Impact of type 2 diabetes and postmenopausal hormone therapy on incidence of cognitive impairment in older women

Mark A. Espeland, Roberta Diaz Brinton, Christina Hugenschmidt, Jo Ann E. Manson, Suzanne Craft, Kristine Yaffe, Julie Weitlauf, Leslie Vaughan, Karen C. Johnson, Claudia B. Padula, Rebecca D. Jackson, Susan M. Resnick

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

OBJECTIVE In older women, higher levels of estrogen may exacerbate the increased risk for cognitive impairment conveyed by diabetes. We examined whether the effect of postmenopausal hormone therapy (HT) on cognitive impairment incidence differs depending on type 2 diabetes. RESEARCH DESIGN AND METHODS TheWomen's Health Initiative (WHI) randomized clinical trials assignedwomen to HT (0.625 mg/day conjugated equine estrogens with or without [i.e., unopposed] 2.5 mg/daymedroxyprogesterone acetate) or matching placebo for an average of 4.7-5.9 years. A total of 7,233women, aged 65-80 years, were classified according to type 2 diabetes status and followed for probable dementia and cognitive impairment (mild cognitive impairment or dementia). RESULTS Through a maximumof 18 years of follow-up,women with diabetes had increased risk of probable dementia (hazard ratio [HR] 1.54 [95% CI 1.16-2.06]) and cognitive impairment (HR 1.83 [1.50-2.23]). The combination of diabetes and random assignment to HT increased their risk of dementia (HR 2.12 [1.47-3.06]) and cognitive impairment (HR 2.20 [1.70-2.87]) compared with women without these conditions, interaction P = 0.09 and P = 0.08. These interactions appeared to be limited to women assigned to unopposed conjugated equine estrogens. CONCLUSIONS These analyses provide additional support to a prior report that higher levels of estrogenmay exacerbate risks that type 2 diabetes poses for cognitive function in older women. The role estrogen plays in suppressing non-glucose-based energy sources in the brain may explain this interaction.

Original languageEnglish (US)
Pages (from-to)2316-2324
Number of pages9
JournalDiabetes care
Volume38
Issue number12
DOIs
StatePublished - Dec 2015
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Fingerprint

Dive into the research topics of 'Impact of type 2 diabetes and postmenopausal hormone therapy on incidence of cognitive impairment in older women'. Together they form a unique fingerprint.

Cite this