Endogenous Estradiol Changes Associating Impaired Cognition in Elderly

SUMMARY AND CONCLUSIONThis study was done to clarify the association between the endogenous estradiol (the active form of estrogen) level and the cognitive functions in healthy and demented elderly individual.We included 40 demented patients (21 Alzheimer and 19 patients with dementia other than Alzheimer) as well as 20 age, sex and educationally matched controls during the period from March 2004 to April 2005.All were subjected to the following:(1) Delailed history taking.(2) Complete general and neurological examination.(3) Neuropsychiatric assessment using Mini Mental State Examination, Clinical Dementia Rating scale as well as assessment of daily activities using Blessed dementia rating scale.(4) Laboratory investigations including liver and kidney function tests and lipid profile.(5) Serum level of Estradiol were measured using IMMULITE analyzer.(6) Computed tomography on the brain to assess the brain atrophic changes using indices for ventricular volume (bifrontal index ”F.I”, maximum bifrontal distance ”F” and the maximum width of 3rd ventricular volume ”V3”).The results showed that:1) The percentage of illiteracy was high in our patients.2) Alzheimer patients were older than non Alzheimer patients and controls.3) There was no correlation between age of our patients and severity of cognitive impairment or impairment in daily activities, brain atrophic changes or level of E2 in (males and females).4) The duration of dementia was significantly correlated with the severity of cognitive impairment, brain atrophic changes as well as E2 level in males and females.5) A negative correlation was found between the measured E2 (in males and females) and the severity of cognitive impairment).6) There was a positive correlation between the severity of cognitive impairment and the severity of brain atrophy in our patients.7) A negative correlation was found between the level of E2 in males and the severity of brain atrophy (the increase in brain atrophy as assessed by F, F-T and V3), the decrease in E2 level.8) Our study suggested a threshold level of endogenous E2 in elderly persons for developing dementia (E2 less than 15 pg/ml in men and less than 1 pg/ml in women).Conclusion and Recommendations- We concluded that estradiol play an important role in cognitive function in elderly, there was a threshold level of endogenous estradiol in elderly persons for developing dementia (E2 less than 15 pg/ml in men and less than 1 pg/ml in women).- We recommend measuring E2 levels in elderly patient with early cognitive impairment and further studies to evaluate the supplementation of estrogen in demented patient.