A Cochrane review [Abstract] 1 included 7 trials involving 351 women with Alzheimer's disease. On a clinical global rating, clinicians scored patients taking CEE as significantly worse compared with the placebo group on the Clinical Dementia Rating scale after 12 months (overall WMD = 0.35, 95% CI 0.01 to 0.69).Patients taking conjugated equine estrogens (CEE) had a worse performance on the delayed recall of the Paragraph Test (overall WMD = -0.45, 95% CI = -0.79 to -0.11) after one month than those taking placebo. They had a worse performance on Finger Tapping after 12 months (WMD = -3.90, 95% CI = -7.85 to 0.05).Limited positive effects were found for the lower dosage of CEE (0.625 mg/day) which showed a significant improvement in MMSE score only when assessed at two months, and disappeared after correction for multiple testing. No significant effects for MMSE were found at longer end points (3, 6 and 12 months of treatment). With a dosage of 1.25 mg/d CEE, short-term significant effects were found for Trial-Making test B at one month and Digit Span backward at four months. After two months of transdermal diestradiol treatment, a highly significant effect was observed for the word recall test (WMD = 6.50, 95% CI = 4.04 to 8.96). No other significant effects were found for other outcomes measured.
Reviewers' conclusions: Currently, HRT or ERT for cognitive improvement or maintenance is not indicated for women with AD. Other types of dementia (e.g. vascular dementia) remain to be investigated.
Comment: The evidence is downgraded by imprecise results (small sample size).
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