激素调节疗法 (HMT) 是一种被广泛接受的激素受体阳性乳腺癌治疗方法，尽管其认知影响，包括与阿尔茨海默病和相关痴呆 (ADRD) 的潜在联系，尚未得到充分研究。癌症治疗和 65 岁或以上女性患 ADRD 的风险。这项队列研究使用了来自监测、流行病学和最终结果 (SEER)-医疗保险链接数据库的综合数据集来识别在初次诊断乳腺癌 3 年后，评估其晚年患 ADRD 的风险。预先诊断为 ADRD 或在诊断乳腺癌之前接受 HMT 的个体被排除在外。这项研究于 2022 年 6 月至 2024 年 1 月进行。HMT 的接收。与 HMT 相关的 ADRD 风险；风险与年龄、自我认同种族和 HMT 类型的关联。使用危险比 (HR) 和 95% CI 来测量风险，并根据人口统计学、社会文化和临床变量等潜在混杂因素进行调整。 2007 年至 2009 年间，18808 名 65 岁及以上女性被诊断患有乳腺癌（1266 名黑人 [6.7] %]、16526 名白人[87.9%]、1016 名其他人[5.4%]）、12356 名（65.7%）在诊断后 3 年内接受了 HMT，而 6452 名（34.3%）没有接受。两个样本中最常见的年龄组是 75 至 79 岁年龄组（HMT，2721 名女性 [22.0%]；无 HMT，1469 名女性 [22.8%]），并且两组中的大多数女性都自我认定为白人（HMT，10904 名女性 [88.3%]；无 HMT，5622 名女性 [87.1%]）。在平均 12 年的随访期间，2926 名 HMT 用户（23.7%）和 1802 名非 HMT 用户（27.9%）出现了 ADRD。 HMT 与 ADRD 总体相对风险降低 7% 相关（HR，0.93；95% CI，0.88-0.98；P = .005）。这种关联随着年龄的增长而减弱，并因种族而异。对于自认为是黑人的 65 至 74 岁女性来说，与 HMT 相关的 ADRD 风险降低幅度最大（HR，0.76；95% CI，0.62-0.92）。这种关联在 75 岁或以上的女性中下降（HR，0.81；95% CI，0.67-0.98）。年龄在 65 至 74 岁之间、自我认定为白人的女性的相对风险降低了 11%（HR，0.89；95% CI，0.81-0.97），但这种关联在 75 岁或以上的女性中消失了（HR，0.96；95） % CI，0.90-1.02）。其他种族显示 HMT 和 ADRD 之间没有显着关联。基于年龄和种族的关联也因 HMT 类型而异。在这项回顾性队列研究中，激素治疗与 65 岁或以上新诊断乳腺癌女性的 ADRD 预防相关。黑人女性和 75 岁以下女性的风险降低幅度相对较大，而 HMT 的保护作用随着年龄的增长而减弱，并且在女性中因种族而异。当决定对 65 岁或以上女性使用 HMT 治疗乳腺癌时，临床医生应在治疗决策中考虑年龄、自我认定的种族和 HMT 类型。

Hormone-modulating therapy (HMT) is a widely accepted treatment for hormone receptor-positive breast cancer, although its cognitive effects, including a potential link to Alzheimer disease and related dementias (ADRD), remain understudied.To investigate the association between HMT for breast cancer treatment and risk of developing ADRD in women aged 65 years or older.This cohort study used a comprehensive dataset from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify patients who did and did not receive HMT treatment within 3 years after the initial diagnosis of breast cancer and assessed their risk of developing ADRD in later life. Individuals with a preexisting diagnosis of ADRD or receiving HMT before the diagnosis of breast cancer were excluded. This study was performed from June 2022 through January 2024.Receipt of HMT.Risk of ADRD associated with HMT; associations of risk with age, self-identified race, and HMT type. Risk was measured using hazard ratios (HRs) with 95% CIs and adjusted for potential confounders such as demographic, sociocultural, and clinical variables.Among 18 808 women aged 65 years and older diagnosed with breast cancer between 2007 and 2009 (1266 Black [6.7%], 16 526 White [87.9%], 1016 other [5.4%]), 12 356 (65.7%) received HMT within 3 years after diagnosis, while 6452 (34.3%) did not. The most common age group in both samples was the 75 to 79 years age group (HMT, 2721 women [22.0%]; no HMT, 1469 women [22.8%]), and the majority of women in both groups self-identified as White (HMT, 10 904 women [88.3%]; no HMT, 5622 women [87.1%]). During an average of 12 years of follow-up, 2926 (23.7%) of HMT users and 1802 (27.9%) of non-HMT users developed ADRD. HMT was associated with a 7% lower relative risk of ADRD overall (HR, 0.93; 95% CI, 0.88-0.98; P = .005). The association decreased with age and varied by race. The reduction in ADRD risk associated with HMT was greatest for women aged 65 to 74 years who self-identified as Black (HR, 0.76; 95% CI, 0.62-0.92). This association decreased among women aged 75 years or older (HR, 0.81; 95% CI, 0.67-0.98). Women aged 65 to 74 years who self-identified as White had an 11% relative risk reduction (HR, 0.89; 95% CI, 0.81-0.97), but the association disappeared for women aged 75 years or older (HR, 0.96; 95% CI, 0.90-1.02). Other races showed no significant association between HMT and ADRD. Age- and race-based associations also varied by HMT type.In this retrospective cohort study, hormone therapy was associated with protection against ADRD in women aged 65 years or older with newly diagnosed breast cancer; the decrease in risk was relatively greater for Black women and women under age 75 years, while the protective effect of HMT diminished with age and varied by race in women. When deciding to use HMT for breast cancer in women aged 65 years or more, clinicians should consider age, self-identified race, and HMT type in treatment decisions.