A new study from researchers at Mass General Brigham has uncovered concerning evidence suggesting that menopausal hormone therapy (HT) may accelerate tau accumulation in the brains of women over the age of 70. Tau is a protein closely associated with Alzheimer’s disease, and its buildup is one of the key indicators of the condition. The findings, published in Science Advances, could have important implications for how menopausal hormone therapy is prescribed to older women and how it may impact the risk of Alzheimer’s disease.
The study found that women over the age of 70 who had taken HT more than a decade ago experienced faster accumulation of tau in specific regions of the brain compared to women who had not used HT. However, there was no significant difference observed in amyloid beta accumulation between the two groups. Amyloid beta is another protein linked to Alzheimer’s, but the focus of this study was on tau, which is considered a more direct marker for Alzheimer’s progression.
“Approximately a quarter of currently postmenopausal women who are 70 years and older have a history of HT use and have now entered a critical age of risk for Alzheimer’s disease,” explained Rachel F. Buckley, PhD, a senior author of the study and a member of the Department of Neurology at Massachusetts General Hospital. “Our findings add to the growing body of evidence that delaying the initiation of HT, particularly in older women, could lead to worsened Alzheimer’s outcomes.”
The study compared brain scans of 73 women who had used HT an average of 14 years prior to the study with 73 age-matched women who had never used HT. The participants ranged in age from 51 to 89 and underwent PET scans to track amyloid beta and tau over several years, with amyloid beta scans lasting a mean of 4.5 years and tau scans spanning a mean of 3.5 years. The research team noted that while the study provided valuable insights, it is not yet possible to definitively determine whether the findings were due to changes in guidelines surrounding HT prescriptions or simply due to the natural progression of aging.
Current clinical guidance recommends that HT be initiated within 10 years of menopause in order to avoid potential adverse effects. This study, however, raises new concerns regarding the long-term impact of HT on the brain’s tau accumulation, which may influence future recommendations for HT use, particularly in women over the age of 70.
These findings underscore the importance of individualized care and the need for further research to determine the safest approach to menopausal hormone therapy, especially for women at higher risk for Alzheimer’s disease.
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