Onset of dementia is associated with age at menopause in women with Down's syndrome

• Published in: Annals of neurology Vol. 54; no. 4; pp. 433 - 438
• Main Authors: Schupf, Nicole, Pang, Deborah, Patel, Bindu N., Silverman, Wayne, Schubert, Romaine, Lai, Florence, Kline, Jennie K., Stern, Yaakov, Ferin, Michel, Tycko, Benjamin, Mayeux, Richard
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2003; Willey-Liss
• Subjects: Adult; Age of Onset; Aging; Alleles; Alzheimer Disease; Apolipoprotein E4; Apolipoproteins E - blood; Apolipoproteins E - genetics; Apolipoproteins E - metabolism; Biological and medical sciences; Body Mass Index; Case-Control Studies; Chromosome aberrations; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia - blood; Dementia - etiology; Dementia - genetics; Depression - etiology; Down Syndrome - blood; Down Syndrome - complications; Down Syndrome - genetics; Female; Hormones - blood; Humans; Hypothyroidism; Intelligence; Medical genetics; Medical sciences; Menopause; Mental Status Schedule; Middle Aged; Neurology; Polymerase Chain Reaction - methods; Chromosomal aberration; Endocrinopathy; Human; Nervous system diseases; Trisomy; Alzheimer disease; Menopause; Thyroid diseases; Estrogen; Chromosome G21; Aneuploidy; Developmental disorder; Down syndrome; Congenital disease; Mental retardation; Estradiol; Cerebral disorder; Age of onset; Central nervous system disease; Risk factor; Intellectual deficiency; Degenerative disease
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.10677

Women with Down's syndrome experience early onset of both menopause and Alzheimer's disease. This timing provides an opportunity to examine the influence of endogenous estrogen deficiency, indicated by age at menopause, on risk of Alzheimer's disease. A community‐based sample of 163 postmenopausal women with Down's syndrome, 40 to 60 years of age, was ascertained through the New York State Developmental Disability service system. Information from cognitive assessments, medical record review, neurological evaluation, and caregiver interviews was used to establish ages for onset of menopause and dementia. We used survival and multivariate regression analyses to determine the relation of age at menopause to age at onset of Alzheimer's disease, adjusting for age, level of mental retardation, body mass index, and history of hypothyroidism or depression. Women with early onset of menopause (46 years or younger) had earlier onset and increased risk of Alzheimer's disease (AD) compared with women with onset of menopause after 46 years (rate ratio, 2.7; 95% confidence interval [CI], 1.2–5.9). Demented women had higher mean serum sex hormone binding globulin levels than nondemented women (86.4 vs 56.6 nmol/L, p = 0.02), but similar levels of total estradiol, suggesting that bioavailable estradiol, rather than total estradiol, is associated with dementia. Our findings support the hypothesis that reductions in estrogens after menopause contribute to the cascade of pathological processes leading to AD.