背景:隨著我國進入高齡社會，認知功能障礙的盛行率隨之攀升，女性比例高於男性，有研究表示與女性雌激素有關，但兩者之間未有明確定論。

目的:探討臺灣婦女生殖期(即雌激素暴露程度)、初經年齡及停經年齡與認知功能之關係。

材料與方法:本研究使用臺灣營養健康狀況變遷調查(Nutrition and Health Survey in Taiwan, NAHSIT)，分別擷取1999-2000年、2005-2008年與2013-2016年，利用生育史問卷、簡易心智狀態問卷調查表(Short Portable Mental Status Questionnaire, SPMSQ)與簡易心智量表(Mini-Mental State Examination, MMSE)分析生育特質及認知功能。研究設計採橫斷性研究，使用SAS 9.4，除了進行基本資料統計分析、線性迴歸分析及邏輯斯迴歸分析，並針對相關干擾因子控制外，亦將認知功能量表予以敏感度分析。

結果:簡易心智狀態問卷調查表(SPMSQ)，(一)生育特質，平均初經年齡為16.40歲，≧18歲人數最多，<15歲分數最高；平均停經年齡為48.86歲，50-54歲人數最多，50-54歲分數最高；平均生殖期年數為32.46年，31-34年人數最多，35-37年分數最高。(二)認知功能分數，控制干擾因子後，呈初經年齡較晚、停經年齡較早與生殖期較短，其認知功能分數減少最多之趨勢。認知功能障礙，控制干擾因子後，呈初經年齡較晚、停經年齡較早與生殖期較短，其認知功能障礙風險較高之趨勢。經敏感度分析後，亦得到相同的結果。簡易心智量表(MMSE)，(一)生育特質，平均初經年齡為15.37歲，<15歲人數最多，<15歲分數最高；平均停經年齡為50.07歲，50-54歲人數最多，50-54歲分數最高；平均生殖期年數為34.70年，≧38年人數最多，35-37年分數最高。(二)認知功能分數，控制干擾因子後，呈初經年齡較晚、停經年齡較晚與生殖期較短，其認知功能分數減少最多，其中初經年齡≧18歲比參考組(16歲)少2.69分(95% CI [-4.54, -0.84])、生殖期<31年比參考組(35-37年)少2.25分(95% CI [-3.93, -0.57])，≧38年少1.97分(95% CI [-3.43, -0.52])。認知功能障礙，控制干擾因子後，呈初經年齡較晚、停經年齡較晚與生殖期較長，其認知功能障礙風險較高。其中生殖期<31年是參考組(35-37年)的3.31倍(95% CI [1.02, 10.72])、≧38年是4.33倍(95% CI [1.44, 13.04])。經敏感度分析後，呈初經年齡較晚、停經年齡較早與生殖期較短，其認知功能障礙風險較高之趨勢。

結論:結果顯示，在這項橫斷性研究當中，發現雌激素暴露程度較低之生育特質(生殖期短，初經年齡較晚，停經年齡較早)與認知功能障礙風險增加及認知功能分數減少有關。即生殖期、初經年齡與停經年齡對於認知功能的影響反映雌激素可能具有保護作用。

The prevalence of cognitive impairment increases in Taiwan. Proportionally, female is more than male where there are studies describing the associated effects of estrogen but the conclusion is yet to be reached. This study centers on the relationships among the reproductive periods (also indicating the scale of exposure to estrogen), the age of both menarche and menopause, and the cognitive functions of the female in Taiwan. The data based on the childbearing history, Short Portable Mental Status Questionnaire (SPMSQ) and Mini-Mental State Examination (MMSE) was retrieved from the Nutrition and Health Survey in Taiwan (NAHSIT) in 1999-2000, 2004-2008 and 2013-2016 respectively, and was used to analyze the reproductive characteristics and cognitive functions in this study. Cross-sectional design was adopted in this study with linear regression analysis, logistic regression analysis and sensitivity analysis. The result showed that, in this cross-sectional study, Reproductive characteristics of less estrogen exposure (shorter reproductive period, later menarche age, early menopausal age) were associated with elevated risk of cognitive impairment and decreased cognitive function scores. Namely, the effect of estrogen was supposed to be protective from the influence of the reproductive period and the age of both menarche and menopause over cognitive functions.

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