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Schrager S, Williams M, Ward E, Henningfield MF, Yuroff A, Johnson G, Sullivan-Wade L, Hawkins J, Turnquist A. African American women's experiences of menopause: A focus group study. Maturitas 2024; 187:108043. [PMID: 38905863 DOI: 10.1016/j.maturitas.2024.108043] [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] [Received: 10/26/2023] [Revised: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES This study aimed to characterize African American women's experiences of menopause and their interactions with the health care system related to menopausal symptoms. STUDY DESIGN We conducted four focus groups with community-dwelling midlife African American women. MAIN OUTCOMES MEASURES Women who consented to participate completed demographic surveys. Transcripts of the four focus groups (n = 26) were analyzed and themes were elucidated. RESULTS In total, 26 midlife African American women participated in the four focus groups. Participants revealed unmet needs regarding obtaining menopause information from their clinicians. Clinician discussions about menopause tended to be initiated by patients based on their symptoms. Some women reported feeling ignored and/or dismissed by the clinician when they initiated discussions of menopause. Women wanted their clinicians to provide information on menopause, which included receiving information prior to the menopause transition to help them know what to expect. CONCLUSION Women wanted their clinicians to initiate discussions of menopause rather than wait for women to mention symptoms. Prioritizing menopause training for clinicians taking care of midlife African American women may help to improve discussions of menopause.
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Affiliation(s)
- Sarina Schrager
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Wisconsin Department of Health and Family Services, Wisconsin Well Woman Program, Madison, WI, United States of America.
| | - Makeba Williams
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St Louis, MO, United States of America
| | - Earlise Ward
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Mary F Henningfield
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Alice Yuroff
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Gale Johnson
- Wisconsin Department of Health and Family Services, Wisconsin Well Woman Program, Madison, WI, United States of America
| | - Lucretia Sullivan-Wade
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Jennifer Hawkins
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Alyssa Turnquist
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
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He X, Hou F, Shen X, Zhao D, Zhao X, Qi M, Li P. Individual and additive-effect relationships of menopausal symptoms and subjective cognitive decline among nurses during menopausal transition: a cross-sectional study. Menopause 2024; 31:617-625. [PMID: 38860940 DOI: 10.1097/gme.0000000000002368] [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: 06/12/2024]
Abstract
OBJECTIVE This study aimed to examine the individual and additive-effect relationships between menopausal symptoms and subjective cognitive decline among nurses during menopausal transition. METHODS Between February and September 2019, a convenience sampling strategy was used, involving 1,335 Chinese nurses undergoing menopausal transition. A general information survey that included the Subjective Cognitive Decline Scale and the Menopause Rating Scale was completed. Based on a cut-off point of the subjective cognitive decline score of 7.5, the overall sample was divided into mild and severe groups. Propensity score matching was performed to balance covariates of mild and severe subjective cognitive decline. The individual and cumulative effects of menopausal symptoms and subjective cognitive decline were analyzed using binary logistic regression and the Cochran-Armitage trend test, respectively. RESULTS After propensity score matching, none of the parameters showed significant differences between the groups. Logistic regression analysis revealed that four menopausal symptoms were closely associated with severe subjective cognitive decline. The Cochran-Armitage trend test indicated odds ratios linking the presence of these symptoms with increased severe subjective cognitive impairment. In addition, nurses simultaneously experiencing two or more core menopausal symptoms were over six times more likely to have severe subjective cognitive decline than nurses experiencing none or one core menopausal symptom during menopausal transition. CONCLUSIONS Individual and additive numbers of menopausal symptoms significantly influenced subjective cognitive decline in nurses during their menopausal transition. These findings suggest that interventions aimed at enhancing the cognitive performance of nurses experiencing menopause should consider menopausal symptoms.
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Affiliation(s)
- Xudong He
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Fangyan Hou
- Shandong Youth Political College, Jinan, Shandong, China
| | - Xiaona Shen
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Di Zhao
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xiangyu Zhao
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Meiling Qi
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Ping Li
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Zhu C, Thomas N, Arunogiri S, Gurvich C. Systematic review and narrative synthesis of cognition in perimenopause: The role of risk factors and menopausal symptoms. Maturitas 2022; 164:76-86. [DOI: 10.1016/j.maturitas.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/14/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
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Jaff NG, Crowther NJ. The Association of Reproductive Aging with Cognitive Function in Sub-Saharan African Women. Methods Mol Biol 2022; 2343:71-91. [PMID: 34473316 DOI: 10.1007/978-1-0716-1558-4_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Life expectancy in sub-Saharan African women is increasing, and by the late 2020s an estimated 76% of postmenopausal women globally will be living in developing countries. Menopause transition has been associated with cognitive decline in a wide range of studies, but data on cognition and reproductive aging are lacking in sub-Saharan African women. Approximately 72 million people in the region are expected to suffer from dementias and neurocognitive decline by 2050. Studies show that compromised cognitive health in low-income countries has significant implications for adult quality of life and socioeconomic development. There is now an urgent need to further examine risk factors for cognitive decline in these aging women and to understand the ability of public health programs to diagnose and treat cognitive dysfunction. This review examines studies assessing cognition and aging in sub-Saharan African adults, while addressing the significant research gaps. It examines data on the association of the menopause transition with cognitive function and describes how validated tools should be available to assess both menopausal stage and symptoms. Culturally appropriate and validated neurocognitive measures are required to better understand the relationship of reproductive aging with cognition. Longitudinal population-based studies are needed to assess the effect of lifestyle interventions, such as diet and exercise, on cognitive health in sub-Saharan African populations, with an emphasis on women as they transition into menopause.
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Affiliation(s)
- Nicole G Jaff
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wang L, Zhang R, Yang Y, Sun X, Zhang B, Zhu H, Luo X, Ma X, Zhang X. Severity and factors of menopausal symptoms in middle-aged women in Gansu Province of China: a cross-sectional study. BMC Womens Health 2021; 21:405. [PMID: 34879847 PMCID: PMC8653527 DOI: 10.1186/s12905-021-01531-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the severity and risk factors of menopausal symptoms in the middle-aged women in Gansu Province of China. METHODS In this cross-sectional study, a total of 7319 women (aged 40-55 years) attended the health survey in Gansu Province in China were enrolled. Information on demographics, menopausal status, reproductive history, and history of chronic diseases was collected via a structured questionnaire. Severity of menopausal symptom was evaluated by the Modified Kupperman Menopausal Index. Ordinal logistic regression model was applied to explore its risk factors. RESULTS A total of 7319 participants were included in present study, among them, 3606 (49.27%) had moderate or severe menopausal symptom. Compared with premenopausal women, perimenopausal and postmenopausal women have a higher mKMI score. We observed that older age, higher BMI, non-married status, longer duration of menstruation (≥ 7 days), number of pregnancy (> 3 times), longer duration of breastfeeding (> 12 months), peri- or post-menopausal status, and menopause hormone therapy was positively associated with menopausal symptom score, while higher level of family income, educational and physical activity, and history of gynecological, breast or chronic disease were negatively associated with the score. CONCLUSIONS Numerous factors were associated with the severity of menopausal symptom among the Chinese women. Because it was gradually increased with aging, more attention is warranted to manage the menopausal symptom.
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Affiliation(s)
- LiRong Wang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - Rui Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - Ye Yang
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoYan Sun
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - BaoLi Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - HaiYing Zhu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoRong Luo
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoLing Ma
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - XueHong Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China.
- The First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, No. 1, Donggangxi Rd, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
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Koebele SV, Hiroi R, Plumley ZMT, Melikian R, Prakapenka AV, Patel S, Carson C, Kirby D, Mennenga SE, Mayer LP, Dyer CA, Bimonte-Nelson HA. Clinically Used Hormone Formulations Differentially Impact Memory, Anxiety-Like, and Depressive-Like Behaviors in a Rat Model of Transitional Menopause. Front Behav Neurosci 2021; 15:696838. [PMID: 34366807 PMCID: PMC8335488 DOI: 10.3389/fnbeh.2021.696838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/04/2021] [Indexed: 01/29/2023] Open
Abstract
A variety of U.S. Food and Drug Administration-approved hormone therapy options are currently used to successfully alleviate unwanted symptoms associated with the changing endogenous hormonal milieu that occurs in midlife with menopause. Depending on the primary indication for treatment, different hormone therapy formulations are utilized, including estrogen-only, progestogen-only, or combined estrogen plus progestogen options. There is little known about how these formulations, or their unique pharmacodynamics, impact neurobiological processes. Seemingly disparate pre-clinical and clinical findings regarding the cognitive effects of hormone therapies, such as the negative effects associated with conjugated equine estrogens and medroxyprogesterone acetate vs. naturally circulating 17β-estradiol (E2) and progesterone, signal a critical need to further investigate the neuro-cognitive impact of hormone therapy formulations. Here, utilizing a rat model of transitional menopause, we administered either E2, progesterone, levonorgestrel, or combinations of E2 with progesterone or with levonorgestrel daily to follicle-depleted, middle-aged rats. A battery of assessments, including spatial memory, anxiety-like behaviors, and depressive-like behaviors, as well as endocrine status and ovarian follicle complement, were evaluated. Results indicate divergent outcomes for memory, anxiety, and depression, as well as unique physiological profiles, that were dependent upon the hormone regimen administered. Overall, the combination hormone treatments had the most consistently favorable profile for the domains evaluated in rats that had undergone experimentally induced transitional menopause and remained ovary-intact. The collective results underscore the importance of investigating variations in hormone therapy formulation as well as the menopause background upon which these formulations are delivered.
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Affiliation(s)
- Stephanie V. Koebele
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Ryoko Hiroi
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Zachary M. T. Plumley
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Ryan Melikian
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Alesia V. Prakapenka
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Shruti Patel
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Catherine Carson
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Destiney Kirby
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Sarah E. Mennenga
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | | | | | - Heather A. Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
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Koebele SV, Quihuis AM, Lavery CN, Plumley ZMT, Castaneda AJ, Bimonte-Nelson HA. Oestrogen treatment modulates the impact of cognitive experience and task complexity on memory in middle-aged surgically menopausal rats. J Neuroendocrinol 2021; 33:e13002. [PMID: 34378820 PMCID: PMC9124643 DOI: 10.1111/jne.13002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Menopause has been linked to changes in memory. Oestrogen-containing hormone therapy is prescribed to treat menopause-related symptoms and can ameliorate memory changes, although the parameters impacting oestrogen-related memory efficacy are unclear. Cognitive experience and practice have been shown to be neuroprotective and to improve learning and memory during ageing, with the type of task playing a role in subsequent cognitive outcomes. Whether task complexity matters, and whether these outcomes interact with menopause and oestrogen status, remains unknown. To investigate this, we used a rat model of surgical menopause to systematically assess whether maze task complexity, as well as order of task presentation, impacts spatial learning and memory during middle age when rats received vehicle, low-17β-oestradiol (E2 ) or high-E2 treatment. The direction, and even presence, of the effects of prior maze experience differed depending on the E2 dose. Surgical menopause without E2 treatment yielded the least benefit, as prior maze experience did not have a substantial effect on subsequent task performance for vehicle treated rats regardless of task demand level during the first exposure to maze experience or final testing. High-dose E2 yielded a variable benefit, and low-dose E2 produced the greatest benefit. Specifically, low-dose E2 broadly enhanced learning and memory in surgically menopausal rats that had prior experience on another task, regardless of the complexity level of this prior experience. These results demonstrate that E2 dose influences the impact of prior cognitive experience on learning and memory during ageing, and highlights the importance of prior cognitive experience in subsequent learning and memory outcomes.
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Affiliation(s)
- Stephanie V. Koebele
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Alicia M. Quihuis
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Courtney N. Lavery
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Zachary M. T. Plumley
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Arthur J. Castaneda
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
| | - Heather A. Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ, USA
- Arizona Alzheimer’s Consortium, Phoenix, AZ, USA
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Aririguzo C, Spencer BS, Freysteinson W. "You're acting womanish!" A qualitative descriptive study of the experiences of African American women in menopausal transition. J Women Aging 2021; 34:258-275. [PMID: 34024266 DOI: 10.1080/08952841.2021.1915095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study explores how African American women understand and experience menopausal transition. Data were collected from 14 women in individual interviews and a focus group of seven participants. Transcripts were analyzed using content analysis. Black Feminist Thought and Womanist Thought were the frameworks used to understand the experiences of participants. Key themes emerged including silence as a form of survival, resilience amidst the chaos, socialization for self-preservation and empowerment, and reshaping and reclaiming womanhood. African American women need to be approached from a culturally sensitive care model to address their care during this phase and to optimize health outcomes.
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Affiliation(s)
- Corletta Aririguzo
- College of Nursing and Health Sciences, Texas A&M University Corpus Christi, Corpus Christi, Texas, USA
| | - Becky S Spencer
- College of Nursing and Health Sciences, Texas Woman's University, Denton, Texas, USA
| | - Wyona Freysteinson
- College of Nursing and Health Sciences, Texas Woman's University, Houston, Texas, USA
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Koebele SV, Nishimura KJ, Bimonte-Nelson HA, Kemmou S, Ortiz JB, Judd JM, Conrad CD. A long-term cyclic plus tonic regimen of 17β-estradiol improves the ability to handle a high spatial working memory load in ovariectomized middle-aged female rats. Horm Behav 2020; 118:104656. [PMID: 31862208 PMCID: PMC7286486 DOI: 10.1016/j.yhbeh.2019.104656] [Citation(s) in RCA: 8] [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] [Received: 07/26/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 01/30/2023]
Abstract
The influence of estrogens on modifying cognition has been extensively studied, revealing that a wide array of factors can significantly impact cognition, including, but not limited to, subject age, estrogen exposure duration, administration mode, estrogen formulation, stress history, and progestogen presence. Less known is whether long-term, extended exposure to estrogens would benefit or otherwise impact cognition. The present study examined the effects of 17β-estradiol (E2) exposure for seven months, beginning in late adulthood and continuing into middle age, using a regimen of cyclic exposure (bi-monthly subcutaneous injection of 10 μg E2), or Cyclic+Tonic exposure (bi-monthly subcutaneous injection of 10 μg E2 + Silastic capsules of E2) in ovariectomized female Fischer-344-CDF rats. Subjects were tested on a battery of learning and memory tasks. All groups learned the water radial-arm maze (WRAM) and Morris water maze tasks in a similar fashion, regardless of hormone treatment regimen. In the asymptotic phase of the WRAM, rats administered a Cyclic+Tonic E2 regimen showed enhanced performance when working memory was taxed compared to Vehicle and Cyclic E2 groups. Assessment of spatial memory on object placement and object recognition was not possible due to insufficient exploration of objects; however, the Cyclic+Tonic group showed increased total time spent exploring all objects compared to Vehicle-treated animals. Overall, these data demonstrate that long-term Cyclic+Tonic E2 exposure can result in some long-term cognitive benefits, at least in the spatial working memory domain, in a surgically menopausal rat model.
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Affiliation(s)
- Stephanie V Koebele
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America; Arizona Alzheimer's Consortium, Phoenix, AZ, United States of America
| | - Kenji J Nishimura
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America
| | - Heather A Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America; Arizona Alzheimer's Consortium, Phoenix, AZ, United States of America
| | - Salma Kemmou
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America
| | - J Bryce Ortiz
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America
| | - Jessica M Judd
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America
| | - Cheryl D Conrad
- Department of Psychology, Arizona State University, Tempe, AZ 85287, United States of America.
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