Climacteric symptoms do not impair cognitive performances in postmenopause

The association of vasomotor symptoms during the menopausal transition and cognition in later life

OBJECTIVE

The majority of women experience vasomotor symptoms (VMS) during the menopausal transition. Whether self-reported VMS are associated with cognitive test performance later in life remains unclear. The goal of this study was to determine whether a greater burden of VMS is associated with poor later-life cognition.

METHODS

The Wisconsin Longitudinal Study is a prospective study of randomly selected Wisconsin high school graduates of the class of 1957. At ages 65 and 72, a random subset of participants completed six cognitive tests, including similarities, letter and category fluency, immediate and delayed word recall, and digit ordering. Nested regression models were used to examine the association between extent of VMS, assessed at age 54, and baseline cognition at 65, adjusting for early-life socioeconomic status, women's reproductive health variables, intelligence quotient, and midlife income. This series of models was also used to examine the association between VMS and change in cognition score from age 65 to 72. In sensitivity analyses, models were repeated in a sample using multiple imputation for missing covariates.

RESULTS

Of the 5,326 women enrolled, 874 had data onVMS, covariates, and all cognitive tests. In an unadjusted model, higher VMS were associated with a lower similarities score (b = -0.09 95% CI -0.16 to -0.02) at age 65 but no other cognitive tests. In adjusted models, VMS were not related to cognition at age 65 or change in cognition. Results remained similar with multiple imputation.

CONCLUSIONS

Our study does not support a relationship between self-reported VMS and cognition later in life.

Is cognitive performance of women sensitive to the severity of menopausal symptoms?

OBJECTIVE

Menopause is a natural phenomenon among women during their midlife, which is accompanied by unfavorable physical, physiological, and psychological consequences. Therefore, the major aim of the present cross-sectional study was to examine whether the cognitive performance of women is sensitive to the severity of menopausal symptoms.

METHODS

A total number of 404 rural women aged between 40 and 65 years were included in the present study. The menopausal symptoms and cognitive performance of the women were assessed using the Greene Climacteric Scale and Hindi Mini-Mental State Examination scale respectively.

RESULTS

The results of the present study demonstrated that women experiencing severe menopausal symptoms (higher Total Greene climacteric score) presented significantly lower mean values for orientation (8.11 vs 8.90, P < 0.001), registration (2.77 vs 2.91, P < 0.001), attention (4.31 vs 4.48, P < 0.01), recall (2.26 vs 2.53, P < 0.05), and language/visuo-spatial skills (7.13 vs 7.91, P < 0.001) as compared with their counterparts with mild menopausal symptoms. The multivariate linear regression model (after adjustment for age, marital status, and educational status) recorded severe depression and greater sexual dysfunction as the factors significantly associated with lower Mini-Mental State Examination scores.

CONCLUSION

Hence, the findings of the present study indicated that the cognitive performance of women was sensitive to severe depression and sexual dysfunction.

Women’s experiences of menopause at work and performance management

Presenting findings from our global evidence review of menopause transition and economic participation emboldened us to establish a menopause policy at the university where we all worked at the time. Our report was published in July 2017 and the policy was in place by November that year. Our critical reflection on this activism focuses on issues that are not commonly recognized around such interventions, and which we ourselves have only been able to acknowledge through engaged action. Challenges remain in normalizing menopause in organizations, specifically around gendered ageism and performance management. In drawing on Meyerson and Kolb’s framework for understanding gender in organizations, we highlight how policies are both vital and yet insufficient in and of themselves in revising the dominant discourse around menopause at work. At the same time, we highlight the importance and shortcomings of academic activism within these processes.

Does genetic testing for ERα gene polymorphisms provide new possibilities of treatment for cognitive function disorders in postmenopausal women?

It is commonly considered that cognitive abilities decrease with age, especially with respect to processing and psychomotor speed. It is an interesting issue whether, apart from the ageing process, the undergoing of menopause itself deteriorates cognitive functions, compared to women at reproductive age. Hopes for improvement of cognitive functions were pinned on the use of menopausal hormone therapy. However, the results of studies concerning the effect of hormone replacement therapy on cognition proved to be contradictory. It seems that the essence of the problem is more complicated than only estrogen deficiency. It is suggested that estrogen receptor α (ERα) polymorphism may be responsible for the differences in the effect of estrogens on cognitive processes. The article presents current knowledge concerning the effect of estrogens on the central nervous system, especially the role of ERα polymorphism, with respect to foreseeing benefits from the use of exogenous estrogens for cognitive functions. At the present stage of research, ERα appears to be poorly specific; nevertheless, it may be an important instrument for the classification of peri- and post-menopausal patients in the group where therapy with the use of estrogens may bring about benefits in terms of prevention and treatment of cognitive disorders. It also seems necessary to conduct prophylactic, screening examination of cognitive functions in post-menopausal women, in order to identify those at risk of the development of dementia.

Effects of menopausal hot flashes on mental workload

This study examined the differences in psychophysiological responses during mental task performance between women with (Group S) and without (Group A) menopausal hot flashes. Twelve women who reported experiencing daily moderate or severe menopausal hot flashes (Group S) and twelve women who reported having no hot flashes (Group A) participated in a mental arithmetic (Task) and a control (Non-task) experiment that occurred twice during 30 min. Although Group S experienced frequent hot flashes during mental arithmetic task, no significant differences between the two groups emerged for the percentage of correct responses and reaction time, and cardiovascular and thermoregulatory responses. However, the STAI state anxiety score was significantly higher in Group S than in Group A during both rest and mental tasks, and stress-related cortisol secretion showed a tendency to increase in Group S compared with Group A after task. The present study indicates that there were no significant differences in physiological responses and cognitive performance between women with and without menopausal hot flashes during mental arithmetic, but women with menopausal hot flashes might perceive higher psychological stress during rest and mental arithmetic tasks than asymptomatic women.

Estrogen + progestin therapy and cognition: a randomized placebo-controlled double-blind study

AIMS

The use of hormone therapy (HT) is a relevant and topical issue in the treatment of menopausal symptoms in women. Information regarding the effects of combination treatment with estrogen and progesterone as well as treatment timing on cognitive function is lacking and was evaluated in healthy pre- and postmenopausal women.

METHODS

Sixteen premenopausal (45-51 years) and 16 postmenopausal (58-70 years) women were randomly assigned to receive either estrogen + progestin therapy (HT) or placebo (PL) for six months. The study was double-blind. Cognitive performance was measured at baseline and follow up with tests of verbal and visuomotor functions, verbal and visual memory, and attention.

RESULTS

In premenopausal women, cognitive attention, when compared to baseline, improved with HT but declined slightly with PL in the two-choice reaction time task (P = 0.049), while PL was associated with better performance in tests of shared attention (P = 0.024) and auditory attention (P < 0.05). In postmenopausal women, HT was associated with improved performance in verbal episodic memory (P = 0.024) and a minor decline in auditory attention (P = 0.025).

CONCLUSIONS

HT, with estradiol valerate and norethisterone, in healthy women showed only minor effects on attention around the menopausal transition and on memory in postmenopause.

Menopause-associated symptoms and cognitive performance: results from the study of women's health across the nation

A long-standing, but unproven hypothesis is that menopause symptoms cause cognitive difficulties during the menopause transition. This 6-year longitudinal cohort study of 1,903 midlife US women (2000-2006) asked whether symptoms negatively affect cognitive performance during the menopause transition and whether they are responsible for the negative effect of perimenopause on cognitive processing speed. Major exposures were depressive, anxiety, sleep disturbance, and vasomotor symptoms and menopause transition stages. Outcomes were longitudinal performance in 3 domains: processing speed (Symbol Digit Modalities Test (SDMT)), verbal memory (East Boston Memory Test), and working memory (Digit Span Backward). Adjustment for demographics showed that women with concurrent depressive symptoms scored 1 point lower on the SDMT (P < 0.05). On the East Boston Memory Test, the rate of learning among women with anxiety symptoms tested previously was 0.09 smaller per occasion (P = 0.03), 53% of the mean learning rate. The SDMT learning rate was 1.00 point smaller during late perimenopause than during premenopause (P = 0.04); further adjustment for symptoms did not attenuate this negative effect. Depressive and anxiety symptoms had a small, negative effect on processing speed. The authors found that depressive, anxiety, sleep disturbance, and vasomotor symptoms did not account for the transient decrement in SDMT learning observed during late perimenopause.

Maintaining cognitive health in elderly women

This review indicates that possible preventative activities and lifestyle changes undertaken to maintain cognitive health and prevent dementia in old age may be particularly important in middle age. Risk factors for cardiovascular disease are the same as those for dementia, including its most common form, Alzheimer’s disease. Treating high blood pressure, high cholesterol and thyroid hormone deficiency, maintaining a normal weight, having a healthy diet and engaging in resistance or aerobic exercise can all potentially help to sustain cognitive health. Long-term treatment with estrogenic compounds (> 1 year) does not seem to be indicated and may actually confer risks for dementia in older women over the age of 65 years. The same may be the case for phytoestrogens. The possibility that folate can offset some of the negative effects of phytoestrogens merits more research in this area. Whether there is an optimum age to engage with these types of lifestyle behaviors is currently unclear and also requires additional research.

Memory after menopause: preliminary considerations of hormone influence on cognitive functioning

Oestrogen has been shown to have a wide variety of organisational and activating effects on brain structure and function. Despite the significant amount of research investigating the relation and effects of oestrogen to cognitive performance in menopausal women over the past two decades, studies have failed to produce consistent findings. This paper reports on evaluations of eighty-one community-based postmenopausal Australian women comparing current, past and never users of hormone therapy (HT) on a wide range of cognitive measures of general, verbal and visual memory, delayed recall, attention, concentration and verbal comprehension. Few significant differences were found among the three groups in the demographic profile, health status or psychological functioning. Although never users had significantly lower scores on verbal memory than past users, the differences were not statistically significant when adjustments were made controlling for age, education level, verbal comprehension, attention and concentration. These findings challenge long-held beliefs regarding the usefulness of oestrogen supplements as a protective factor against cognitive decline in older women's later years.

Serum levels of estradiol and testosterone and performance in different cognitive domains in healthy elderly men and women

Sex hormones could protect against age-related cognitive decline in elderly men and women. We investigated the relationships between serum total testosterone (TT), total estradiol (TE2) levels and cognitive function in 145 non-demented elderly volunteers (aged 61-91 years) who were not using hormone replacement therapy (HRT). Women (n=66) were better at verbal recall than men (n=79) and men were slightly better at naming. There was a positive relationship between serum levels of TE2 and verbal list recall but not with other verbal memory tests (e.g. Verbal Paired Associates) in women. There was a negative relationship of serum TT levels with verbal recall. Surprisingly, women who were in the upper age tertile (> 77 years of age) were better at verbal recall than men and than women younger than 72; this effect was independent of hormone levels. Men between 61 and 72 years of age showed a positive relationship between high TE2 levels and Spatial Span performance and between high TT levels and speed of information processing, while for women of this age-group, a negative relationship was found. These preliminary results were unchanged when controlling for education, sex hormone binding globulin levels, body mass index, depression, daily alcohol use and smoking. In sum, not all cognitive functions were better with higher levels of sex steroids and effects seemed to be modified by sex; the sex-sensitive tests showing the clearest effects. More research is required to investigate whether there is a window of time in which hormone therapy could be beneficial for middle-aged men.

State of vigilance, oestrogen replacement therapy, and lipid profile as modifiers of nocturnal movement-induced heart rate responses

STUDY OBJECTIVES

To investigate the body movement-associated heart rate responses during sleep in postmenopausal women and to evaluate the possible effect of transdermal oestrogen replacement therapy and metabolic factors on these responses.

DESIGN

A prospective double-blind cross-over placebo-controlled trial.

SETTING

A university sleep research unit.

PATIENTS

Seventy-one healthy postmenopausal women.

METHODS

The subjects underwent a whole-night polysomnography including an electrocardiogram (ECG) and a sensitive whole-body movement sensor channel. Body movements of 2-15 s duration with an artefact-free ECG were identified and heart rate was automatically analysed for 30 s before and 60 s after movement. The movement-induced reflex tachycardia and the following rebound bradycardia were measured for the awake state, non-rapid eye movement (REM) sleep and REM sleep. Indices of the heart rate response correlated with age, body mass index (BMI) and high-density lipoprotein (HDL)/low-density lipoprotein (LDL) cholesterol ratio.

RESULTS

The tachycardia response to a body movement was stronger during sleep than in the awake state, being strongest in REM sleep. The rebound bradycardia following a tachycardia response was relatively similar in REM and in the awake states, but attenuated in non-REM sleep. Oestrogen did not influence the heart rate response. Increasing age and BMI attenuated the response, while an increase in the HDL/LDL cholesterol ratio enhanced the rebound bradycardia response.

CONCLUSIONS

Sleep powerfully modulates the rapid cardiac autonomic responses to internal stressors. Postmenopausal hormone replacement therapy does not influence these responses, but they are strongly modulated by lipid metabolism and closely correlated with age and BMI.

Cognitive function effects of suppressing ovarian hormones in young women

OBJECTIVE

To evaluate the effect of a pharmacologically induced, temporary suppression of ovarian hormones on healthy young women's cognitive functioning.

DESIGN

Sixteen healthy women with normal menstrual cycles completed the California Verbal Learning Test, a digit span test, and a verbal fluency test in the follicular phase of a normal menstrual cycle and a second time after four monthly injections of the gonadotropin-releasing hormone (GnRH) agonist. Women were randomly assigned to complete a third testing either after resuming cycles in the follicular phase or after three more injections of the GnRH agonist and while wearing an estradiol patch. The control group consisted of 10 women who were tested three times in the follicular phase of their menstrual cycles.

RESULTS

Results showed no change in cognitive functioning across sessions or groups in women with suppressed ovarian function. Women who had the highest levels of menopausal symptoms when taking the GnRH agonist did not have significantly lower cognitive functioning.

CONCLUSIONS

This study did not find any effect of suppression in ovarian hormones on cognitive performance of young women.

The effects of estrogen replacement therapy on neuropsychological functioning in postmenopausal women with and without dementia: a critical and theoretical review

We review 42 studies examining the effects of estrogen replacement therapy (ERT) on memory and cognition in nondemented postmenopausal women. Although there are an appreciable number of nonsignificant findings, the number of significant findings favoring ERT users considerably outnumbers the rare findings of better performance in controls. Experimental studies demonstrate a consistent beneficial effect on verbal memory, but these are short-term studies of the more acute effects of ERT. The observational studies suggest that there may be a long-lasting effect of continued ERT on cognitive functioning, but these studies need to be interpreted with caution because of the lack of random assignment and a possible "healthy user bias." We also summarize findings from studies on the effects of ERT on Alzheimer's disease (AD). ERT is associated with a decreased risk for dementia, but there is little evidence for a positive effect on cognition in women with AD. Definitive answers to questions about the long-term effects of ERT on cognitive aging and risk of developing AD should be provided by 3 ongoing clinical trials.

Cognitive function in postmenopausal women treated with raloxifene

BACKGROUND

In postmenopausal women, estrogen may have a beneficial effect on cognition or reduce the risk of decline in cognitive function. Whether raloxifene, a selective estrogen-receptor modulator, might have similar actions is not known.

METHODS

As part of the Multiple Outcomes of Raloxifene Evaluation trial, we studied 7478 postmenopausal women with osteoporosis (mean age, 66 years), who were enrolled at 178 sites in 25 countries. The women were randomly assigned to receive raloxifene (60 mg or 120 mg) or placebo daily for three years. We compared the mean scores of the groups on six tests of cognitive function, which were administered at base line and at six months and one, two, and three years. Women were classified as having a decline in cognitive function if the change in their scores at three years was in the worst 10 percent.

RESULTS

The mean cognitive scores in the three groups of women were similar at base line. The scores improved slightly in all three groups during the three-year study period, with no significant differences among the groups. The risk of decline in the cognitive function, as measured by four of the six tests, did not differ significantly between the two raloxifene groups combined and the placebo group, but there was a trend toward less decline in the combined raloxifene group on the two tests of verbal memory (relative risk, 0.77) and attention, (relative risk, 0.87). Newly reported or worsening hot flashes did not negatively influence test scores or the effect of treatment on test performance.

CONCLUSIONS

Raloxifene treatment for three years does not affect overall cognitive scores in postmenopausal women with osteoporosis.

The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis

We reviewed epidemiological and experimental studies of female gonadal hormone replacement therapy (HRT) on cognitive function in post-menopausal women and carried out meta-analyses. In healthy ageing women, HRT has small and inconsistent effects that include enhancement of verbal memory, abstract reasoning and information processing. Epidemiological studies show larger effects than experimental studies, which is not related to sample size. Important confounds may be that women who start using HRT are healthier than women who do not. Also, controlling for socio-economic status diminishes the effect of HRT. The effects of HRT may depend on the age and type of menopause and the therapeutic intervention used, with the most widely used drug, Premarin, having least effect. However, the effects are independent of mood and climacteric symptom alleviation. There is a paucity of experimental studies that include healthy elderly women. The evidence for an estrogen deficiency in women with dementia and cognitive dysfunction is inconsistent. Nevertheless, epidemiological studies suggest that HRT protects against the development of clinically diagnosed Alzheimer's disease. However, poor recall of HRT use by patients and altered physician behaviour may have confounded the effects. Surprisingly, both healthy and demented women with low education seem to benefit most from HRT. Three recent controlled experimental studies using Premarin showed no effects of HRT in preventing further cognitive decline in women who already have Alzheimer's disease. Duration of treatment seems to play an important role, with beneficial effects declining-and even reversing-with longer treatment in women with Alzheimer's disease.Future research should further investigate the cognitive effect of different HRT preparations, serum estrogen levels, and the interactions of HRT with age, menopausal status and existing protective (e.g. education) and risk factors (e.g. smoking and apolipoprotein E genotype) for cognitive decline and Alzheimer's disease.

The effect of estrogen replacement therapy on cardiac autonomic regulation

OBJECTIVE

To study the effects of estrogen replacement therapy (ERT) and sleep stage on autonomic cardiac regulation. SRUDY DESIGN: Seventy-one healthy postmenopausal women received transdermal ERT and placebo separated by a washout in a randomized, placebo-controlled, double-blind, cross-over trial. Polysomnography was conducted at the end of each treatment. Heart rate variability (HRV) was assessed in epochs of the awake state, stage 2, slow wave and REM sleep. The effects of estradiol and sleep stages on HRV were analyzed.

RESULTS

ERT decreased heart rate in the awake state and quiet sleep, but not in REM sleep. ERT did not change the heart rate variability. Heart rate decreased and HRV increased during stage 2 and slow wave sleep compared with the awake state with placebo. In REM sleep, similarly, heart rate increased above awake values and the values of HRV parameters fell back to awake levels.

CONCLUSIONS

The results suggest that ERT increases vagal tone, but does not change cardiac vagal modulation. Changes in HRV suggest a strong vagal influence in non-REM and a sympathetic influence in REM sleep.

Climacteric vasomotor symptoms do not imply autonomic dysfunction

OBJECTIVE

To study whether oestrogen replacement therapy has an effect on autonomic haemodynamic control in postmenopausal women.

DESIGN

A placebo-controlled, prospective, randomised, double-blind cross-over trial.

POPULATION

Fourteen healthy postmenopausal women who had had a hysterectomy, of whom 12 were double-blind.

METHODS

At the end of each treatment period we conducted autonomic nervous system tests: the Valsalva manoeuvre, the deep breathing test, study at rest and the active orthostatic test. Baroreflex sensitivity was evaluated non-invasively from the Valsalva manoeuvre. Heart rate variability was assessed in time and frequency domains during supine rest and standing. Serum oestradiol was also measured and the previous two weeks' symptoms were assessed.

RESULTS

Autonomic nervous function was mostly normal for age and unchanged by oestrogen. Vasomotor symptoms were not associated with autonomic dysfunction. Baroreflex sensitivity was 13.3 ms/mmHg (SD 7.4 ms/mmHg) with placebo and 10.5 ms/mmHg (SD 5.4 ms/mmHg) with oestrogen (P = 0.052). This was mostly due to a fall in three of the highest indices. In the orthostatic test the 30 s blood pressure overshoot in two women exceeded the normal 90% confidence interval upper limit, making the mean response strong, especially in the symptomatic group (n = 7). Oestrogen attenuated this overshoot.

CONCLUSIONS

Oestrogen did not have a consistent effect on the autonomic nervous system. Oestrogen attenuated a highly sensitive baroreflex and a strong 30 s blood pressure rise in the orthostatic test. This minor effect of oestrogen could be due to the fact that, in general, women with menopausal symptoms do not have impaired autonomic haemodynamic control. The effect of oestrogen in women with autonomic nervous system dysfunction remains to be studied.