Trajectories of loneliness, depressive symptoms, and anxiety symptoms during the COVID-19 pandemic in Austria.

OBJECTIVE: There is considerable heterogeneity within populations regarding the effects of the COVID-19 pandemic on mental health. This study aimed at identifying latent groups of individuals within the older Austrian population that differ in their mental health trajectories across three phases of the pandemic. STUDY DESIGN: Data were gathered from a longitudinal survey study among a sample of older adults in Austria. The survey was carried out in May 2020 (N1 = 556), March 2021 (N2 = 462), and December 2021 (N3 = 370) via either computer-assisted web or telephone interviewing. METHODS: Latent class growth analysis was conducted to explore different homogenous groups in terms of non-linear trajectories of loneliness, depressive symptoms, and anxiety symptoms as well as potential correlates thereof. RESULTS: We identified four latent classes. The vast majority of individuals belong to two classes that are either resilient (71%) or that have recovered relatively quickly from an initial COVID-19 shock (10.2%). Deterioration in mental health after the first phase of the pandemic (13.4%) or a generally high mental health burden (5.4%) characterizes the other two classes. CONCLUSIONS: About 19% of individuals showed increasing or elevated levels in loneliness, depressive symptoms, and anxiety symptoms across the COVID-19 pandemic. The feeling of being socially supported and in control over one's own life emerged as potentially protective factors.

Longitudinal effects of COVID-19-related loneliness on symptoms of mental distress among older adults in Austria.

OBJECTIVE: COVID-19-related social restrictions resulted in more loneliness, but whether this had further effects on mental health remains unclear. This study aimed at examining the longitudinal effects of COVID-19-related loneliness on mental health among older adults (aged ≥60 years) in Austria. STUDY DESIGN: Survey data were gathered from a longitudinal observational study among a random sample of older Austrian adults. The first survey wave was conducted in May 2020 (N1 = 557), and the second wave was conducted in March 2021 (N2 = 463). METHODS: Data collection was based on either computer-assisted web or telephone interviewing. For statistical analysis, we used a cross-lagged panel analysis. RESULTS: The results showed the perceived COVID-19-related social restrictions to predict loneliness, which in turn predicted depressive and anxiety symptoms 10 months later. CONCLUSIONS: COVID-19-related loneliness emerged as a risk factor for subsequent mental distress among older adults in Austria.

[Attitudes Towards End-of-Life Decisions and Long-Term Care Dependency: Results of a Representative Survey of Austrians Aged 50]. / Einstellungen zu Entscheidungen am Lebensende und Pflegebedürftigkeit: Ergebnisse einer repräsentativen Befragung der österreichischen Bevölkerung (50+).

AIM OF THE STUDY: Existing research on attitudes in the general population regarding end-of-life decisions has included neither old age long-term care dependency nor worries regarding age(ing). The aim of this study is to present first results from a recent survey on this topic. METHODS: A nationally representative cross-sectional survey of the population aged 50+was conducted in Austria (n=968) in 2015. RESULTS: 29.0% of the respondents indicated not wanting to live on as a severely care-dependent older person. In the case of an older care-dependent person, 48.5% approved of forgoing life-sustaining treatment, 41.7% of assisted suicide and 34.1% of euthanasia if requested. Worries about old age and ageing were widespread (53.7-83.0%) and highly worried respondents were more inclined to support assisted suicide and euthanasia compared to those less worried. CONCLUSIONS: Worries and negative stereotypes regarding age(ing) and long-term care dependency should be addressed by information campaigns.

[Perception of hearing problems in the older population]. / Wahrnehmung von Hörproblemen bei älteren Menschen.

BACKGROUND: Age-related hearing loss is one of the most common chronic sensory impairments in the older population. This chronic condition is associated with bio-psychosocial consequences such as cognitive decline, depression, withdrawal, isolation, and reduced wellbeing. OBJECTIVE: This study aimed to investigate the perception of hearing problems among older women and men (≥55 years) with age-related hearing loss. Furthermore, the association between functional hearing loss and perceived hearing problems was examined. Lastly, this study undertook a detailed investigation of subjective experiences in order to better understand the consequences of age-related hearing loss for daily life. MATERIALS AND METHODS: With the aid of mixed methods, quantitative data were gathered from 65 participants with age-related hearing impairment in Austria using the Hearing Handicap Inventory for the Elderly (HHIE). Moreover, qualitative data regarding experiences with hearing problems were collected by performing semi-structured problem-centered interviews and analyzing the results of a further 14 older adults with hearing loss. RESULTS: On average, participants assessed their hearing handicap as mild and perceived consequences on emotional, social, and communication levels. Moreover, feelings of insecurity were evident. In addition, the findings indicate a relationship but also a discrepancy between hearing loss and hearing handicap, i. e., not all participants perceived a hearing handicap. CONCLUSION: Patient-centered care encompassing (1) objective and self-report measures for assessing hearing problems, (2) involvement of family members and significant others, (3) counseling and exchange of information, and (4) a shared decision-making approach could enhance quality of life and quality of care.

Differentiating health statuses using positive health indicators in an occupational context.

OBJECTIVES: To identify different health statuses beyond the dichotomy of 'health' vs 'illness'. To achieve this, positive indicators based on current scientific definitions and concepts were constructed. STUDY DESIGN: Data were collected between 2008 and 2010 in a nationwide representative cross-sectional survey. METHODS: Data for approximately 11,800 wage or salary earners were analysed. Health statuses were modelled using hierarchical cluster analysis, and the relationships between clusters and working conditions were tested using discriminant analyses. RESULTS: According to response patterns in the various health dimensions, four health statuses were found: individuals who were holistically healthy; individuals with multiple health impairments; individuals with stagnating potential for development; and individuals with higher tendency to wear out. CONCLUSIONS: The use of positive health concepts enables better differentiation of health statuses. Under existing working conditions, it is possible to identify group-specific needs for the working population, and to derive appropriate measures as part of workplace health promotion.

Manpower and portfolio of European ENT.

The aim of this study is to evaluate highly variable ENT manpower among European countries. A descriptive study design is used. Manpower in medicine is highly variable among European countries. EU and associated countries are keeping officially appointed representatives to the European Union of medical specialists--otorhinolaryngology section (UEMS--ORL section). UEMS--ORL section is running a working group for manpower in ENT collecting data regarding demographics and ENT manpower in European countries. These ENT manpower data are presented in this paper and compared to available data concerning manpower in European medicine in general. To further evaluate these huge differences, representatives of the particular countries were also asked to fill out a questionnaire concerning specifics of ENT healthcare in their country. Furthermore, typical tasks of ENT doctors based on the official UEMS logbook for ENT training were listed and could be rated regarding their frequency, performed in everyday routine of an average ENT doctor of the country. Divergences in doctors/inhabitants ratios were remarkable within European countries, but disparities in ENT manpower were even more so. The ratio of ENT doctors/inhabitants was the lowest in Ireland (1:80,000) and Great Britain (1:65,000). Greece (1:10,000), Italy, Czech Republic, Lithuania, Poland and Slovakia (1:12,000) were--at the time of the study--the countries with the highest density of ENT doctors. The EU average for 2009 was (1:21,000). The presence of non-surgical working ENT doctors was significantly associated with higher densities of ENT doctors, whereas the necessity of being referred to an ENT doctor (gatekeeping or similar measures) was not. Estimated average waiting times for an appointment in non-urgent, chronic conditions, respectively, diseases were highly variable and predominantly showed a significant correlation to the ENT doctors/inhabitants ratio in the investigated countries. But also for acute conditions like acute hypacusis, dysphonia and hemoptysis, significant differences correlating to the ENT doctors/inhabitants ratio in waiting times for an ENT appointment were found. Estimated frequencies of different ENT tasks in everyday routine were extremely diverse as well, however, without detectable correlations to the ENT doctors/inhabitants ratio. In countries like Great Britain, Ireland, Malta and The Netherlands ENT doctors are primarily seen and serving as surgeons. In most Central European countries like Germany, Austria, Czech Republic, Poland and Slovakia, ENT doctors aside of surgery are also dealing with high percentages of conservative medicine, which may include vast fields like the management of Allergology, Phoniatrics, Audiology, etc. In some countries ENT doctors are even playing a significant role in primary health care as well. These various portfolios of ENT may be one explanation for the huge difference in numbers of European ENT manpower.

Social status as a mediator of self-perceived health, quality of life and health-related behaviour in obesity.

OBJECTIVES: Obesity prevalence is increasing worldwide and associated with a high health risk. Unfavourable psychological factors, lower self-ratings of health and worse health-related behaviour can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of our study was to investigate whether normal weight vs. obese subjects with a high vs. low socioeconomic status (SES) differ with regard to self-perceived health, quality of life and health-related behaviour. METHODS: Data of the Austrian Health Interview Survey (ATHIS) 2006/07, precisely of 8015 subjects were analysed stratified by sex and adjusted by age concerning these outcomes. RESULTS: The results have shown that men and women with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, intensity of physical activities, alcohol consumption, and eating behaviour (men: p <0.001; women: p<0.001). A significant interaction between the body mass index (BMI) and SES occurred in men concerning quality of life in the domains physical (p<0.05) and psychological health (p<0.01), in women as to self-perceived health (p<0.01), quality of life in the domains physical health (p<0.01) and environment (p<0.05), as well as physical activities (p<0.01). CONCLUSION: The SES has a strong negative impact on health-related variables, especially in obese subjects, and therefore risk assessment in the primary health-care setting should include socioeconomic factors. Furthermore, a continued strong public health programme is required with an absolute priority placed on obese subjects of low SES.

Attitude toward xenotransplantation of patients prior and after human organ transplantation.

Xenotransplantation is a potential strategy to overcome the shortage of human donor organs. As this technique has a major medical and psychological impact on patients and their family and friends, the attitude of patients currently waiting for organ transplantation is important. Therefore, we conducted a survey on the attitude toward xenotransplantation of patients on the waiting list and already transplanted patients. Patients received detailed information before being asked to fill in the questionnaire. We found that 65% would accept xenotransplantation, irrespective of gender, education level or if the patients were on the waiting list or already transplanted. The most common concern was transmission of diseases or genetic material, followed by psychological concerns and ethical issues. More patients had a positive attitude toward accepting cell or tissue transplantation when compared to whole organs. Pig pancreas islet cell transplantation is generally well accepted, patients with diabetes mellitus show even higher acceptance rates than patients without diabetes. In conclusion, xenotransplantation seems to be well accepted in patients who are potential future candidates for organ transplantation. Informing patients about the current status of research tended to decrease acceptance rates slightly.

Stalking and health ­ an Austrian prevalence study.

OBJECTIVE: The aim of this study was to estimate the prevalence of stalking and related subjective health impairment, based on concrete definitions of stalking, for a representative random sample of the female population in the Austrian Federal State of Styria. METHODS: A representative random sample (randomised last digits procedure) of 2000 women selected from the female population of Styria aged 18 years or older underwent a computer-aided phone interview survey (CATI). Questions centred on the occurrence of stalking, the exact period of stalking, the gender of the stalker, the subjective impairment through stalking, addressing the aspects of life-style and the subjectively perceived state of health, and socio-demographic variables. For data analyses descriptive statistics, and chi(2)-tests and t-tests were applied. RESULTS: Lifetime prevalence varies between ca. 6% and 18%, depending on definition levels. The annual prevalences reveal a range of 1-4%. 39-43% of the stalked women feel they are impaired in their life-style, and 32-40% feel impaired in their health. Higher age and living in a partnership reduce the likelihood of being stalked. 81% of the stalked women are stalked by a male person. CONCLUSION: The prevalences found in this study are in line with other international studies, although, in a direct comparison, they are in the lower range. However, these data document the relevance of the phenomenon of stalking for the female Austrian population.

[Gender specific differences in the frequency of admission to intensive care units, duration of stay and the application of intensive medical care measures in men and women aged 75 years and above in an Austrian region]. / Geschlechtsspezifische Unterschiede bezüglich Aufnahmeraten auf Intensivstationen, Aufenthaltsdauer und durchgeführten intensivmedizinischen Massnahmen bei Personen im Alter ab 75 Jahren in einer Osterreichischen Region.

OBJECTIVE: It was the aim of this study to evaluate the frequency of admission to intensive care units, duration of stay and application of intensive care treatments in patients aged 75 years and above and to analyse possible gender specific differences. METHODS: Analysis of hospital in-patient data of all hospitals of a southern Austrian region (federal state of Carinthia). RESULTS: In the year 2003, 4.7% of the men and 3.2% of the women aged 75 years and above were treated in intensive care units (p<0.001). This gender specific difference was independent of the reason for the intensive care admission. The mean duration of stay in intensive care units was longer for 75-79 year old men compared to women (6.38 vs. 4.91 days, p<0.01). Typical intensive care treatments like mechanical ventilation, artificial airways and vasoactive medication were applied more often to men than to women. CONCLUSION: In the aged there are marked gender specific differences in the application of intensive care treatments, especially in the end-of-life state in Austria. The reasons for these differences should be subject of future research.

Visual rating of age-related white matter changes on magnetic resonance imaging: scale comparison, interrater agreement, and correlations with quantitative measurements.

BACKGROUND AND PURPOSE: To provide further insight into the MRI assessment of age-related white matter changes (ARWMCs) with visual rating scales, 3 raters with different levels of experience tested the interrater agreement and comparability of 3 widely used rating scales in a cross-sectional and follow-up setting. Furthermore, the correlation between visual ratings and quantitative volumetric measurement was assessed. METHODS: Three raters from different sites using 3 established rating scales (Manolio, Fazekas and Schmidt, Scheltens) evaluated 74 baseline and follow-up scans from 5 European centers. One investigator also rated baseline scans in a set of 255 participants of the Austrian Stroke Prevention Study (ASPS) and measured the volume of ARWMCs. RESULTS: The interrater agreement for the baseline investigation was fair to good for all scales (kappa values, 0.59 to 0.78). On the follow-up scans, all 3 raters depicted significant ARWMC progression; however, the direct interrater agreement for this task was poor (kappa, 0.19 to 0.39). Comparison of the interrater reliability between the 3 scales revealed a statistical significant difference between the scale of Manolio and that of Fazekas and Schmidt for the baseline investigation (z value, -2.9676; P=0.003), demonstrating better interrater agreement for the Fazekas and Schmidt scale. The rating results obtained with all 3 scales were highly correlated with each other (Spearman rank correlation, 0.712 to 0.806; P< or =0.01), and there was significant agreement between all 3 visual rating scales and the quantitative volumetric measurement of ARWMC (Kendall W, 0.37, 0.48, and 0.57; P<0.001). CONCLUSIONS: Our data demonstrate that the 3 rating scales studied reflect the actual volume of ARWMCs well. The 2 scales that provide more detailed information on ARWMCs seemed preferential compared with the 1 that yields more global information. The visual assessment of ARWMC progression remains problematic and may require modifications or extensions of existing rating scales.

Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers.

Mixed population studies suggest a relationship between deep and subcortical white matter hyperintensities on magnetic resonance imaging and cerebrovascular disease. To further clarify this issue we compared the prevalence and extent of such signal abnormalities between a group of 133 consecutive stroke patients (mean age, 54.7 +/- 16.7 years) and 101 normal volunteers (mean age, 54.7 +/- 13.1 years). Diabetes and cardiac disease were significantly more common in patients than in normal subjects. Prevalence rates of clinically silent lesions were 44% and 47.5%, respectively. Beginning confluent and confluent foci were seen in 19.5% of patients, but in only 7.5% of normal subjects. Significant univariate correlations were found for the presence and extent of lesions with age, diabetes, cardiac disease, severity of extracranial carotid arteriosclerosis, and arterial hypertension, but not with the diagnosis of stroke or the type of brain infarction. Multivariate regression analysis established age and diabetes mellitus as the only independent predictors of white matter damage. We conclude that more extensive white matter abnormalities in stroke patients stem from their higher rate of cerebrovascular risk factors but are unrelated to the occurrence of ischemic attacks per se.

Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals.

To search for a morphologic basis of cognitive impairment possibly associated with essential hypertension, we studied 35 otherwise asymptomatic hypertensive individuals (mean age, 38.7 years; range, 22 to 49 years) and 20 normotensive control subjects (mean age, 37.9 years; range, 26 to 49 years) using neuropsychologic tests and magnetic resonance imaging. Irrespective of drug treatment, hypertensive individuals performed significantly worse than did control subjects when assessed for verbal memory and total learning and memory capacity, while there were no differences in test results of visual memory, attention, vigilance, and reaction time. The hypertensive individuals also described themselves as less active but ranked similar on five other mood subscales. Punctate high-signal intensities of the white matter were found almost twice as often in the hypertensive group (38%) as in the control group (20%). There was no difference in test performance between hypertensive individuals with and those without white matter lesions, however. Our results confirm the presence of subtle neuropsychologic deficits and indicate a higher frequency of white matter signal abnormalities in essential hypertension, as shown on magnetic resonance imaging, but do not indicate a correlation of these findings with each other.

Assessment of MRI criteria for a diagnosis of MS.

To test the reliability of four previously proposed MRI criteria for the diagnosis of MS, we reviewed 1,500 consecutive brain scans for the presence, number, size, and location of areas of increased signal (AIS) on proton-density and T2-weighted images, unaware of the patients' clinical presentations and ages. This series included 134 subjects with a clinical diagnosis of MS. Relying exclusively on the presence of at least three or four AIS for a positive diagnosis of MS resulted in high sensitivity (90% for three AIS and 87% for four) but inadequate specificity (71% for three AIS and 74% for four) and positive predictive value (23% for three AIS and 25% for four). If one of these lesions was required to border the lateral ventricles, specificity was 92% and positive predictive value was 50% at a sensitivity of 87%. Using the Fazekas criteria (at least three AIS and two of the following features: abutting body of lateral ventricles, infratentorial lesion location, and size > 5 mm) led to a further highly significant improvement of specificity (96%; p = 0.0000) and increase of the positive predictive value (65%) at the expense of a less significant decrease in sensitivity (81%; p < 0.01).

The Mattis Dementia Rating Scale: normative data from 1,001 healthy volunteers.

We administered the Mattis Dementia Rating Scale (MDRS) to 1,001 healthy volunteers, aged 50 to 80 years, randomly selected from our community. Multivariate regression analysis revealed educational level (p = 0.000004) and age (p = 0.00001), but no other sociodemographic or risk factors for stroke, to be significantly associated with the MDRS score. The age- and education-specific lowest quintile cutoff scores ranged from 140 in subjects aged 50 to 59 years with at least college experience to 130 in subjects aged 70 to 80 years with only 4 to 9 years of schooling. These percentile distributions obtained for decades of age and different levels of education should be useful reference values for clinicians and investigators when applying the MDRS to assess cognitive functioning.

Brain magnetic resonance imaging in coronary artery bypass grafts: a pre- and postoperative assessment.

We undertook a study to determine (1) the frequency and prognostic significance of preexisting MRI brain abnormalities in patients undergoing coronary artery bypass grafts (CABG) and (2) whether MRI can detect surgery-related brain damage in 31 neurologically asymptomatic CABG patients (mean age, 61.0 +/- 6.6 years). MRIs were performed within 7 days before and 8 to 17 days after surgery. When we compared the preoperative images with those of 31 age- and risk factor-matched neurologically asymptomatic controls free of cardiac disease (mean age, 60.3 +/- 6.1 years), higher rates of thromboembolic infarcts (16% versus 0%), lacunes (58.1% versus 32.3%), and brainstem lesions (22.6% versus 3.8%) were noted. Subjective rating demonstrated significantly larger ventricles in patients than in controls (p = 0.002). CABG candidates also had significantly increased ventricular-to-intracranial cavity ratios (VICR) as determined by semiquantitative volumetric measurements (6.9 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.0004). Eleven patients had postsurgical complications, with eight having symptoms consistent with diffuse encephalopathy. The only MRI finding that separated encephalopathic from complication-free patients was ventricular size (VICR 9.0 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.006). This difference remained statistically significant after adjustment for the effects of age (p = 0.04). Postoperative MRI consistently failed to demonstrate surgery-related brain damage responsible for the encephalopathy.

Neuropsychologic correlates of MRI white matter hyperintensities: a study of 150 normal volunteers.

To determine the effects of MRI white matter hyperintensities (WMH) on cognitive functioning, we used neuropsychologic tests and MRI to study 150 elderly volunteers free of neuropsychiatric or general disease. There were 76 (50.3%) individuals without and 74 (49.7%) with WMH. The latter subset was older (61.3 +/- 6.6 years versus 58.5 +/- 5.8 years, p = 0.005), had a higher mean arterial blood pressure (103.7 +/- 11.4 mm Hg versus 99.9 +/- 10.3 mm Hg, p = 0.03), and a larger ventricular-to-intracranial-cavity ratio (6.3 +/- 5.6% versus 4.7 +/- 1.6%, p = 0.02). Individuals with WMH performed worse than their counterparts without such abnormalities on all tests administered. After adjusting for the group differences in age, arterial blood pressure, and ventricular size, we noted statistically significant results on form B of the Trail Making Test (121.8 +/- 37.8 msec versus 100.3 +/- 47.9 msec, p = 0.04), a complex reaction time task (680.8 +/- 104.9 msec versus 607.1 +/- 93.9 msec, p = 0.001), and the assembly procedure of the Purdue Peg-board Test (27.5 +/- 5.8 versus 30.6 +/- 5.9, p = 0.02). Partial correlations did not reveal any relationship between test scores and the semiautomatically assessed total area of WMH. Our data suggest that the presence of WMH exerts a subtle effect on neuropsychologic performance of normal elderly individuals, which becomes particularly evident on tasks measuring the speed of more complex mental processing.

Mini mental state examination: influence of sociodemographic, environmental and behavioral factors and vascular risk factors.

Age and education have been found to affect the Mini Mental State Examination (MMSE) score of elderly normals, but there have been no studies assessing the influence of environmental and behavioral factors on this test. We therefore administered the MMSE to 1437 normal elderly subjects in the setting of a stroke prevention study and correlated their results to 16 sociodemographic, environmental, and behavioral factors, and vascular risk factors. Study statistics composed of a multiple logistic regression analysis and graphical models revealed the relations between variables in greater detail. Logistic regression yielded education level, occupational status, living as a single, general life stress, physical strain, and physical inactivity to be independent predictors of the MMSE score. Age was not included in this model. Graphical models demonstrated similar results, but did not include living as a single and physical inactivity. As shown in our independence graph, general life stress is the crucial predictor and links other environmental and sociodemographic variables with the test performance of elderly normals.

The relationship between body weight and patterns of smoking in women and men.

BACKGROUND: In the scientific literature, studies of the relationship between cigarette smoking and body weight yield conflicting results. Weight-lowering effects in women and men have been associated with smoking, however, no effects on weight have been proven. The purpose of this study was to examine the gender-related association between cigarette smoking and relative weight in a rural population in Styria, Austria. METHODS: A database from a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria was used for these analyses. The sample consisted of 27,344 participants, 16,185 women and 11,159 men, aged > or = 15 years. We controlled for possible confounding factors such as age, years of education, alcohol consumption, regular physical activity, and chronic diseases. RESULTS: For women and men, in comparison to non- and ex-smokers, smoking is significantly correlated with lower body mass index (BMI). In contrast, heavy smoking and smoking cessation are significantly associated with higher relative weight. CONCLUSIONS: We found significant results confirming an association between cigarette smoking and lower BMI in women and men, whereas heavy smoking as well as smoking cessation were significantly correlated with higher relative weight. Health intervention programmes to quit smoking should take into account the underlying perceived benefits of smoking with regard to weight, especially its gender specificity.

Estrogen replacement therapy in older women: a neuropsychological and brain MRI study.

OBJECTIVE: To determine if postmenopausal women receiving estrogen perform better on demanding cognitive tests than women without estrogen replacement and if this beneficial effect on cognition is caused by estrogen-related prevention of silent ischemic brain damage. DESIGN: Cross-sectional study comparing postmenopausal estrogen users and non-users. SETTING: Austrian Stroke Prevention Study. PARTICIPANTS: A total of 70 women currently using estrogen and 140 women who have never used estrogen from a subset of 222 postmenopausal women without neuropsychiatric or general disease undergoing extensive diagnostic work-up in a large-scale stroke prevention study among randomly selected community members. MEASUREMENTS: Neuropsychological test scores and focal brain abnormalities as well as size of ventricles and cortical sulci as assessed by 1.5 Tesla MRI. RESULTS: Estrogen users performed better than non-users on almost all neuropsychological tests administered. When ANCOVA was used to correct for slight differences between groups in age, length of education, mean arterial blood pressure and self-reported activation, values of P < .05 were noted on tasks assessing conceptualization, attention, and visuopractical skills. After adjustment for multiple comparisons, the differences in conceptualization and visuopractical skills remained significant. MRI showed a lower rate and extent of white matter hyperintensities and a significantly smaller total white matter hyperintensity area in women treated with estrogen (P = .043). The total white matter hyperintensity area was inversely related to the duration of estrogen replacement therapy(P = .040). However, there was no difference in neuropsychological performance between estrogen users with and without white matter abnormalities, and this was also supported by the lack of an association between cognitive test results and the extent of white matter disease. CONCLUSIONS: Our study demonstrated an association between estrogen replacement therapy and better cognitive functioning and a lower rate of clinically unsuspected ischemic brain damage in postmenopausal women.