After more than a century of research, we have failed to develop a pharmacological prevention or cure for dementia. There are strong indicators that sex hormones influence cognition. In this paper we discuss the role of these hormones at the intersection between vascular disease and dementia, in light of the mounting literature covering the shared risk factors, pathological features alongside the timeline of hormonal change with the evolution of vascular and neurodegenerative disease. Interactive risk factors and the role of inflammation over the duration of disease evolution are highlighted. Our summary tables assessing the impact of estrogen-based hormone therapy on cognition over the past 45 years illustrate the effort expended to determine the ideal age for intervention and the type, dose, administration, and duration of therapy that might improve or protect cognition as well as alleviate menopausal symptoms. As the prevalence of dementia is rising and is higher in women, it is crucial we advance our knowledge from the “inconclusive” position statement on menopausal hormone therapy of the US Preventive Services Task Force.

经过一个多世纪的研究，我们未能开发出预防或治疗痴呆症的药物。有强有力的指标表明性激素会影响认知。在本文中，我们讨论了这些激素在血管疾病和痴呆之间的交叉作用中的作用，鉴于越来越多的文献涵盖了共同的风险因素、病理特征以及随着血管和神经退行性疾病的发展而发生的激素变化的时间线。强调了相互作用的风险因素和炎症在疾病演变过程中的作用。我们在过去 45 年中评估基于雌激素的激素治疗对认知的影响的汇总表说明了为确定干预的理想年龄以及类型、剂量、给药、和可能改善或保护认知以及缓解更年期症状的治疗持续时间。由于痴呆症的患病率正在上升并且在女性中更高，因此我们必须从美国预防服务工作组关于更年期激素治疗的“不确定”立场声明中提高我们的知识。