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Cognitive and Noncognitive Associations

V. Senanarong, MD; S. Vannasaeng, MD; N. Poungvarin, MD; S. Ploybutr, MSC; S. Udompunthurak, MSC; P. Jamjumras, RN; L. Fairbanks, PhD; J. L. Cummings, MD

Arch Neurol. 2002;59:385-389.

Objective  To investigate an association between endogenous estradiol (E₂) levels and cognition and behavior in elderly individuals.

Patients  We studied 135 community-based men and women aged 52 to 85 years in urban Bangkok, Thailand; 72 had dementia and 63 did not.

Materials and Methods  Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria after appropriate investigations. Blood samples for assay were collected in the morning after 6 hours of fasting. Levels of E₂ were measured by radioimmunoassay (double antibody technique). The Thai version of the Mini-Mental State Examination was used to assess cognition; the Neuropsychiatric Inventory was used to assess neuropsychiatric symptoms; and the Functional Assessment Questionnaire was used to assess instrumental activities of daily living.

Results  There was no correlation between age and level of E₂ in either men or women. Individuals with lower estrogen levels had more behavioral disturbances (men: r = -0.467, n = 45; P = .001; women: r = -0.384, n = 90; P<.001) and worse cognition (men: r = 0.316, n = 45; P = .03; women: r = 0.243, n = 90; P = .02) and function (men: r = -0.417, n = 45; P = .004; women: r = -0.437, n = 90; P<.001). The threshold level of endogenous E₂ in elderly individuals for the risk of developing dementia was less than 15 pg/mL (<55 pmol/L) in men and less than 1 pg/mL (<4 pmol/L) in women.

Conclusion  Lower E₂ levels are correlated with poor cognitive, behavioral, and functional status in older individuals.

From the Division of Neurology, Department of Medicine (Drs Senanarong and Poungvarin and Ms Jamjumras), the Division of Endocrinology, Department of Medicine (Dr Vannasaeng and Ms Ploybutr), and the Division of Clinical Epidemiology, Department of Research Development (Mr Udompunthurak), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; and the Departments of Psychiatry and Biobehavioral Sciences (Drs Fairbanks and Cummings) and Neurology (Dr Cummings), University of California, Los Angeles, UCLA School of Medicine.

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