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Metcalf CA, Page CE, Stocker BOS, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Treating new-onset cognitive complaints after risk-reducing salpingo-oophorectomy: A randomized controlled crossover trial of lisdexamfetamine. Gynecol Oncol 2024; 190:62-69. [PMID: 39146756 DOI: 10.1016/j.ygyno.2024.07.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/05/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To determine whether the psychostimulant lisdexamfetamine improves subjective and objective measures of cognitive functioning among women genetically at-risk for cancer who have undergone risk-reducing salpingo-oophorectomy and report new-onset executive functioning difficulties. METHODS 69 participants were assigned to a randomized controlled crossover trial with 6-week trials of active medication (lisdexamfetamine) and placebo, separated by a minimum 2-week washout in an intent-to-treat framework (clinical trial registration number: NCT03187353). At trial baseline, midpoint, and endpoint, participants completed a self-report measure of executive functioning (Brown Attention Deficit Disorder Scale). At study baseline and trial endpoint, participants completed sustained attention, attention/working memory, and verbal learning/memory cognitive tasks. Side effects were assessed at 2, 3, 4, and 6 weeks for each trial. RESULTS From trial baseline to trial endpoint, lisdexamfetamine - relative to placebo - significantly improved total scores on the self-report Brown Attention Deficit Disorder Scale (and scores on four of five subdomains) as well as attention and working memory performance. Significantly more participants endorsed side effects across the lisdexamfetamine trial versus placebo; however, trial completion rates were similar, indicating that lisdexamfetamine was nonetheless well-tolerated. CONCLUSIONS Lisdexamfetamine improved both subjective and objective measures of attention and working memory and could offer women experiencing cognitive difficulties post-risk-reducing salpingo-oophorectomy an alternative therapeutic option.
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Affiliation(s)
- Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Brianna O S Stocker
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States.
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Maki PM, Jaff NG. Menopause and brain fog: how to counsel and treat midlife women. Menopause 2024; 31:647-649. [PMID: 38888619 DOI: 10.1097/gme.0000000000002382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Brain fog, referring to menopause-related subjective cognitive difficulties, is common in midlife women. Longitudinal studies find small but reliable declines in objective memory performance as women transition into perimenopause, and these are not explained by advancing age alone. When memory declines occur, performance levels remain within normal limits for all but a very small number of women. Women's experience of brain fog extends beyond memory complaints, reflecting the negative effect on a broad range of cognitive abilities. Clinicians can counsel women about how menopause symptoms, estrogen, hormone therapy, and modifiable risk factors (eg, hypertension, sedentary lifestyle) can influence cognitive health.
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Affiliation(s)
| | - Nicole G Jaff
- University of the Witwatersrand, Johannesburg, South Africa
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Page CE, Soreth B, Metcalf CA, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Natural vs. Surgical Postmenopause and Psychological Symptoms Confound the Effect of Menopause on Executive Functioning Domains of Cognitive Experience. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:97-108. [PMID: 38694151 PMCID: PMC11058919 DOI: 10.1176/appi.focus.23021034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Objective The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. Study Design A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CES-D). Main Outcome Measures We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). Results In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). Conclusions The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.Reprinted from Maturitas 2023; 170:64-73, with permission from Elsevier. Copyright © 2023.
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Affiliation(s)
- Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Brianna Soreth
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Rachel L Johnson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Mary D Sammel
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - James Loughead
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
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Epperson CN. Hormones as Psychotropic Interventions in Females. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:63-66. [PMID: 38694158 PMCID: PMC11058925 DOI: 10.1176/appi.focus.20230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, Aurora, Colorado; Center for Women's Behavioral Health and Wellness, Aurora, Colorado; and Department of Psychiatry and Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
Hormonal fluctuations in the perimenopause are associated with an array of physical and psychological symptoms. Those with pre-existing mental disorders may experience changes to their symptoms and response to treatment during the perimenopausal and postmenopausal periods and may also be at risk of poorer longer-term physical health outcomes in menopause. The transition towards menopause may be compounded by the oestradiol-suppressing effect of many psychotropics on the hypothalamopituitary-gonadal axis. A collaborative approach between primary care and secondary mental health services is an opportunity for proactive discussion of symptoms and support with management of the perimenopause. This may involve lifestyle measures and/or hormone replacement therapy, which can both lead to improvements in well-being and mental and physical health.
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Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep 2023; 25:501-511. [PMID: 37755656 PMCID: PMC10842974 DOI: 10.1007/s11920-023-01447-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW To review recent research regarding cognitive problems during perimenopause, including which menopause-related symptoms, demographic variables, stress exposures, and neural biomarkers are associated with cognitive problems and which interventions demonstrate efficacy at improving cognitive performance. RECENT FINDINGS Cognitive problems are common during perimenopause and have a significant impact on a substantial proportion of women. Evidence continues to indicate that verbal learning and verbal memory are the cognitive functions that are most negatively affected during perimenopause, and new research suggests that perimenopause may also be associated with deficits in processing speed, attention, and working memory. Recent research suggests that the cognitive profiles of women transitioning through perimenopause are heterogenous - with some showing strengths and others demonstrating weaknesses in particular cognitive domains. Depression, sleep problems, and vasomotor symptoms in perimenopause may be associated with cognitive difficulties. Recent neuroimaging studies are identifying changes in activity patterns within brain regions that correlate with cognitive performance in perimenopause, but future causal studies are needed to understand the neural mechanisms of cognitive problems during this time. Although clinical treatment studies for cognitive concerns have historically focused on postmenopause, some small trials in perimenopausal samples have been conducted recently but are frequently underpowered. Current guidelines from the North American Menopause Society do not support the use of hormone therapy at any age for cognitive problems. Animal research demonstrates that estradiol and levonorgestrel combined may alleviate working memory problems. Much progress has been made in understanding how perimenopause impacts cognition, and more research is needed to better identify who is at highest risk and how to meaningfully prevent and alleviate cognitive problems during this reproductive stage. Larger-scale randomized intervention trials specifically during perimenopause are urgently needed to address cognitive concerns in this population of women. More consistent reproductive staging, inclusion of covariates, and analyses examining perimenopause specifically would improve study quality and the ability to draw clear conclusions from this research.
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Affiliation(s)
- Christina A Metcalf
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Chloe E Page
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
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7
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Page CE, Soreth B, Metcalf CA, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Natural vs. surgical postmenopause and psychological symptoms confound the effect of menopause on executive functioning domains of cognitive experience. Maturitas 2023; 170:64-73. [PMID: 36806931 DOI: 10.1016/j.maturitas.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. STUDY DESIGN A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CESD). MAIN OUTCOME MEASURES We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). RESULTS In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). CONCLUSIONS The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.
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Affiliation(s)
- Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brianna Soreth
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mary D Sammel
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States.
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8
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Maki PM, Jaff NG. Brain fog in menopause: a health-care professional's guide for decision-making and counseling on cognition. Climacteric 2022; 25:570-578. [PMID: 36178170 DOI: 10.1080/13697137.2022.2122792] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Midlife women commonly experience changes in their cognitive function as they transition through menopause and express concern about whether these changes represent the initial stages of a more serious cognitive disorder. Health-care practitioners play an important role in counseling women on cognitive changes at midlife and normalizing women's experience. The aim of this commissioned International Menopause Society White Paper on cognition is to provide practitioners with an overview of data informing the clinical care of menopausal women and a framework for clinical counseling and decision-making. Among the topics presented are the specific cognitive changes occurring in menopause, the duration of such changes and their severity. The role of estrogen and menopause symptoms is reviewed. We present talking points for clinical counseling on the effects of hormone therapy on cognition and dementia risk in women, including discussion of absolute risk. Lastly, a brief review of modifiable risk factors for age-related cognitive decline and dementia is presented, with guidance for counseling patients on optimizing their brain health at midlife and beyond.
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Affiliation(s)
- P M Maki
- Department of Psychiatry, Psychology and OB/GYN, University of Illinois College of Medicine, Chicago, IL, USA
| | - N G Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
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Bradshaw PJ, Baller EB, Riddle JN, Leistikow N, Ross DA, Osborne LM. From Forgotten to Ignored: Herstory of Involutional Melancholia, Menopause, and Cognition. Biol Psychiatry 2022; 92:e37-e39. [PMID: 36202544 DOI: 10.1016/j.biopsych.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Phillip J Bradshaw
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Erica B Baller
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia N Riddle
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Nicole Leistikow
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - David A Ross
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Lauren M Osborne
- Departments of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York
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The effects of lisdexamfetamine dimesylate on eating behaviour and homeostatic, reward and cognitive processes in women with binge-eating symptoms: an experimental medicine study. Transl Psychiatry 2022; 12:9. [PMID: 35013131 PMCID: PMC8744047 DOI: 10.1038/s41398-021-01770-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 02/01/2023] Open
Abstract
Lisdexamfetamine dimesylate (LDX) is the only drug currently approved by the FDA for the treatment of Binge-Eating Disorder (BED), but little is known about the behavioural mechanisms that underpin the efficacy of LDX in treating BED. We examined the behavioural and neural effects of an acute dose of LDX (50 mg) in 22 women with binge-eating symptomatology using a randomised, crossover, double-blind, placebo-controlled experimental medicine design. LDX reduced self-reported appetite ratings and intake of both a pasta meal and a palatable cookie snack. LDX also decreased the eating rate of pasta but not of cookies and reduced self-reported liking ratings for pasta at the end of the meal. When viewing food pictures during an fMRI scan, LDX reduced activity bilaterally in the thalamus. LDX enhanced sustained attention and reduced impulsive responding in a continuous performance task but had no effect on emotional bias or working memory. These results suggest the observed effects of LDX on food intake (and by implication the efficacy of LDX in treating BED) may be related to the actions of the drug to enhance satiety, reduce food-related reward responding when full and/or increase cognitive control. Novel pharmacotherapies for BED might be most effective if they have a broad spectrum of effects on appetite, reward and cognition.
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11
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Sullivan A, Kane A, Valentic G, Rensel M. Recommendations to Address the Unique Clinical and Psychological Needs of Transgender Persons Living With Multiple Sclerosis. Int J MS Care 2022; 24:35-40. [PMID: 35261570 PMCID: PMC8883816 DOI: 10.7224/1537-2073.2021-066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
BACKGROUND People living with multiple sclerosis (MS) face challenges coping with chronic illnesses, and transgender (TGD) persons living with MS may experience additional unique challenges and barriers to care. Medical biases toward TGD people are widely reported, and best practices in TGD MS care have not been identified. METHODS A case report of a TGD person living with MS is reviewed that helped to identify and inform us regarding the unique aspects of their clinical and psychological care needs. We conducted a systematic review of the literature according to the standard methods in PubMed. The literature was reviewed and summarized for relevant topics related to the unique care needs of TGD persons living with MS, and proposed care recommendations were created. RESULTS We used the aforementioned case to identify and inform the special care needs and subsequently describe proposed recommendations to achieve inclusive comprehensive care of TGD persons with MS. The importance of providing an inclusive environment, comprehensive care, mental health screening, domestic violence screening, and case coordination are highlighted with the goal of providing best practice recommendations for the comprehensive inclusive care of TGD persons living with MS. CONCLUSIONS The lack of published guidance on the care of TGD persons living with MS and our informative case have led to the proposed recommendations for the care of TGD persons living with MS.
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Affiliation(s)
- Amy Sullivan
- From the Department of Psychiatry and Psychology (AS, AK), Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Alexa Kane
- From the Department of Psychiatry and Psychology (AS, AK), Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Gianna Valentic
- Department of Psychology, Miami University, Oxford, OH, USA (GV)
| | - Mary Rensel
- Department of Neurology (MR), Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
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Shea AK, Wolfman W, Fortier M, Soares CN. Guideline No. 422c: Menopause: Mood, Sleep, and Cognition. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1316-1323.e1. [PMID: 34758906 DOI: 10.1016/j.jogc.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. TARGET POPULATION Perimenopausal and postmenopausal women. BENEFITS, HARMS, AND COSTS Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. EVIDENCE Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. SUMMARY STATEMENTS RECOMMENDATIONS.
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Shea AK, Wolfman W, Fortier M, Soares CN. Directive clinique n° 422c : Ménopause : Humeur, sommeil et cognition. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1324-1333.e1. [PMID: 34555544 DOI: 10.1016/j.jogc.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIF Proposer des stratégies fondées sur les plus récentes données publiées pour améliorer les soins aux femmes ménopausées ou en périménopause. POPULATION CIBLE Les femmes ménopausées ou en périménopause. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées communiquées par leurs fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques, y compris le statu quo, pour la prise en charge des symptômes et morbidités associés à la ménopause. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, MEDLINE et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant l'approche d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: gynécologues, obstétriciens, médecins de famille, internistes, urgentologues, infirmières (autorisées et praticiennes), pharmaciens, stagiaires (étudiants en médecine, résidents, moniteurs cliniques) et autres fournisseurs de soins de santé pour la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Antoniou E, Rigas N, Orovou E, Papatrechas A, Sarella A. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. Mater Sociomed 2021; 33:114-118. [PMID: 34483739 PMCID: PMC8385721 DOI: 10.5455/msm.2021.33.114-118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The attention-deficit/hyperactivity disorder (ADHD) was initially considered a male disorder. As it has recently been shown, however, its presentation in girls is a topic of increasing scientific interest and research. There have been quite a few studies so far showing the differences in the symptoms between genders and the progression of the condition depending on the individual’s profile. However, there are some special characteristics in the female gender, including neuropathology and hormonal factors, that play a decisive role in understating ADHD in women. Although it is known that the symptoms in ADHD girls are overshadowed by those of the impulsive and hyperactive boys, an effort was made in this study to highlight ADHD symptoms in women from childhood to menopause. Objective: Taking into account the small but significant differences in the development of ADHD in women, this literature review aims at identifying the special characteristics of ADHD symptoms in all stages of a woman’s life from childhood to menopause. Being aware of these signs is important to provide the best quality of health care in ADHD women. Methods: A review of the literature was conducted through the databases on the occurrence of ADHD symptoms in girls, adolescents, women of childbearing age and women in menopause. Results: ADHD and its comorbid disorders affect the female sex throughout its life. The hormonal fluctuations and transitional periods of life seem to influence the symptoms of ADHD more. Conclusion: Higher awareness is thus required by health professionals about ADHD behavioural characteristics in girls, adolescent girls and women in their productive period or in menopause to identify the special signs defining the disease, to treat them early and protect the women’s mental health.
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Affiliation(s)
- Evangelia Antoniou
- Department of Midwifery, University of West Attica, Athens, Greece.,Non-Profits/Non-Governmental Organizations (NGO) "Fainareti
| | - Nikolaos Rigas
- Non-Profits/Non-Governmental Organizations (NGO) "Fainareti
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Athens, Greece
| | | | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Athens, Greece
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Executive function after risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: does current mood and early life adversity matter? ACTA ACUST UNITED AC 2021; 27:746-755. [PMID: 32187134 DOI: 10.1097/gme.0000000000001535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite the fact that negative mood and executive dysfunction are common after risk-reducing salpingo-oophorectomy (RRSO), occurring in up to a third of women, little is known about risk factors predicting these negative outcomes. Adverse childhood experiences (ACE) predict poorer health in adulthood and may be a risk factor for negative outcomes after RRSO. Given the complex relationship between early life stress, affective disorders, and cognitive dysfunction, we hypothesized that ACE would be associated with poorer executive function and that mood symptoms would partially mediate this relationship. METHODS Women who had undergone RRSO were included in the study (N = 552; age 30-73 y). We measured executive function (continuous performance task, letter n-back task, and Brown Attention Deficit Disorder Scale Score), exposure to early life stress (ACE questionnaire), and mood symptoms (Hospital Anxiety and Depression Scale). Generalized estimating equations were used to evaluate the association between ACE and executive dysfunction and the role of mood symptoms as a mediator in this relationship. RESULTS ACE was associated with greater severity of subjective executive dysfunction (adjusted mean difference [aMD] = 7.1, P = 0.0005) and worse performance on both cognitive tasks (continuous performance task: aMD = -0.1, P = 0.03; n-back: aMD = -0.17, P = 0.007). Mood symptoms partially mediated ACE associations with sustained attention (21.3% mediated; 95% CI: 9.3%-100%) and subjective report of executive dysfunction (62.8% mediated; 95% CI: 42.3%-100%). CONCLUSIONS The relationship between childhood adversity and executive dysfunction is partially mediated by mood symptoms. These data indicate that assessing history of childhood adversity and current anxiety and depression symptoms may play a role in treating women who report cognitive complaints after RRSO. : Video Summary:http://links.lww.com/MENO/A571.
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16
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Novick AM, Scott AT, Neill Epperson C, Schneck CD. Neuropsychiatric effects of tamoxifen: Challenges and opportunities. Front Neuroendocrinol 2020; 59:100869. [PMID: 32822707 PMCID: PMC7669724 DOI: 10.1016/j.yfrne.2020.100869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 02/08/2023]
Abstract
Epidemiological, clinical, and basic research over the past thirty years have described the benefits of estrogen on cognition, mood, and brain health. Less is known about tamoxifen, a selective estrogen receptor modifier (SERM) commonly used in breast cancer which is able to cross the blood-brain barrier. In this article, we review the basic pharmacology of tamoxifenas well as its effects on cognition and mood. The literature reveals an overall impairing effect of tamoxifen on cognition in breast cancer patients, hinting at central antiestrogen activity. On the other hand, tamoxifen demonstrates promising effects in psychiatric disorders, like bipolar disorder, where its therapeutic action may be independent of interaction with estrogen receptors. Understanding the neuropsychiatric properties of SERMs like tamoxifen can guide future research to ameliorate unwanted side-effects and provide novel options for difficult to treat disorders.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States.
| | - Anthony T Scott
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
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17
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Nguyen HB, Loughead J, Lipner E, Hantsoo L, Kornfield SL, Epperson CN. What has sex got to do with it? The role of hormones in the transgender brain. Neuropsychopharmacology 2019; 44:22-37. [PMID: 30082887 PMCID: PMC6235900 DOI: 10.1038/s41386-018-0140-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023]
Abstract
Sex differences and hormonal effects in presumed cisgender individuals have been well-studied and support the concept of a mosaic of both male and female "characteristics" in any given brain. Gonadal steroid increases and fluctuations during peri-puberty and across the reproductive lifespan influence the brain structure and function programmed by testosterone and estradiol exposures in utero. While it is becoming increasingly common for transgender and gender non-binary individuals to block their transition to puberty and/or use gender-affirming hormone therapy (GAHT) to obtain their desired gender phenotype, little is known about the impact of these manipulations on brain structure and function. Using sex differences and the effects of reproductive hormones in cisgender individuals as the backdrop, we summarize here the existing nascent neuroimaging and behavioral literature focusing on potential brain and cognitive differences in transgender individuals at baseline and after GAHT. Research in this area has the potential to inform our understanding of the developmental origins of gender identity and sex difference in response to gonadal steroid manipulations, but care is needed in our research questions and methods to not further stigmatize sex and gender minorities.
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Affiliation(s)
- Hillary B Nguyen
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Philadelphia, PA, USA
| | | | - Emily Lipner
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - C Neill Epperson
- School of Arts and Sciences, Philadelphia, PA, USA.
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychiatry, Philadelphia, PA, USA.
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am 2018; 45:663-678. [PMID: 30401549 PMCID: PMC6226029 DOI: 10.1016/j.ogc.2018.07.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity and sleep patterns.
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Affiliation(s)
- Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Cynthia Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
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19
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Nguyen HB, Chavez AM, Lipner E, Hantsoo L, Kornfield SL, Davies RD, Epperson CN. Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Curr Psychiatry Rep 2018; 20:110. [PMID: 30306351 PMCID: PMC6354936 DOI: 10.1007/s11920-018-0973-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW With increasing numbers of transgender and gender non-binary individuals presenting for care, knowing how to elucidate the mental health and cognitive outcomes of gender-affirming hormone therapy (GAHT) is necessary. This article reviews the present literature covering GAHT effects on mood, behavioral health, and cognition in these individuals and offers research priorities to address knowledge gaps. RECENT FINDINGS Although there are some conflicting data, GAHT overwhelmingly seems to have positive psychological effects in both adolescents and adults. Research tends to support that GAHT reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem in both male-to-female and female-to-male transgender individuals. Clinically, prescribing GAHT can help with gender dysphoria-related mental distress. Thus, timely hormonal intervention represents a crucial tool for improving behavioral wellness in transgender individuals, though effects on cognitive processes fundamental for daily living are unknown. Future research should prioritize better understanding of how GAHT may affect executive functioning.
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Affiliation(s)
- Hillary B. Nguyen
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA,Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - Alexis M. Chavez
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - Emily Lipner
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Kornfield
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - C. Neill Epperson
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
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20
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Dumas JA, Makarewicz JA, Bunn J, Nickerson J, McGee E. Dopamine-dependent cognitive processes after menopause: the relationship between COMT genotype, estradiol, and working memory. Neurobiol Aging 2018; 72:53-61. [PMID: 30212711 DOI: 10.1016/j.neurobiolaging.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022]
Abstract
The present study examined how a gene related to functioning of the dopaminergic system, catechol-O-methyltransferase (COMT), and estradiol were related to brain functioning in healthy postmenopausal women. Participants were 118 healthy, cognitively normal postmenopausal women between the ages of 50-60 years. All women provided a blood sample for COMT and estradiol analyses and underwent a magnetic resonance imaging scan. Working memory performance and related brain activation were measured with BOLD functional magnetic resonance imaging during the N-back task. Results were examined across each COMT genotype and a median split was performed on the circulating estradiol levels to create high and low estradiol groups for each genotype. COMT genotype and estradiol level were hypothesized to be proxy measures for brain dopamine levels with the Met/Met and high estradiol group having the most dopamine and Val/Val and low estradiol group having the least dopamine. The functional magnetic resonance imaging results showed that the N-back task activated the expected bilateral frontal and bilateral parietal working memory network. However, no main effects of COMT genotype or estradiol group were found. There was COMT-estradiol interaction found in a small area of decreased activation in the right precentral gyrus (Brodmann Area 6) that was related to the increasing hypothesized dopamine level. Specifically, women with a Met/Met genotype in the high estradiol group had the least activation in this frontal lobe working memory region. Women with a Val/Val genotype in the low estradiol group had greater activation in this region relative to the other groups. Performance on the N-back task did not show any group differences. These data indicate that after menopause COMT genotype and potentially the menopause-related changes to the dopaminergic system are not related to cognition. Future studies should examine how the relationship between COMT, estradiol, and cognition around the menopause transition as there appear to be differences in this relationship for premenopausal and postmenopausal women.
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Affiliation(s)
- Julie A Dumas
- Department of Psychiatry, University of Vermont Robert Larner, M.D. College of Medicine, Burlington, VT.
| | - Jenna A Makarewicz
- Department of Psychiatry, University of Vermont Robert Larner, M.D. College of Medicine, Burlington, VT
| | - Janice Bunn
- Department of Medical Biostatistics, University of Vermont Robert Larner, M.D. College of Medicine, Burlington, VT
| | - Joshua Nickerson
- Department of Diagnostic Radiology, School of Medicine, Oregon Health and Science University, Portland, OR
| | - Elizabeth McGee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Robert Larner, M.D. College of Medicine, Burlington, VT
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21
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Dopaminergic contributions to working memory-related brain activation in postmenopausal women. Menopause 2018; 24:163-170. [PMID: 27676634 DOI: 10.1097/gme.0000000000000738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The current study examined the effects of pharmacologic dopaminergic manipulations on working memory-related brain activation in postmenopausal women to further understand the neurochemistry underlying cognition after menopause. METHODS Eighteen healthy postmenopausal women, mean age 55.21 years, completed three study days with dopaminergic drug challenges during which they performed a functional magnetic resonance imaging visual verbal N-back test of working memory. Acute stimulation with 1.25 mg oral D2 agonist bromocriptine, acute blockade with 1.5 mg oral haloperidol, and matching placebo were administered randomly and blindly on three study days. RESULTS We found that dopaminergic stimulation increased activation primarily in the posterior regions of the working memory network compared with dopaminergic blockade using a whole brain cluster-level corrected analysis. The dopaminergic medications did not affect working memory performance. CONCLUSIONS Patterns of increased blood-oxygen-level dependent signal activation after dopaminergic stimulation were found in this study in posterior brain regions with no effect on working memory performance. Further studies should examine specific dopaminergic contributions to brain functioning in healthy postmenopausal women to determine the effects of the increased brain activation on cognition and behavior.
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Shanmugan S, Loughead J, Cao W, Sammel MD, Satterthwaite TD, Ruparel K, Gur RC, Epperson CN. Impact of Tryptophan Depletion on Executive System Function during Menopause is Moderated by Childhood Adversity. Neuropsychopharmacology 2017; 42:2398-2406. [PMID: 28322235 PMCID: PMC5645747 DOI: 10.1038/npp.2017.64] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 12/25/2022]
Abstract
Many healthy women with no history of cognitive dysfunction experience subjective executive difficulties during menopause. Preclinical literature suggests latent effects of early life adversity on serotonin function may play a role in this phenomenon. However, evidence in human participants regarding the mechanisms by which loss of estradiol contributes to this vulnerability is lacking. Here we examined the impact of tryptophan depletion (TD) and adverse childhood experiences (ACE) on brain activation during a working memory task in menopausal women. We hypothesized that an interactive effect between ACE and TD would be observed when women were hypogonadal, and that treatment with estradiol would attenuate this effect. Thirty-three women underwent functional imaging at four time points (123 total scans) in this double-blind, placebo controlled, cross-over study. The effects of TD, ACE, and TD × ACE were evaluated using a voxel-wise, mixed-effects, 2 × 2 ANOVA. In the absence of exogenous estradiol, a TD by ACE interaction was observed on BOLD signal in the right DLPFC such that TD increased activation in high ACE subjects but decreased activation in low ACE subjects. While a similar interaction was observed with placebo treatment, treatment with estradiol attenuated the effects of ACE and TD such that no between or within group differences were observed. Together, these results suggest that early life adversity may have a lasting impact on serotonergic circuits underlying executive function that are unmasked by loss of estradiol during menopause.
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Affiliation(s)
- Sheila Shanmugan
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mary D Sammel
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - C Neill Epperson
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry or Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Penn Center for Women’s Behavioral Wellness, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA, Tel: +(215) 573-8871, Fax: +(215) 573-8881, E-mail:
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Salagre E, Solé B, Tomioka Y, Fernandes BS, Hidalgo-Mazzei D, Garriga M, Jimenez E, Sanchez-Moreno J, Vieta E, Grande I. Treatment of neurocognitive symptoms in unipolar depression: A systematic review and future perspectives. J Affect Disord 2017. [PMID: 28651185 DOI: 10.1016/j.jad.2017.06.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive symptoms in Major Depressive Disorder (MDD) are persistent and commonly entail neurocognitive impairment and a decline in quality of life. This systematic review gathers the current scientific evidence on therapeutic strategies for neuropsychological impairment in MDD. METHOD A systematic search on PubMed, PsycINFO and Clinicaltrials.gov was carried out on December 2016 according to PRISMA using Boolean terms to identify interventions for the treatment of cognitive dysfunction in MDD. Only English-written articles providing original data and focusing in adults with MDD were included with no time restrictions. RESULTS A total of 95 studies reporting data on 40 pharmacological and non-pharmacological interventions were included. Interventions were grouped into the following categories: 1) Pharmacological Therapies (antidepressants, stimulants, compounds acting on NMDA receptors, compounds acting on the cholinergic system, compounds showing anti-inflammatory or antioxidant properties, other mechanisms of action), 2) Physical Therapies and 3) Psychological Therapies, 4) Exercise. There are some promising compounds showing a positive impact on cognitive symptoms including vortioxetine, lisdexamfetamine or erythropoietin. LIMITATIONS The studies included showed significant methodological differences in heterogeneous samples. The lack of a standardized neuropsychological battery makes comparisons between studies difficult. CONCLUSION Current evidence is not sufficient to widely recommend the use of procognitive treatments in MDD although promising results are coming to light.
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Affiliation(s)
- E Salagre
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Y Tomioka
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - D Hidalgo-Mazzei
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Garriga
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jimenez
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Sanchez-Moreno
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - I Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Impact of early life adversity and tryptophan depletion on functional connectivity in menopausal women: A double-blind, placebo-controlled crossover study. Psychoneuroendocrinology 2017; 84:197-205. [PMID: 28755550 PMCID: PMC5609529 DOI: 10.1016/j.psyneuen.2017.07.239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/03/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
Abstract
During the menopause transition, women are at increased risk of subjective symptoms of executive dysfunction. Evidence from animal and human participant studies suggests adverse childhood experiences (ACE) may be a risk factor for executive complaints during this hormonal transition. Preclinical literature indicates early life adversity effects on serotonin function may play a role in this increased susceptibility. However, the mechanisms underlying this increase in vulnerability in human participants remain relatively unknown. Here we examined the impact of ACE and tryptophan depletion (TD), a paradigm used to lower central serotonin levels, on functional network connectivity in discovery and replication datasets. We hypothesized that ACE would be associated with decreased within-network connectivity. We predicted that TD would further lower connectivity in women with high levels of early adversity, but have no effect in women with low levels of early adversity. Forty women underwent two functional imaging sequences at two time points (141 total scans) in a double-blind, placebo controlled, crossover study. The effects of ACE and TD were evaluated using generalized estimating equations (GEE). As predicted, ACE was associated with lower within-network connectivity. While TD had no effect on connectivity in the low ACE group, TD increased connectivity in the high ACE group. The robust effect of ACE remained significant in the replication dataset, though the ACE×TD interaction did not. Together, these results suggest that early life adversity has lasting impacts on large-scale functional networks underlying executive function. Alterations in functional network connectivity may be one mechanism by which early life adversity increases the risk of cognitive disorders during menopause.
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Lisdexamfetamine Effects on Executive Activation and Neurochemistry in Menopausal Women with Executive Function Difficulties. Neuropsychopharmacology 2017; 42:437-445. [PMID: 27550732 PMCID: PMC5399233 DOI: 10.1038/npp.2016.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/15/2016] [Accepted: 08/12/2016] [Indexed: 01/04/2023]
Abstract
Many women with no history of executive dysfunction report difficulties in this domain during the menopause transition. Lisdexamfetamine (LDX) has been suggested to be a safe and effective treatment option for these women. However, the mechanism by which LDX improves executive functioning in these women is not known. Here we investigated the effects of LDX on brain activation and neurochemistry, hypothesizing that LDX would be associated with increased activation and decreased glutamate in executive regions. Fourteen women underwent multimodal neuroimaging at 7T at three time points in this baseline-corrected, double-blind, placebo-controlled, crossover study. Effects of LDX on symptom severity, blood-oxygen-level-dependent (BOLD) signal, and dorsolateral prefrontal cortex (DLPFC) glutamate+glutamine (Glx) were measured using a clinician-administered questionnaire, fMRI during performance of a fractal n-back task, and 1H-MRS, respectively. The effect of treatment (LDX minus baseline vs placebo minus baseline) on these behavioral and neural markers of executive function was examined using repeated measures mixed effects models. LDX treatment was associated with decreased symptom severity, increased activation in the insula and DLPFC, and decreased DLPFC Glx. In addition, the magnitude of LDX-induced improvement in symptom severity predicted both direction and magnitude of LDX-induced change in insular and DLPFC activation. Moreover, symptom severity was positively correlated with Glx concentration in the left DLPFC at baseline. These findings provide novel evidence that the neural mechanisms by which LDX acts to improve self-reported executive functioning in healthy menopausal women with midlife onset of executive difficulties include modulation of insular and DLPFC recruitment as well as decrease in DLPFC Glx concentration.
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Pesce M, Rizzuto A, La Fratta I, Tatangelo R, Campagna G, Iannasso M, Ferrone A, Franceschelli S, Speranza L, Patruno A, De Lutiis M, Felaco M, Grilli A. Super-oxide anion production and antioxidant enzymatic activities associated with the executive functions in peripheral blood mononuclear cells of healthy adult samples. Neurosci Res 2016; 106:23-8. [DOI: 10.1016/j.neures.2015.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/08/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022]
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Pines A. Midlife ADHD in women: any relevance to menopause? Climacteric 2016; 19:423-5. [PMID: 26914101 DOI: 10.3109/13697137.2016.1152536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, there has been a growing interest in better understanding of the adult-type attention deficit hyperactive disorder (ADHD). It is now accepted that many children with ADHD continue to have symptoms later in life, although the characteristics of the disease may change substantially in adults. Data are emerging on ADHD in midlife and old age and some studies analyze gender differences and co-morbidities during the lifespan of ADHD patients. This short communication discusses the possible resemblance of certain menopausal symptoms and those of adult ADHD and the potential contribution of the female hormonal environment. Further, there might be a promising role for psychostimulants, the mainstay of ADHD management, as treatment of impairment of some executive function domains in menopausal women.
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Affiliation(s)
- A Pines
- a Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
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Abstract
The peri- and postmenopausal periods represent a window of vulnerability for emergence of anxiety symptoms and disorders in the life cycle of adult women. Compared to depression, anxiety symptoms and disorders remain largely unexplored during this phase of a woman's life, despite the significant impact on quality of life if not diagnosed and treated. Here, we review the literature to present our current understanding of the epidemiology, causal factors, diagnosis, and treatment of anxiety in the aging woman.
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Affiliation(s)
- Andrew M Siegel
- Hospital of the University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sarah B Mathews
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Women's Behavioral Wellness, University of Pennsylvania, Philadelphia, PA, USA
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Mathews SB, Epperson CN. Neuropsychiatric Disorders Among Aging Women: Assessing Risk Factors and Tailoring Treatment. Curr Behav Neurosci Rep 2015. [DOI: 10.1007/s40473-015-0057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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