leuprolide and Dementia

In the 1990s, estrogens were thought to protect the aging brain. Large randomized controlled studies, however, showed that estrogens did not treat dementia symptoms and even increased risk for dementia in older women. These findings contrast with earlier positive findings, including a wealth of cell culture and animal data all suggesting that estrogens could be a prophylactic treatment for dementia. Observational data had also suggested a significantly decreased risk for dementia in women who had been treated with estrogens for menopausal symptoms in midlife. This review discusses the "Critical Window", Healthy Cell Bias' and "Limited Duration" hypotheses, and forms of bias (healthy user, recall and survivor bias) and potential mediators (e.g., body mass, genetics) to attempt to explain the differences seen between the studies. On the basis of limited data, we conclude that estrogens only have limited positive effects on some tests for a number of months regardless of age. These effects were seen in recently menopausal women, but also in women with dementia, who are at least 15 years past the average age of menopause. In addition, after a longer period of time, treatment may confer risk, especially in older women. From this it would follow that longer term treatment with estrogens to maintain cognitive function is not indicated for older women. Whether there still is a case to treat surgical menopausal women with estrogens for a longer or shorter period of time remains to be tested.

Topics: Aged; Aged, 80 and over; Animals; Brain; Cardiovascular Diseases; Cognition Disorders; Comorbidity; Confounding Factors, Epidemiologic; Dementia; Estrogen Replacement Therapy; Female; Humans; Leuprolide; Male; Menopause; Menopause, Premature; Middle Aged; Models, Biological; Obesity; Prevalence; Randomized Controlled Trials as Topic; Risk Factors; Sex Factors

Topics: Age Factors; Aged; Aggression; Androgen Antagonists; Dementia; Flutamide; Humans; Leuprolide; Male; Psychiatric Status Rating Scales; Testosterone

Three demented patients who manifested an aggressive syndrome and motor disturbances including agitation, pacing, and restlessness received a therapeutic trial of the antiandrogen agents medroxyprogesterone acetate and luprolide acetate. Within 4 weeks of the start of the antiandrogen therapy, verbal and physical aggressivity had ceased; activity disturbances such as agitation, pacing, and restlessness were markedly reduced. One patient also manifested marked disinhibited and disruptive sexual behavior. Following treatment, that behavior also ceased. Further control studies assessing the efficacy and safety of antiandrogen agents are recommended.

Topics: Aged; Aged, 80 and over; Aggression; Alzheimer Disease; Androgen Antagonists; Dementia; Humans; Leuprolide; Male; Medroxyprogesterone Acetate; Psychomotor Agitation; Social Behavior

A patient with dementia and features of the Klüver-Bucy syndrome was treated for verbal, physical, and sexually aggressive behavior disturbances. Propranolol was effective in controlling verbal and physical aggression but not sexually aggressive and inappropriate behaviors. The latter responded completely to treatment with leuprolide. The differential response to these treatments suggests that two basic forms of aggressive behavior in demented men can be identified and treated with relative specificity.

Topics: Adult; Aggression; Brain Diseases; Dementia; Humans; Leuprolide; Male; Sexual Behavior

We treated a patient with Huntington's disease and exhibitionism using leuprolide acetate (Lupron Depot, TAP Pharmaceuticals), a gonadotropin-releasing hormone agonist. The result was elimination of his deviant sexual behavior with few side effects. This regimen may be a safe and effective pharmacological treatment of the paraphilias. The occurrence of paraphilias in basal ganglia disorders is reviewed.

Topics: Adult; Delayed-Action Preparations; Dementia; Exhibitionism; Humans; Huntington Disease; Injections, Intramuscular; Leuprolide; Male; Neurologic Examination