Long-Term Estrogen Replacement Therapy in Female Patients with Dementia of the Alzheimer Type: 7 Case Reports

These are some example cases of individuals going through estrogen replacement therapy. To see all the cases reported in this article, please refer to the Ohkura T., et. al..

Case 1: H.M.

When the patient was 69 years old, her family recognized her conspicuous forgetfulness and repeating the same words and phrases. During the next four years, the family reported that the patient was rapidly losing memory. She first visited the outpatient clinic of psychiatry of the Tokyo Metropolitan Tama Geriatric Hospital on March 22, 1990, when she was 76 years old. The diagnosis was moderate dementia of the Alzheimer's type (DAT). The patient was 146.6 cm in height and weighed 41.4 kg. The serum estradiol level was less than 10pg.ml and the patient had no contraindications to Estrogen Replacement Therapy (ERT). The patient received 0.625 mg of conjugated equine estrogen (CEE) orally twice a day for 6 weeks when she was 76 years old. She responded very well to ERT. Marked improvements were observed in syndromes of intellectual impairment and different symptoms common in dementia. However, there was a decrease in improvements after the termination of ERT. The family made a request for the continuation of ERT after the completion of the initial 6-week treatment with 1.25 mg/day of CEE. Therefore, the patient received long-term low dose ERT. The patient responded well again to the second ERT with 0.625 mg/day of CEE. The patient continued treatment with .625 mg/day CEE from days 1 to 21 and 5 mg/day MPA from days 12 to 21 of estrogen treatment (sequential CEE and MPA therapy), which brought a drastic improvement in the Mini-Mental State Examination (MMSE) score. However, her family complained that MPA administration made her physical condition worse even though the MMSE scores were improved. For example, during MPA administration the patient often urged to go to her home in the evening and she became easily irritated. ERT was discontinue in order to evaluated the therapeutic affect. The family reported that the patient's daily activities had deteriorated more than might be expected. Therefore, the untreated control study was abandoned and ERT was into session again after 10 weeks. However, the resumption of ERT could not restore the patient's daily activities and the test scores to the level before discontinuation of ERT. To make matters worse, on October 10, 1992, she sprang her ankle. Furthermore, she fell down and pumped her head on December 30, 1992. These accidents caused a further decrease in test scores. Overall, long-term ERT was very effective in this case, however, ERT have to be conducted on a continuous term.

Case 2: K.A.

When the patient became 72 years old (in the spring of 1988), she became forgetful. She forgot she had eaten a meal and soon afterwards, she would wanted a meal again. When she was 73, she stared dressing the wrong way, wearing winter clothes in the summer. In the autumn of 1989, she got lost and was found at a stranger's home. The patient first visited the outpatient clinic on May 10, 1990, when she was 74 years old. The patient received 0.625 mg of CEE orally twice a day for 6 weeks. During those 6 weeks of ERT, it seemed that estrogen was not so effective for improvement in cognitive functions from the viewpoint of the test scores, however, the GBS scores, which is directly related to the degree of dementia showed improvements. Improvements on the GBS score were observed in the items regarding motor insufficiency in undressing and dressing, impaired orientation in space, distractibility, and different symptoms common in dementia. In the patient's daily activity, neighbors told the family that she greeted them cheerfully. The patient could remember her daughter's husband whom she had not seen for a long time. Her personal hygiene improved. Her self-delusion or excitement became less frequent. However, the GBS score returned to the pretreatment level after the termination of the first short-term ERT;therefore, the family made a request for long-term ERT. The patient received the second treatment of long-term, low-dose ERT for 13 months. She responded very well to this second ERT compared to the first On December 23, 1991 (66 weeks after the initiation of the first ERT), 5 mg/day of MPA was administered to the patients. However, the family reported that during MPA administration, her physical condition deteriorated, accompanied by urinary incontinence. Furthermore, on the night of December 29, the patient fainted transiently while watching television. She was hospitalized for one night and discharged the next day. The cause of her transient faintness was uncleared. ERT was discontinued at the beginning of January,1992. Gradually speaking, dementia symptoms progress gradually and steadily in the course of 1 year. However, in this case, the last GBS scores improved and after eight months, the GBS scores even improved more, indicating the effectiveness of long-term ERT indirectly. Withdrawal bleeding was observed after the termination of short-term ERT, nevertheless, withdrawal bleeding was observed after the termination of long-term ERT. On the whole, long-term ERT was very effective in this case. However, MPA administration along with CEE made the patientıs physical condition worse.

Case 3, K.T.

When the patient was about 50 years old, she was gradually getting forgetful. She was a licensed cook and could still accomplish her work at that time. Her menopause was at 53 years old, when her memory disturbance became conspicuous. The patient first visited the out patient clinic on July 18, 1991, when she was 56 years old. The patient was obese, but it she has no contraindications to ERT. The patient received 0.625 mg of CEE orally twice a day when she was 56 years old. She responded well. As regards to the daily activities of the patient during ERT, the family reported as follows: the patient did not nurse the delusion any more that she had her purse stolen, and her depression and irritation disappeared. After the termination of ERT, her test scores decreased with the exception of the GBS score. The patient received the second treatment of long-term, low-dose ERT. At the 2nd the 3rd weeks after the initiation of the second ERT with 0.625 mg/day of CEE, her scores were increased up to alomost the same degree of the first ERT scale scores. At the 6th and 8th weeks after the initiation of the second ERT, her scores decreased just below and just above the baseline levels, respectively. At 22 weeks after the initiation of the second ERT, she had a slight heart attack (angina pectoris) and ERT was discontinued. After the termination of ERT, both the MMSE and HDS scores decreased rapidly, which indicated a rapid deterioration of the disease. Withdrawal bleeding was not observed either during short-term or long-term ERT. On the whole, long-term ERT was moderately effective in this case.

Conclusion