Reader Response: Use of Hormone Replacement Therapy and Risk of Dementia
Joseph S.Jeret, MD, FAAN, Icahn School of Medicine
Submitted November 06, 2022
I read this article by Dr. Sung et al. with interest.1 After screening 522,350 women, 150,623 met selection criteria. The authors identified 702 patients with dementia confirmed by ICD-9-CM coding by a board-certified neurologist or psychiatrist. However, the study includes several serious methodological flaws.
Of the 702 women in the study, over 77% were classified not as Alzheimer’s or vascular dementia patients (the two most common causes of dementia), but as other. In the comparison cohort, other dementia was diagnosed 75.8% of the time. It is disappointing that the authors could not reach a diagnosis for some three-quarters of their patients. If these individuals had AIDS, Huntington’s, or neurosyphilis, it would change the conclusion.
Further, the causes of Alzheimer’s and vascular dementia are quite different. To lump them together is illogical. To combine this group of 77% without a specific etiology compounds the problem.
In addition, the use of ergoloid mesylates and ginko were sufficient to be included in the diagnosis of dementia. Use of these products does not prove a diagnosis of dementia. In summary, these data are interesting, but of little use in clinical decision making. I would be interested to see a more complete study after the authors personally review the 542 charts of patients with "other" dementia.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Sung YF, Tsai CT, Kuo CY, et al. Use of Hormone Replacement Therapy and Risk of Dementia: A Nationwide Cohort Study [published online ahead of print, 2022 Sep 2]. Neurology. 2022;10.1212/WNL.0000000000200960.
I read this article by Dr. Sung et al. with interest.1 After screening 522,350 women, 150,623 met selection criteria. The authors identified 702 patients with dementia confirmed by ICD-9-CM coding by a board-certified neurologist or psychiatrist. However, the study includes several serious methodological flaws.
Of the 702 women in the study, over 77% were classified not as Alzheimer’s or vascular dementia patients (the two most common causes of dementia), but as other. In the comparison cohort, other dementia was diagnosed 75.8% of the time. It is disappointing that the authors could not reach a diagnosis for some three-quarters of their patients. If these individuals had AIDS, Huntington’s, or neurosyphilis, it would change the conclusion.
Further, the causes of Alzheimer’s and vascular dementia are quite different. To lump them together is illogical. To combine this group of 77% without a specific etiology compounds the problem.
In addition, the use of ergoloid mesylates and ginko were sufficient to be included in the diagnosis of dementia. Use of these products does not prove a diagnosis of dementia. In summary, these data are interesting, but of little use in clinical decision making. I would be interested to see a more complete study after the authors personally review the 542 charts of patients with "other" dementia.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References