Association of Bilateral Salpingo-Oophorectomy Before Menopause Onset With Medial Temporal Lobe Neurodegeneration

Abstract

Key Points Question Do women who underwent bilateral salpingo-oophorectomy before menopause show greater medial temporal lobe structural changes, β-amyloid accumulation, and white matter lesion load on neuroimaging later in life compared with a control group? Findings In this case-control study, women with bilateral salpingo-oophorectomy before menopause had smaller amygdala volumes, thinner parahippocampal-entorhinal cortices, and lower entorhinal white matter fractional anisotropy values compared with control participants. Meaning Abrupt hormonal changes associated with bilateral salpingo-oophorectomy in premenopausal women may lead to medial temporal lobe structural abnormalities later in life; because alterations in structural imaging biomarkers of the medial temporal lobe neurodegeneration may precede clinical symptoms of dementia, longitudinal follow-up of this cohort with cognitive testing is necessary.

Risk factors of neurovascular ageing in women

“…This risk remained increased after adjustments for education and indication for the oophorectomy . This fundamental observation has been confirmed by several subsequent studies of other cohorts …”

“…The 18 chronic conditions that were significantly increased following bilateral oophorectomy included depression, thus suggesting the impact of the abrupt loss of ovarian hormones on neuronal function . Consistent with these clinical findings, women who had bilateral oophorectomy ≤45 years of age had neurodegenerative changes in the medial temporal lobe, with smaller amygdala volumes, thinner para‐hippocampal‐entorhinal cortices and lower white matter fractional anisotropy values in the entorhinal cortex compared to referent women . These changes may place these women at risk for future cognitive impairment.…”

Functional reorganization of brain networks across the human menstrual cycle

“…Future multimodal neuroimaging studies in humans can 351 clarify the link between estradiol's ability to stimulate dopamine release and the 352 hormone's ability to drive cortical efficiency within PFC circuits.353 Dense-sampling approaches to probe brain-hormone interactions could reveal 354 organizational principles of the functional connectome previously unknown, transforming 355 our understanding of how hormones influence brain states. Human studies implicate sex 356 steroids in the regulation of brain structure and function, particularly within ER-rich 357 25regions like the PFC and hippocampus 11,12,15,16,30,31,[50][51][52] , and yet, the neuroendocrine basis 358 of the brain's network organization remains understudied. Here, we used a network 359 neuroscience approach to investigate how hormonal dynamics modulate the integration of 360 functional brain networks, showing that estradiol is associated with increased coherence 361 across broad swaths of cortex.…”

“…regions like the PFC and hippocampus 11,12,15,16,30,31,[50][51][52] , and yet, the neuroendocrine basis 358 of the brain's network organization remains understudied. Here, we used a network 359 neuroscience approach to investigate how hormonal dynamics modulate the integration of 360 functional brain networks, showing that estradiol is associated with increased coherence 361 across broad swaths of cortex.…”

The Effect of Prophylactic Adnexectomy on the Quality of Life and Psychosocial Functioning of Women with the BRCA1/BRCA2 Mutations

“…Moreover, these women are at a higher risk of developing Alzheimer's disease [46]. The long-term effects of RRSO on cognitive function and the nervous system are not known, but Zeydan et al (2018) suggest that a sudden change in hormonal status associated with adnexectomy in premenopausal women can lead to abnormalities in the structure of the temporal lobe and, consequently, to cognitive disorders later in life [47].…”