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Raloxifene (EvistaR) and memory function
Title: Cognitive function in postmenopausal women treated with Raloxifene
Author: K. Yaffe, et al.
Address: San Francisco, California
Source: New England Journal of Medicine 344:1207-1213 (April) 2001
Summary:Some studies indicate that in women who are postmenopausal, it is
possible that estrogen has a beneficial effect of cognition or reduces the risk
of decline in cognitive function. The present study was conducted to determine if
raloxifene, a selective estrogen-receptor modulator used for the prevention and
treatment of postmenopausal osteoporosis, might have similar actions. They
studied 7478 postmenopausal women with osteoporosis with an average age of 66
ears. Subjects were randomly assigned to receive raloxifene (60 mg or 120 mg) or
placebo daily for 3 years. The women were given tests of cognitive function at
base line and at 6 months and 1, 2, and 3 years. Researchers compared the average
scores of the groups and those whose change in score at three years was in the
worst 10 percent were classified as having a decline in cognitive function.
Average cognitive scores in the 3 groups were similar at base line. The scores
improve slightly in all groups during the three-year study period, with no
significant differences among the groups. The risk of decline in the cognitive
function, as measure by 4 of the 6 tests, did not differ significantly between
the two raloxifene groups combined and the placebo group, but there was a trend
toward less decline in the combined raloxifene group on the two tests of verbal
memory (relative risk, 0.77) and attention (relative risk, 0.87). It is important
to note that raloxifene increases the incidence of hot flashes in women, and it
has been suggested that hot flashes are associated with poorer cognitive
performance. However, in this study newly reported or worsening hot flashes did
not negatively influence test scores or the effect of treatment on test
performance. Researchers concluded that while there is limited evidence that
raloxifene treatment for three years may lower the risk of a decline in verbal
memory and attention, it does not affect overall cognitive scores in
postmenopausal women with osteoporosis.
Comment: It is still open to debate whether an estrogen treated group, which should have been included, would have done better.