Examining the Relationship Between Neurosteroids, Cognition, and Menopause With Neuroimaging Methods

Spatial learning and memory impairment at the post-follicular depletion state is associated with reduced hippocampal glucose uptake

The menopausal transition is a complex neuroendocrine aging process affecting brain structure and metabolic function. Such changes are consistent with neurological sequelae noted following the menopausal transition, including cognitive deficits. Although studies in rodent models of the menopause revealed changes in learning and memory, little is known about the structural and metabolic changes in the brain regions serving the cognitive function in these models. The administration 4-vinylcyclohexene diepoxide (VCD) in laboratory animals results in follicular depletion, and thus, is a powerful translational tool that models the human menopause. In the studies presented here, we evaluated behavior, brain structure, and metabolism in young female rats administered with either VCD or vehicle for 15 days across the early, mid, and post-follicular depletion states at 1-, 2-, and 3-months post-final injection, respectively. Additionally, we evaluated the serum hormonal profile and ovarian follicles based on the estrous cycle pattern. Positron emission tomography (PET) was utilized to determine regional brain glucose metabolism in the hippocampus, medial prefrontal cortex, and striatum. Subsequently, the rats were euthanized for ex-vivo magnetic resonance imaging (MRI) to assess regional brain volumes. VCD-induced rats at the post-follicular depleted time points had diminished spatial learning and memory as well as reduced hippocampal glucose uptake. Additionally, VCD-induced rats at post-follicular depletion time points had marked reductions in estradiol, progesterone, and anti-mullerian hormone with an increase in follicle-stimulating hormone. These rats also exhibited fewer ovarian follicles, indicating that substantial ovarian function loss during post-follicular time points impairs the female rats' spatial learning/memory abilities and triggers the metabolic changes in the hippocampus.

Remembering the null hypothesis when searching for brain sex differences

Human brain sex differences have fascinated scholars for centuries and become a key focus of neuroscientists since the dawn of MRI. We recently published a major review in Neuroscience and Biobehavioral Reviews showing that most male-female brain differences in humans are small and few have been reliably replicated. Although widely cited, this work was the target of a critical Commentary by DeCasien et al. (Biol Sex Differ 13:43, 2022). In this response, I update our findings and confirm the small effect sizes and pronounced scatter across recent large neuroimaging studies of human sex/gender difference. Based on the sum of data, neuroscientists would be well-advised to take the null hypothesis seriously: that men and women's brains are fundamentally similar, or "monomorphic". This perspective has important implications for how we study the genesis of behavioral and neuropsychiatric gender disparities.

Relationship between sex hormones, reproductive stages and ADHD: a systematic review

OBJECTIVE

This systematic review aims to summarize current available evidence for the relationship between sex hormones or reproductive life stages (adrenarche in males and females, menarche, pregnancy, postpartum and menopause) and ADHD.

METHODS

We systematically reviewed studies investigating the relationship between sex hormones and symptoms of inattention and/or hyperactivity in individuals with an ADHD diagnosis or equivalent assessment of symptoms with validated scales. Articles were screened sequentially by two reviewers who were clinically and academically familiar with ADHD. Studies were rated according to Oxford Levels of Evidence (CEBM 2009).

RESULTS

Four studies matched inclusion criteria. One article was a case report of a female with ADHD and premenstrual syndrome experiencing worsening symptoms prior to each period (Quinn, J Clin Psychol 61:579-587, 2005). Another was a review article analysing literature relating to the effect of hormones on ADHD symptoms and supporting that a relationship exists between ADHD symptoms and sex hormone levels, without further characterization (Haimov-Kochman and Berger, Front Hum Neurosci 8, 2014). Giotakos and colleagues found no relationship between Wender Utah scores and sex hormone levels (Giotakos et al., J Forensic Psychiatry Psychol 16:423-433, 2005). An exploratory study by Ostojic and Miller found evidence for an association between early pubertal onset, inattention and risk-taking behaviour (Ostojic and Miller, J Atten Disord 20:782-791, 2016).

CONCLUSION

The literature on the relationship between sex hormones and ADHD is limited. Available studies present contradicting information. It is not known how this lack of evidence affects the treatment of ADHD during the lifespan. Further research is required to correctly characterize the mechanisms behind ADHD symptoms and its potential association with sex hormones.

Brain-based sex differences in autism spectrum disorder across the lifespan: A systematic review of structural MRI, fMRI, and DTI findings

Females with autism spectrum disorder (ASD) have been long overlooked in neuroscience research, but emerging evidence suggests they show distinct phenotypic trajectories and age-related brain differences. Sex-related biological factors (e.g., hormones, genes) may play a role in ASD etiology and have been shown to influence neurodevelopmental trajectories. Thus, a lifespan approach is warranted to understand brain-based sex differences in ASD. This systematic review on MRI-based sex differences in ASD was conducted to elucidate variations across the lifespan and inform biomarker discovery of ASD in females We identified articles through two database searches. Fifty studies met criteria and underwent integrative review. We found that regions expressing replicable sex-by-diagnosis differences across studies overlapped with regions showing sex differences in neurotypical cohorts. Furthermore, studies investigating age-related brain differences across a broad age-span suggest distinct neurodevelopmental patterns in females with ASD. Qualitative comparison across youth and adult studies also supported this hypothesis. However, many studies collapsed across age, which may mask differences. Furthermore, accumulating evidence supports the female protective effect in ASD, although only one study examined brain circuits implicated in "protection." When synthesized with the broader literature, brain-based sex differences in ASD may come from various sources, including genetic and endocrine processes involved in brain "masculinization" and "feminization" across early development, puberty, and other lifespan windows of hormonal transition. Furthermore, sex-related biology may interact with peripheral processes, in particular the stress axis and brain arousal system, to produce distinct neurodevelopmental patterns in males and females with ASD. Future research on neuroimaging-based sex differences in ASD would benefit from a lifespan approach in well-controlled and multivariate studies. Possible relationships between behavior, sex hormones, and brain development in ASD remain largely unexamined.

Altered Spontaneous Brain Activity in Women During Menopause Transition and Its Association With Cognitive Function and Serum Estradiol Level

OBJECTIVE

Serum hormone deficiencies during menopause transition may affect spontaneous brain activity and global cognition. The purpose of this study was to explore the differences in spontaneous brain activity between premenopausal and perimenopausal women, and to investigate the associations between spontaneous brain activity, serum hormone levels and global cognition.

METHODS

Thirty-two premenopausal women (47.75 ± 1.55 years) and twenty-five perimenopausal women (51.60 ± 1.63 years) underwent resting-state functional MRI (fMRI) scan. Clinical information including Mini-Mental State Examination (MMSE), levels of estradiol (E2), free testosterone, progesterone, prolactin, follicle-stimulating hormone and luteinizing hormone were measured. Regional homogeneity (ReHo) was used to evaluate spontaneous brain activity alterations between perimenopausal and premenopausal women. Correlation analysis was used to investigate the associations between brain functional alterations and clinical measures in perimenopausal group.

RESULTS

The results demonstrated increased ReHo value in the right lingual gyrus (LG) and decreased ReHo value in the right superior frontal gyrus (SFG) in perimenopausal women compared with premenopausal women. In perimenopausal group, ReHo of the right LG showed a negative correlation with level of E2 (r = -0.586, p = 0.002), ReHo of the right SFG showed a positive correlation with level of E2 (r = 0.470, p = 0.018) and MMSE (r = 0.614, p = 0.001).

CONCLUSIONS

The results demonstrated that women approaching menopause suffered from altered functions in brain regions related to cognitive function, working memory, the results also revealed a direct association between levels of E2 and brain functions in perimenopausal women.

The Role of Estrogen Receptors and Their Signaling across Psychiatric Disorders

Increasing evidence suggests estrogen and estrogen signaling pathway disturbances across psychiatric disorders. Estrogens are not only crucial in sexual maturation and reproduction but are also highly involved in a wide range of brain functions, such as cognition, memory, neurodevelopment, and neuroplasticity. To add more, the recent findings of its neuroprotective and anti-inflammatory effects have grown interested in investigating its potential therapeutic use to psychiatric disorders. In this review, we analyze the emerging literature on estrogen receptors and psychiatric disorders in cellular, preclinical, and clinical studies. Specifically, we discuss the contribution of estrogen receptor and estrogen signaling to cognition and neuroprotection via mediating multiple neural systems, such as dopaminergic, serotonergic, and glutamatergic systems. Then, we assess their disruptions and their potential implications for pathophysiologies in psychiatric disorders. Further, in this review, current treatment strategies involving estrogen and estrogen signaling are evaluated to suggest a future direction in identifying novel treatment strategies in psychiatric disorders.