Postmenopausal hormone therapy and cognitive outcomes: The Women's Health Initiative Memory Study (WHIMS)

Abstract

This review discusses major findings from the Women's Health Initiative Memory Study (WHIMS). WHIMS reported hormone therapy (HT) – conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) – increased the risk for dementia (HR 1.76 [95% CI, 1.19–2.60]; P = 0.005) and global cognitive decline, with a mean decrement relative to placebo of 0.21 points on the Modified Mini Mental State Examination (3MS) ( P = 0.006) in women age 65 and older. A subset of WHIMS participants joined the ancillary WHI Study of Cognitive Aging (WHISCA) trials, in which domain-specific cognitive tests and mood were measured annually. Compared with placebo, CEE + MPA had a negative impact on verbal memory over time ( P = 0.01); and CEE-Alone was associated with lower spatial rotational ability ( P ≤ 0.01) at the initial assessment, but the difference diminished over time. The ancillary WHIMS-MRI study measured subclinical cerebrovascular disease to possibly explain the negative cognitive findings reported by WHIMS and the increased clinical stroke in older women reported by the WHI. WHIMS-MRI reported that while CEE + MPA and CEE-Alone were not associated with increased ischemic brain lesion volume relative to placebo; both CEE + MPA and CEE-Alone were associated with lower mean brain volumes in the hippocampus ( P = 0.05); frontal lobe ( P = 0.004); and total brain ( P = 0.07). HT-associated reductions in hippocampal volumes were greatest in women with baseline 3MS scores ≤90.