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July 19, 2000

Estrogen as a Treatment for Alzheimer Disease—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(3):307-308. doi:10.1001/jama.284.3.303

In Reply: While there is general agreement, as Dr Cosgrove suggests, that estrogen affects cognition in specific domains, it is very difficult to administer such tests to persons with AD. Although instruments to test explicit verbal memory have been used extensively in the study of cognitive change associated with ERT, the validity of these tests in persons with dementia has not been established. The ADAS-Cog represents a standardized instrument for measurement of verbal memory in dementia clinical trials,1 as well as regulatory applications for marketing approval. In addition, the expanded ADAS-Cog was augmented by additional components of proven reliability and sensitivity, which extended the cognitive domains and range of symptom severity.2 All our other tests for specific cognitive domains, with the exception of Emotional Faces Recognition, are well-known, standardized instruments.