduced deposition of β-amyloid in the brain. Clinical and epidemiological evidence, however, has lagged behind. It could well be that there is a critical age window within which neuroprotective effects express themselves. This study examined the association between oophorectomy, performed before the start of menopause for reasons unrelated to tumor, with the risk of subsequent cognitive impairment or dementia as disclosed by a modified form of the Telephone Interview for Cognitive Status. The final study groups included 813 women having unilateral oophorectomy; 676 having bilateral oophorectomy; and 1472 referent women matched for age with the surgical groups. Compared to referent women, those undergoing unilateral or bilateral oophorectomy had an increased risk of cognitive impairment or dementia. The hazard ratio was 1.46 and the 95% confidence interval 1.13-1.90 after adjusting for education and a history of depression. The risk of cognitive dysfunction or dementia increased as the age at the time of oophorectomy declined, and was significantly increased when oophorectomy was done before age 49 years. The findings were independent of the indication for oophorectomy, and were similar following unilateral and bilateral oophorectomy. Oophorectomy-either unilateral or bilateral-appears to carry with it an increased risk of cognitive impairment or dementia when performed before the start of menopause. This study is one of the first to support the idea of a critical age window for protective effects of estrogen on the brain. The findings encourage a reassessment of prophylactic oophorectomy in premenopausal women and also of estrogen therapy following oophorectomy. |
| Databáze: | OpenAIRE |
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