The growth in information about hormone replacement therapy (HRT) over the past few years has been impressive. This review summarizes the latest information on HRT and cardiovascular disease, osteoporotic fractures, and cognitive function. The risks of HRT (e.g., stroke, breast cancer, and venous thromboembolism) clearly outweigh the benefits (e.g., reduction in osteoporotic fractures). The use of HRT for primary or secondary prevention of coronary heart disease or to decrease the risk of cognitive dysfunction is also not supported. While the evidence in older adults is substantial, there is some controversy regarding the effectiveness of HRT initiated in women at the start of menopause.
Key words: hormone replacement therapy, cardiovascular disease, osteoporosis, cognitive function, dementia.
Lars S. Rasmussen, MD, PhD, Department of Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Postoperative Cognitive Dysfunction (POCD) is a decline in cognitive function detected days or weeks after surgery. It is usually subtle and lasts for weeks or months. The impairment must be evidenced by neuropsychological testing that is, unfortunately, associated with many problems related to its administration, statistical analysis and the interpretation of the test results. Risk factors for POCD are increasing age and type of surgery, with a very high risk after cardiac surgery (incidence 30-70% one week after surgery) and a low risk after minor, non-cardiac procedures, especially if performed on an outpatient basis.
Key words: cognitive function, postoperative, anesthesia, neuropsychological testing.
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