Which group of women is recommended against using HRT for primary prevention of dementia?

The recommendation against using hormone replacement therapy (HRT) for primary prevention of dementia primarily applies to women over the age of 65. Research, including findings from significant studies like the Women's Health Initiative, indicates that starting HRT in this age group does not confer protective benefits against dementia and may even be associated with increased risks for adverse outcomes.

In contrast, younger women or those in earlier stages of menopause may not have the same risks, and some studies suggest that HRT initiated near the onset of menopause might have a protective cardiovascular effect, which could theoretically impact cognitive health.

Moreover, while women with a family history of Alzheimer's disease (AD) may be at higher risk for developing cognitive disorders, this does not translate to a blanket recommendation against HRT for primary prevention of dementia, as individual risk factors and potential benefits may vary significantly.

Understanding the nuances of hormonal therapy and its implications on brain health in different age groups is essential for informed clinical decision-making. Therefore, the recommendation against HRT as a preventive measure for dementia is specifically pertinent to older women, particularly those over 65.