Disertasi

Peran Gonadotropin, Estradiol, Soluble Leptin Receptor (sOB-R), Leptin, dan Keluhan Menopause sebagai Penapis Hendaya Kognitif Nir-Demensia (HKND) pada Perempuan Pascamenopause. = The Role of Gonadotropin, Estradiol, Soluble Leptin Receptor (sOB-R), Leptin, and Menopausal Symptoms as Screening Method for Cognitive Impairment No Dementia (CIND) in Postmenopausal women.

Pada perempuan pascamenopause diperlukan marka biokimiawi dan klinis pada masa jendela terapeutik yang diharapkan dapat digunakan untuk menapis HKND yang berperan sangat penting dalam menghindari dampak demensia tipe alzheimer setelah terapi hormon. Penapisan HKND dapat dimanfaatkan juga untuk upaya terapeutik HKND pada perempuan pascamenopause dan mencegah perburukan ke dalam kondisi demensia tipe alzheimer. Dilakukan studi potong lintang pada 282 perempuan pascamenopause di Jakarta yang dibagi menjadi 2 kelompok, yaitu kelompok positif dengan HKND dan kelompok tanpa HKND. Pemeriksaan dilakukan pada sejumlah variabel seperti usia, lama menopause, keluhan vasomotor, IMT, kadar FSH, kadar LH, kadar leptin, kadar estradiol, dan status kognitif, kemudian dianalisis secara statistik. Diperoleh nilai FSH yang berhubungan bermakna dengan kejadian HKND (p = 0,018), serta variabel lain seperti nisbah FSH/estradiol (p = 0,029) dan nisbah FSH/sOB-R (p = 0,011), sementara variabel lain tidak bermakna. Analisis multivariat menunjukkan nisbah FSH/estradiol adalah variabel yang paling berperan terhadap kejadian HKND, dengan nilai OR 1,15. Berdasarkan kurva ROC didapat nilai titik potong nisbah FSH/estradiol dalam memprediksi HKND adalah 1,94 dengan sensitivitas 66,5% dan spesifisitas 46,8%. Nisbah FSH/estradiol pada perempuan pascamenopause yang menderita HKND yang lebih tinggi secara bermakna dibandingkan dengan kelompok tanpa HKND dikaitkan dengan peran neuron KNDy terhadap peningkatan sekresi GnRH dan rendahnya neurosteroid estradiol di otak perempuan pascamenopause yang berisiko menderita HKND. Nilai nisbah FSH/estradiol (> 1,94) dapat digunakan untuk penapis diagnostik HKND pada perempuan pascamenopause.
Kata kunci: FSH, hendaya kognitif nir demensia (HKND), menopause.



Biochemical and clinically important markers are needed in the window therapeutic period for postmenopausal women which are expected to be used as a screening methods for CIND as it is very important in avoiding the effect of dementiaassociated Alzheimer disease after hormone therapy. CIND screening was also useful for CIND treatment strategies in postmenopausal women and preventing postmenopausal women from impaired cognitive function due to dementia. A cross-sectional study included 282 postmenopausal women in Jakarta was done, and subjects were further classified into two groups, with CIND and without CIND. Several related variables such as age, duration of menopause, vasomotor symptoms, BMI, FSH level, LH level, leptin level, estradiol level, and cognitive status, were assessed and analyzed statistically. The prevalence of CIND was significantly correlated with FSH level (p = 0.018), along with ratio of FSH levels/estradiol (p = 0.029) and ratio of FSH/sOB-R (p = 0.011), while other variables were not. By multivariate analysis, FSH/estradiol ratio of 1.15 was found as the most significant factor with probability of having CIND in postmenopausal women. Using the ROC curve, the ratio threshold of FSH/estradiol to predict CIND was 1.94, with sensitivity 66.5% and specificity 46.8%. Level of FSH/estradiol ratio in postmenopausal women with CIND was significantly higher than women without CIND, and is related to the role of KNDy neurons that induce the secretion of GnRH, and low level of neurosteroid estradiol in postmenopausal women’s brain with risk of CIND. Ratio of FSH/estradiol levels (> 1.94) could be used for screening methods of CIND in postmenopausal women.
Keywords: cognitive impairment not dementia (CIND), FSH, menopause.