Abstract:
:Studies in experimental animal models provide a convincing rationale for a role for ERT in the treatment and prevention of dementia. These studies establish the role of estrogen in the regeneration and preservation of neuronal elements within the CNS that are analogous to those regions of the brain most sensitive to the neurodegenerative changes associated with AD. Furthermore, behavioral studies in these animals establish a correlation between the hormone dependent changes in the neuronal architecture and learning and memory. However, extrapolation of these studies to post-menopausal women must be done with caution. Surgical and natural loss of ovarian function does not result in a clinically relevant decline in cognitive function over the short term (1 to 2 decades) or ever in some women. The modest changes that are observed may relate to the hormone's effect on neurotransmitter levels or their receptors. Although Singh et al. noted changes in neurotransmitter concentrations 5 weeks after ovariectomy, changes in cognitive performance in their rat model did not become significant until 28 weeks after ovariectomy--the equivalent of approximately 2 decades of human life. Except for the familial forms of the disease, AD is rarely seen in the first 2 decades after the menopause. However, by the third decade after the menopause, 50% of women can be expected to manifest the histopathological changes of AD. Approximately half of these women are without clinical evidence of disease. Thus, the neurodegenerative process of AD probably precedes by many years the age of onset of the disease. We do not know what factors contribute to the selective neuronal injury which, over time, eventually leads to the neuronal loss and reduced synaptic density that result in the cognitive impairment of AD. At this time we can only speculate as to estrogen's role in modifying this process. Data from experimental animal models suggest that estrogen deficiency would selectively increase the vulnerability of estrogen-responsive neural elements, for example, the cholinergic neurons of the basal forebrain and hippocampus--offulnerability mediated perhaps by the reduced expression of neurotrophic factors, decreased clearance of the amyloid protein, and/or reduced cerebral blood flow that are associated with estrogen deficiency. The brain's ability to adapt to the neuronal loss by stimulating axonal and synaptic regeneration would also be impaired by estrogen deficiency as suggested by estrogen's ability to restore the synaptic density of lesioned brains of ovariectomized animals. Thus, estrogen deficiency, like the apolipoprotein E4 allele, can be considered not a cause of AD but one of perhaps several factors modifying the neuronal injury and loss leading to AD. The limited epidemiologic data and intervention trials currently available are consistent with this interpretation. Because of the urgency and enormity of the problem of dementia in our aging society, there would now appear to be sufficient reason to allocate the resources needed to conduct the appropriate clinical trials to determine estrogen's efficacy in both the treatment and prevention of this devastating condition. These trials are needed so that women and their physicians can adequately weigh the risks and benefits of hormone replacement for the treatment and, more importantly, the prevention of dementia.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Birge SJdoi
10.1111/j.1532-5415.1996.tb03749.xsubject
Has Abstractpub_date
1996-07-01 00:00:00pages
865-70issue
7eissn
0002-8614issn
1532-5415journal_volume
44pub_type
杂志文章,评审abstract::A trial by any means that can possibly prevent or retard the development of arteriosclerosis is to be recommended. Arteriosclerosis is the chief cause of strokes and heart attacks. The heavy evening meal now in vogue is characteristically rich in animal fats. Normal digestion is at its peak at about the seventh hour, ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1978.tb02404.x
更新日期:1978-06-01 00:00:00
abstract:OBJECTIVE:To study the relationship between subjective memory complaints, cognitive functioning, and clinical diagnosis of dementia. DESIGN:Cross-sectional, total-population survey. MEASUREMENTS:A two-phase study was done. All 2368 were screened by Mini-Mental State Examination (MMSE). Then the 314 who screened posit...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1993.tb06478.x
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVES:To establish the prevalence and correlates of disability during the 2 years before hip fracture. DESIGN:Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time poi...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13658
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:To determine patterns of dementia diagnosis seen after chemotherapy treatment. DESIGN:Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, International Classification of Diseases, Ninth Revision (ICD-9) diagnoses of dementia occurring in the years after breast cancer diagn...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01848.x
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVES:To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. DESIGN:A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and function...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53102.x
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVES:To describe factors associated with provider-ordered influenza testing in hospitalized older adults. DESIGN:Information on participant demographics, symptoms, and provider-ordered influenza testing were collected by questionnaire and chart review. We conducted prospective laboratory-based surveillance using...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15298
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVES:To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD). DESIGN:Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical serv...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14672
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVES:To identify factors that influence the breast cancer treatment decisions of women aged 80 and older. DESIGN:Medical record review. SETTING:One academic primary care clinic and two community health centers in Boston. PARTICIPANTS:Sixty-five women aged 80 and older diagnosed with breast cancer between 1994 ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03820.x
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVES:The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationsh...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb02634.x
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVES:Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to health care planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization meas...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50120.x
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVES:To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacu...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15371
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVES:To determine the perspectives of seriously ill individuals on reasons for 30-day hospital readmission. DESIGN:A prospective qualitative study was conducted employing individual interviews conducted at bedside. SETTING:Department of Veterans Affairs Greater Los Angeles Healthcare System. PARTICIPANTS:Serio...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13238
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVES:To investigate long-term variability in serum high-sensitivity C-reactive protein (CRP) and interleukin-6 (IL-6) and to determine associated risk factors for high-risk inflammatory profiles. DESIGN:Prospective population-based cohort study. PARTICIPANTS:Participants (N = 1,443) of the Epidemiology of Heari...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12382
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial difference...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53155.x
更新日期:2005-03-01 00:00:00
abstract::Seventy consecutive patients receiving warfarin as an anticoagulant were evaluated for the relationship between the response to the loading dose of warfarin and the response to the maintenance dose. No patients were excluded because of complicating diseases or the concurrent use of other drugs. There was a moderate co...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb00116.x
更新日期:1980-01-01 00:00:00
abstract:OBJECTIVES:To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs). DESIGN:Retrospective cohort study. SETTING:SNFs in California, Florida, Michigan, New York, and Texas. PARTICI...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01675.x
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVES:To determine whether serum levels of 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) predict accelerated decline in muscular strength or onset of new disability in mobility and upper extremity functioning over a 3-year follow-up. DESIGN:A community-based prospective cohort study. PARTICIPANTS:S...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50219.x
更新日期:2002-05-01 00:00:00
abstract::The relationship between atrial natriuretic peptide (ANP) and age was studied. In elderly subjects (65 to 84 years) higher basal ANP levels were found as compared with those found in young subjects (21 to 23 years). Volume loading (750 mL 0.9% NaCl in 60 minutes) increased ANP levels only in the aged group, and plasma...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb01502.x
更新日期:1990-11-01 00:00:00
abstract:OBJECTIVE:To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. DESIGN:Descriptive, unmatched study. SETTING:VHA MFHs, home-based primary care (HBPC)...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14517
更新日期:2016-12-01 00:00:00
abstract::The contribution of frailty to human morbidity and mortality is immense. Yet it lacks a conceptual framework. By borrowing from the hypotheses provided by the thermophysicists, frailty can be understood in a way that both interrelates the relationship between form and function and provides medical science with an oper...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract:OBJECTIVES:To establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach. DESIGN:Systematic review and network meta-analysis. PARTICIPANTS:Individuals aged 60 and older. MEASUREMENT...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,meta分析
doi:10.1111/jgs.13395
更新日期:2015-05-01 00:00:00
abstract::The GRECC program was established by the VA in 1975 and has been expanded since then to 16 sites. For more than a decade, GRECC staff have made major contributions to advancing the understanding of the aging process and developing approaches that have improved the care of older veterans as well as all frail elderly pe...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1994.tb06599.x
更新日期:1994-09-01 00:00:00
abstract::Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiova...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1986.tb04222.x
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:To clarify the neuropsychological function in patients with Charles Bonnet Syndrome. DESIGN:Control group comparison study. SETTING:University of Chicago Hospitals. PARTICIPANTS:The neuropsychological function of 15 older adults with presenting complaints of visual hallucinations who met criteria for Charl...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.1996.tb02937.x
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVES:To determine whether providing physical therapy (PT) services in the emergency department (ED) improves outcomes for older adults who fall. DESIGN:We used Medicare claims data to examine differences in recurrent fall-related ED revisit rates of older adults who presented to the ED for a ground-level fall an...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15469
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVES:To determine whether resting heart rate is associated with several types of osteoporotic fractures, mortality, and cause-specific mortality in older women. DESIGN:A prospective cohort study. SETTING:Four communities across the United States. PARTICIPANTS:We prospectively assessed resting pulse rate in 9,7...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50110.x
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVES:To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN:A population-based prospective cohort study from 1993 to 1995. SETTING:Community-d...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52207.x
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVES:To investigate whether plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) remains a specific marker of cardiac illness in very old age and can be used to identify very elderly people at high risk for death independent of the presence of known cardiac diagnoses. DESIGN:Prospective, observational, po...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02218.x
更新日期:2009-05-01 00:00:00
abstract::Osteochondritis dessicans of the hip is rare in comparison with occurrence of the disease in other joints. Only about 50 cases have been reported. The literature is reviewed, and a new case is presented. The patients was a 94-year-old Spanish American War Veteran who was unusally active and in good health until the on...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb00535.x
更新日期:1980-06-01 00:00:00
abstract:OBJECTIVES:To determine the proportion of older people with diabetes mellitus (DM) eligible to enroll in the standard Medicare Part D drug benefit who will exceed the initial $2,250 coverage limit and to determine the effect of hypoglycemic choice on risk of exceeding the coverage limit. DESIGN:Cross-sectional survey....
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2006.00663.x
更新日期:2006-04-01 00:00:00