臨床婦人科産科60巻6号

2006年06月発行

今月の臨床 性差医療

中枢性疾患と性差

2. 認知症と性差

著者： 大藏健義¹

所属機関： ¹獨協医科大学越谷病院産科婦人科

ページ範囲：P.840 - P.843

文献概要

はじめに

　アルツハイマー型認知症（アルツハイマー病 : AD）は女性に多く，その発症率は男性の1.7～3倍高いと報告されている．一方，ホルモン補充療法（HRT）を閉経後早期に行った女性では，ADの発症が約半分程度に低下するという疫学調査結果が数多く報告されている．ここでは性差医学的観点から，ADの発症と予防に関するエストロゲンの役割について述べる．

参考文献

1）Ohkura T, Teshima Y, Isse K, et al : Estrogen increases cerebral and cerebellar blood flows in postmenopausal women. Menopause 2 : 13─18, 1995

2）Maki PM, Resnick SM : Longitudinal effects on estrogen replacement therapy on PET cerebral blood flow and cognition. Neurobiol Aging 21 : 373─383, 2000

3）Smith YR, Minoshima S, Kuhl DE, et al : Effects of long─term hormone therapy on cholinergic synaptic concentrations in healthy postmenopausal women. J Clin Endocrinol Metab 86 : 679─684, 2001

4）Brenner DE, Kukull WA, Stergachis A, et al : Postmenopausal estrogen replacement therapy and the risk of Alzheimer's disease : a population─based case─control study. Am J Epidemiol 140 : 262─267, 1994

5）Henderson VW, Paganini─Hill A, Emanual CK, et al : Estrogen replacement therapy in older women : comparisons between Alzeheimer's disease and cases nondemented control subjects. Arch Neurol 51 : 896─900, 1994

6）Paganini─Hill A, Henderson VW : Estrogen deficiency and risk of Alzheimer's disease in women. Am J Epidemiol 140 : 256─261, 1994

7）Mortel KF, Meyer JS : Lack of postmenopausal estrogen replacement therapy and the risk of dementia. J Neuropsychiatr Clin Neurosci 7 : 334─337, 1995

8）Tang M─X, Jacobs D, Stern Y, et al : Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease. Lancet 348 : 429─432, 1996

9）Kawas C, Resnick S, Morrison A, et al : A prospective study of estrogen replacement therapy and the risk of developing Alzheimer's disease : the Baltimore Longitudinal Study of Aging. Neurology 48 : 1517─1521, 1997

10） Baldereschi M, Di─Carlo A, Lepore V, et al : Estrogen replacement therapy and Alzheimer's disease in the Italian Longitudinal Study on Aging. Neurolgoy 50 : 996─1002, 1998

11） Waring SC, Rocca WA, Peterson RC, et al : Postmenopausal estrogen replacement therapy and risk of AD : a population─based Study. Neurology 52 : 965─970, 1999

12） Seshadri S, Zornberg GL, Derby LE, et al : Risk of Alzheimer disease is not reduced by estrogen replacement therapy. Arch Neurol 58 : 435─440, 2001

13） Zandi PP, Carlson MC, Plassman BL, et al : Hormone replacement therapy and incidence of Alzheimer's disease in older women. JAMA 288 : 2123─2129, 2002

14） Shumaker SA, Legault C, Kuller L, et al : Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women : Women's Health Initiative Memory Study. JAMA 291 : 2947─2958, 2004

15） Wakatsuki A, Okatani Y, Ikenoue N, et al : Effect of medroxyprogesterone acetate on vascular inflammatory markers in postmenopausal women receiving estrogen. Circulation 105 : 1436─1439, 2002

16） Maki PM : Effects of hormone therapy on cognitive function : state of the science post─WHI. Menopause Management 14 : 10─21, 2005

17） Position Statement by the Executive Committee of the International Menopause Society : Guidelines for hormone treatment of women in the menopausal transition and beyond（Revised October 15, 2004）．日更年医誌12 : 298─304, 2004