Sleep quality and cortical amyloid-β deposition in postmenopausal women of the Kronos early estrogen prevention study

Burcu Zeydan, Val J. Lowe, Nirubol Tosakulwong, Timothy G. Lesnick, Matthew L. Senjem, Clifford R. Jack, Julie A. Fields, Taryn T. James, Carey E. Gleason, N. Maritza Dowling, Virginia M. Miller, Kejal Kantarci

Research output: Contribution to journalArticlepeer-review


Hormone therapy improves sleep in menopausal women and recent data suggest that transdermal 17β-estradiol may reduce the accumulation of cortical amyloid-β. However, how menopausal hormone therapies modify the associations of amyloid-β accumulation with sleep quality is not known. In this study, associations of sleep quality with cortical amyloid-β deposition and cognitive function were assessed in a subset of women who had participated in the Kronos early estrogen prevention study. It was a randomized, placebo-controlled trial in which recently menopausal women (age, 42-58; 5-36 months past menopause) were randomized to (1) oral conjugated equine estrogen (n = 19); (2) transdermal 17β-estradiol (tE2, n = 21); (3) placebo pills and patch (n = 32) for 4 years. Global sleep quality score was calculated using Pittsburgh sleep quality index, cortical amyloid-β deposition was measured with Pittsburgh compound-B positron emission tomography standard uptake value ratio and cognitive function was assessed in four cognitive domains 3 years after completion of trial treatments. Lower global sleep quality score (i.e., better sleep quality) correlated with lower cortical Pittsburgh compound-B standard uptake value ratio only in the tE2 group (r = 0.45, P = 0.047). Better global sleep quality also correlated with higher visual attention and executive function scores in the tE2 group (r = -0.54, P = 0.02) and in the oral conjugated equine estrogen group (r = -0.65, P = 0.005). Menopausal hormone therapies may influence the effects of sleep on cognitive function, specifically, visual attention and executive function. There also appears to be a complex relationship between sleep, menopausal hormone therapies, cortical amyloid-β accumulation and cognitive function, and tE2 formulation may modify the relationship between sleep and amyloid-β accumulation.

Original languageEnglish (US)
Pages (from-to)326-331
Number of pages6
Issue number4
StatePublished - Mar 3 2021


  • amyloid-β
  • cognition
  • estrogen
  • menopause
  • sleep

ASJC Scopus subject areas

  • General Neuroscience


Dive into the research topics of 'Sleep quality and cortical amyloid-β deposition in postmenopausal women of the Kronos early estrogen prevention study'. Together they form a unique fingerprint.

Cite this