Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study

Abstract

Background

Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women.

Objective

This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI).

Method

The case–control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA).

Results

Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m², respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20–0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10–0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20–2.38), parity (having >2 children; OR 1.69; 95% CI 1.21–2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09–2.24), hypertension (OR 1.41; 95% CI 1.01–1.96), being sexually active (OR 0.56; 95% CI 0.40–0.79), education >12 years (OR 0.46; 95% CI 0.32–0.65) and MHT use (OR 0.31; 95% CI 0.21–0.46).

Conclusion

Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.

双侧卵巢切除术和更年期激素治疗与轻度认知障碍的关系: REDLINC X研究 摘要

背景:痴呆症是一个重要的公共卫生问题。雌激素是中枢神经系统的调节器, 老年女性认知能力下降可能与雌激素缺乏有关。

目的:探讨双侧卵巢切除术、绝经激素治疗(MHT)等因素与轻度认知功能损害(MCI)的关系。

方法:病例对照研究纳入来自6个拉丁美洲国家941名, 60岁及以上健康的绝经后女性。记录个人和家庭数据, 使用蒙特利尔认知评估测试(MoCA)评估MCI。

结果:平均年龄为66.1±5.8岁, 平均受教育年限为12.4±5.0岁, 平均体重指数为26.0±4.3 kg/m²。共有30.2%患者行双侧卵巢切除术, 40.3%患者曾接受MHT。共有232名女性(24.7%)患有MCI。与接受MHT女性相比, 卵巢完整且未接受MHT女性MCI患病率更高(29.3% vs 11.7%[比值比(OR) 0.32;95%可信区间(CI) 0.20 ∼ 0.51])。在切除卵巢的女性中, 未接受MHT女性的MCI患病率高于MHT使用者(45.2% vs. 12.8% [OR 0.18;95%可信区间0.10 - -0.32)。Logistic回归分析表明, 与MCI相关的变量为年龄>65岁 (OR 1.69;95% CI 1.20 ∼ 2.38), 多胎(>2个孩子;或1.69;95% CI 1.21-2.37), 双侧卵巢切除术(OR 1.56;95% CI 1.09-2.24)、高血压(OR 1.41;95% CI 1.01-1.96), 性活跃(OR 0.56;95% CI 0.40-0.79), 受教育年限>12年(OR 0.46;95% CI 0.32-0.65)和接受MHT(OR 0.31;95%可信区间0.21 - -0.46)。

结论:年龄、多胎、双侧卵巢切除术和高血压是MCI发生的独立因素;与此相反, 较高的教育水平、性活跃和接受MHT是保护因素。

Keywords:

• Dementias
• mild cognitive impairment
• Montreal Cognitive Assessment test
• postmenopausal women
• bilateral oophorectomy
• menopause hormone therapy

Potential conflict of interest

The authors report no conflicts of interest and are alone responsible for the writing and content of this document.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors. P. Chedraui is supported by Sistema de Investigación y Desarrollo (SINDE); Vice-Rectorado de Investigación & Postgrado (VRIP) of the Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador [grant No. SIU # 554-56 for development of the project ‘Evaluación de resultantes vinculadas a la salud de la mujer en etapa reproductiva y no reproductiva: Proyecto Omega III’].