Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China: a 10/66 population-based cohort study.
Fecha
2018Autor
Prince, Martin J.
Acosta, Daisy
Guerra, Mariella
Huang, Yueqin
Jiménez Velázquez, Ivonne Z.
Llibre Rodríguez, Juan J.
Salas, Aquiles
Sosa, Ana Luisa
Chong Chua, Kia
Dewey, Michael E.
Liu, Zhaorui
Mayston, Rosie
Valhuerdi, Adolfo
Metadatos
Mostrar el registro completo del ítemResumen
Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects
may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine
whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are
inversely associated with dementia incidence. Methods Population-based cohort studies of women aged 65 years and over
in urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and
China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche,
birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five
years later. Results 9,428 women participated at baseline, with 72–98% responding by site. The ‘at risk’ cohort comprised
8,466 dementia-free women. Mean age varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in
Latin America. Mean parity was 4.1 (2.4–7.2 by site), generally higher in rural than urban sites. 6,854 women with baseline
reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895
dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio
[ASHR] 1.001, 95% CI 0.988–1.015) did not support any association with dementia incidence, with no evidence for effect
modification by APOE genotype. No association was observed between incident dementia and; ages at menarche, birth of
first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively
associated with incident dementia (ASHR 1.030, 95% CI 1.002–1.059, I2 = 0.0%). Conclusions We found no evidence to
support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period
influences dementia incidence in late life.
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