1998 Articles

Postmenopausal Estrogen Use and Parkinson's Disease with and without Dementia

Marder, Karen; Tang, Mingxin; Alfaro, Brenda; Mejia-Santana, Helen; Cote, Lucien J.; Jacobs, Diane; Stern, Yaakov; Sano, Mary; Mayeux, Richard Paul

We investigated the effects of estrogen replacement therapy (ERT) on the risk of development of dementia in 87 women with Parkinson's disease without dementia (PDND), 80 women with Parkinson's disease with dementia (PDD), and 989 nondemented healthy women from the same community. ERT was protective for the development of dementia within the setting of PD (OR 0.22, 95% CI 0.05-1.0) and when PDD patients were compared with controls (OR 0.24, 95% CI 0.07-0.78), but did not affect the risk of PD. The results of the study suggest that a randomized clinical trial of ERT may be warranted. Risk factors for Parkinson's disease with dementia (PDD) include age at onset of the motor signs of PD, the presence of severe extrapyramidal signs, and depression.1 It is unknown to what extent PDD overlaps with Alzheimer's disease (AD) or whether the risk factors for AD are also risk factors for PDD. ApoE4 has not been associated with PDD, and no other genetic susceptibility loci for PDD have been identified. Three prospective, observational studies demonstrated reduced risk and delayed age at onset of AD in postmenopausal women who used estrogen,2-4 whereas one did not.5 To determine whether estrogen replacement therapy(ERT) reduced the risk of dementia in women with PD, estrogen usage was ascertained in 167 women with PD, 80 of whom were demented, as well as in 989 nondemented women from the same community.