At-risk women may prevent Alzheimer’s with hormone replacement therapy

Jan. 20, 2023

Hormone Replacement Therapy (HRT) could help prevent Alzheimer’s Dementia among women at risk of developing the disease – according to University of East Anglia (UEA) research.

A study shows that HRT use is associated with better memory, cognition and larger brain volumes in later life among women carrying 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 menopause journey during perimenopause. 

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

Prof Minihane said, “We know that 25 percent of women in the UK are carriers of the APOE4 gene and that almost two-thirds of Alzheimer’s patients are women. In addition to living longer, the reason behind the higher female prevalence is thought to be related to the effects of menopause, and the impact of the APOE4 genetic risk factor being greater in women. We wanted to find out whether HRT could prevent cognitive decline in at-risk APOE4 carriers.” 

The research team studied data from 1,178 women participating in the European Prevention of Alzheimer’s Dementia initiative – which was set up to study participants’ brain health over time. The project spanned 10 countries and tracked participants’ brains from ‘healthy’ to a diagnosis of dementia in some. Participants were included if they were over 50 and dementia-free. The research team studied their results to analyze the impact of HRT on women carrying the APOE4 genotype. 

Prof Anne Marie Minihane said, “Our research looked at associations with cognition and brain volumes using MRI scans. We did not look at dementia cases, but cognitive performance and lower brain volumes are predictive of future dementia risk. 

Prof Craig Ritchie, from the University of Edinburgh, said, “This important finding from the EPAD Cohort highlights the need to challenge many assumptions about early Alzheimer’s disease and its treatment, especially when considering women’s brain health. An effect on both cognition and brain changes on MRI supports the notion that HRT has tangible benefit. These initial findings need replication however in other populations.” 

Hormone Replacement Therapy is associated with improved cognition and larger brain volumes in at risk APOE4 women. Results from the European Prevention of Alzheimer’s Disease (EPAD) cohort are published in the journal Alzheimer's Research and Therapy

University of East Anglia release

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