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

Authors

  • Nicole Schupf PhD,

    Corresponding author
    1. The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York
    2. New York State Institute for Basic Research in Developmental Disabilities, Staten Island
    3. The Gertrude H. Sergievsky Center, Columbia University, New York, NY
    • The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, P.O. Box 16, 630 West 168th Street, New York, NY 10032
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  • Deborah Pang MPH,

    1. New York State Institute for Basic Research in Developmental Disabilities, Staten Island
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  • Bindu N. Patel MPH,

    1. New York State Institute for Basic Research in Developmental Disabilities, Staten Island
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  • Wayne Silverman PhD,

    1. New York State Institute for Basic Research in Developmental Disabilities, Staten Island
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  • Romaine Schubert MD,

    1. New York State Institute for Basic Research in Developmental Disabilities, Staten Island
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  • Florence Lai MD,

    1. Departments of Neurology, Massachusetts General Hospital and McLean Hospital, Belmont, MA
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  • Jennie K. Kline PhD,

    1. The Gertrude H. Sergievsky Center, Columbia University, New York, NY
    2. Department of Epidemiology in the Mailman School of Public Health, Columbia University
    3. Epidemiology of Developmental Brain Disorders, New York State Psychiatric Institute, New York
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  • Yaakov Stern PhD,

    1. The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York
    2. The Gertrude H. Sergievsky Center, Columbia University, New York, NY
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  • Michel Ferin MD,

    1. Departments of Obstetrics and Gynecology, Columbia University, New York, NY
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  • Benjamin Tycko MD, PhD,

    1. The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York
    2. Pathology, Columbia University, New York, NY
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  • Richard Mayeux MD, MSE

    1. The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York
    2. The Gertrude H. Sergievsky Center, Columbia University, New York, NY
    3. Neurology and Psychiatry, Columbia University, New York, NY
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Abstract

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.

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