Reproductive period and risk of dementia in a diverse cohort of health care members

Paola Gilsanz, Catherine Lee, Maria M. Corrada, Claudia H. Kawas, Charles P. Quesenberry, Rachel Whitmer

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Women have >50% greater lifetime risk of dementia than men but the role of female-specific endocrine milieu is not well-understood. This study evaluates associations between indicators of estrogen exposure from women's reproductive period and dementia risk in a large diverse population. METHODS: We evaluated 15,754 female members (29.9% nonwhite) of Kaiser Permanente with clinical examinations and health survey data from 1964 to 1973 and were members as of January 1, 1996. In midlife (mean age 51.1 years), women reported age at menarche and menopause and hysterectomy status. Reproductive span was calculated as menopause age minus menarche age. Dementia diagnoses were abstracted from January 1, 1996 to September 30, 2017 medical records (mean age at start of dementia follow-up 76.5 years). Cox proportional hazard models evaluated associations between aspects of reproductive span and dementia risk adjusting for demographics and life course health indicators. RESULTS: Forty-two percent of women developed dementia. Compared to menarche at age 13.0 (mean menarche age), menarche at ≥16 was associated with 23% greater dementia risk (adjusted hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.01-1.50) adjusting for demographics and life course health indicators. Natural menopause at age <47.4 (mean menopause age) was associated with 19% elevated dementia risk (HR 1.19; 95% CI 1.07-1.31). Reproductive spans <34.4 years (mean duration) were associated with 20% elevated dementia risk (HR 1.20; 95% CI 1.08-1.32). Hysterectomies were associated with 8% elevated dementia risk (HR 1.08; 95% CI 1.01-1.16). CONCLUSION: In this large prospective cohort study, endocrine events signaling less estradiol exposure (i.e., later age at menarche, younger age at menopause, shorter reproductive span, and hysterectomies) were associated with elevated risk of dementia.

Original languageEnglish (US)
Pages (from-to)e2005-e2014
JournalNeurology
Volume92
Issue number17
DOIs
StatePublished - Apr 23 2019
Externally publishedYes

Fingerprint

Reproduction
Dementia
Delivery of Health Care
Menarche
Menopause
Hysterectomy
Confidence Intervals
Odds Ratio
Demography
Health
Health Surveys
Proportional Hazards Models
Medical Records
Estradiol
Estrogens
Cohort Studies
Prospective Studies

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Gilsanz, P., Lee, C., Corrada, M. M., Kawas, C. H., Quesenberry, C. P., & Whitmer, R. (2019). Reproductive period and risk of dementia in a diverse cohort of health care members. Neurology, 92(17), e2005-e2014. https://doi.org/10.1212/WNL.0000000000007326

Reproductive period and risk of dementia in a diverse cohort of health care members. / Gilsanz, Paola; Lee, Catherine; Corrada, Maria M.; Kawas, Claudia H.; Quesenberry, Charles P.; Whitmer, Rachel.

In: Neurology, Vol. 92, No. 17, 23.04.2019, p. e2005-e2014.

Research output: Contribution to journalArticle

Gilsanz, P, Lee, C, Corrada, MM, Kawas, CH, Quesenberry, CP & Whitmer, R 2019, 'Reproductive period and risk of dementia in a diverse cohort of health care members', Neurology, vol. 92, no. 17, pp. e2005-e2014. https://doi.org/10.1212/WNL.0000000000007326
Gilsanz, Paola ; Lee, Catherine ; Corrada, Maria M. ; Kawas, Claudia H. ; Quesenberry, Charles P. ; Whitmer, Rachel. / Reproductive period and risk of dementia in a diverse cohort of health care members. In: Neurology. 2019 ; Vol. 92, No. 17. pp. e2005-e2014.
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abstract = "OBJECTIVE: Women have >50{\%} greater lifetime risk of dementia than men but the role of female-specific endocrine milieu is not well-understood. This study evaluates associations between indicators of estrogen exposure from women's reproductive period and dementia risk in a large diverse population. METHODS: We evaluated 15,754 female members (29.9{\%} nonwhite) of Kaiser Permanente with clinical examinations and health survey data from 1964 to 1973 and were members as of January 1, 1996. In midlife (mean age 51.1 years), women reported age at menarche and menopause and hysterectomy status. Reproductive span was calculated as menopause age minus menarche age. Dementia diagnoses were abstracted from January 1, 1996 to September 30, 2017 medical records (mean age at start of dementia follow-up 76.5 years). Cox proportional hazard models evaluated associations between aspects of reproductive span and dementia risk adjusting for demographics and life course health indicators. RESULTS: Forty-two percent of women developed dementia. Compared to menarche at age 13.0 (mean menarche age), menarche at ≥16 was associated with 23{\%} greater dementia risk (adjusted hazard ratio [HR] 1.23; 95{\%} confidence interval [CI] 1.01-1.50) adjusting for demographics and life course health indicators. Natural menopause at age <47.4 (mean menopause age) was associated with 19{\%} elevated dementia risk (HR 1.19; 95{\%} CI 1.07-1.31). Reproductive spans <34.4 years (mean duration) were associated with 20{\%} elevated dementia risk (HR 1.20; 95{\%} CI 1.08-1.32). Hysterectomies were associated with 8{\%} elevated dementia risk (HR 1.08; 95{\%} CI 1.01-1.16). CONCLUSION: In this large prospective cohort study, endocrine events signaling less estradiol exposure (i.e., later age at menarche, younger age at menopause, shorter reproductive span, and hysterectomies) were associated with elevated risk of dementia.",
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