THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 538.5 Guest: Dr. Myron Weiner, Prof. of Psychiatry, Univ. Of Texas Medical Center at Dallas Topic: Examining how estrogen may aid post menopausal Alzheimer's patients, Producer/Host: Steve Girard

NEMA: Alzheimer's disease researchers around the country have been encouraged of late by the emergence of estrogen as a potential tool to fight the onset or worsening of its effects...and maybe even to reverse the debilitation associated with it. Today we have Dr. Myron Weiner, a professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas, who heads the clinical core of the facility's Alzheimer's disease center. What did we learn from the research unveiled at the international Alzheimer's conference in Japan in July?

WEINER: Well, this was an epidemiological study, where they looked at women who were post-menopausal who had been taking estrogen over a period of time, and women who had not been taking estrogen...and found among the estrogen taking women the prevalence of Alzheimer's disease was considerably less. So that was a hopeful sign that perhaps taking estrogen post-menopausally would be a good way to prevent or delay the onset of Alzheimer's disease...so what's happening at the present moment is there's a national study going on...looking at women who are post-menopausal who have had hysterectomies, on the impact - and it's a one year long study - of the impact of estrogen on the progress of Alzheimer's disease...whether the disease, once established, is slowed by the addition of estrogen. So, we're investigating that now, and the results will probably be available in another year.

NEMA: Now, in these studies, are the side effects and drawbacks of the drug also examined?

WEINER: Post-menopausal bleeding is probably the biggest thing..which ladies have had menopause who are no longer having periods can start up bleeding again, and in addition to that, there's a possibility of breast cancer prevalence...increasing, because it's frequently an estrogen dependent tumor. And some chance of other genital malignancies, with a provocation by estrogen.

NEMA: I understand there is not yet a similar hormonal treatment for men who may have Alzheimer's..and it's also true more women than men are affected by Alzheimer's?

WEINER: Yes, that's correct....the original thought was it's because women live longer than men...but when you age-adjust the data, it looks like women sort of have the edge on men, and perhaps for women, the estrogen is a extra bit of vulnerability...it may turn out that whatever it is that makes men more vulnerable is something else other than estrogen. But at least in women, the estrogen seems to have some relationship to vulnerability.

NEMA: What is it about estrogen that may keep our brains healthier, longer?

WEINER: Evidence from rat studies that go back many years that estrogen increases the sprouting of connections between brain cells. So, there's a good likelihood that estrogen may stimulate or help maintain the inner connectiveness of brain cells. We don't have studies like these in humans, but it would tend to support what we find in humans.

NEMA: What is the next step in establishing this treatment?

WEINER: Two things, one would be a prospective study...that is to say having a group of women who don't have Alzheimer's disease, and giving half of them estrogen and the other half not...and watching and seeing who develops Alzheimer's disease. That would have to be a fairly large study to get up the decent numbers. The other would be to begin treating people who have Alzheimer's disease with estrogen to see if it influences the course of the disease...which would be very good news if it did.

NEMA: Our thanks to Dr. Myron Weiner, Professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. I'm Steve Girard.