Menopause, cognition and dementia – A review

Abstract

There is increasing evidence that menopausal changes can have an impact on women’s cognition and potentially, the future development of dementia. In particular, the role of reduced levels of estrogen in postmenopausal changes has been linked to an increased risk of developing dementia in observational studies. Not surprisingly, this has led to several clinical trials investigating whether postmenopausal hormone replacement therapy can potentially delay/avoid cognitive changes and subsequently, the onset of dementia. However, the evidence of these trials has been mixed, with some showing positive effects while others show no or even negative effects. In the current review, we investigate this controversy further by reviewing the existing studies and trials in cognition and dementia. Based on the current evidence, we conclude that previous approaches may have used a mixture of women with different genetic risk factors for dementia which might explain these contradicting findings. Therefore, it is recommended that future interventional studies take a more personalised approach towards hormone replacement therapy use in postmenopausal women, by taking into account the women’s genetic status for dementia risk.

Inflammatory Potential of Diet Is Associated with Biomarkers Levels of Inflammation and Cognitive Function among Postmenopausal Women

“…Systemic inflammation can lead to cognitive decline and dementia by leading the proinflammatory environment in the central nervous system to induce reactive, proinflammatory microglia and astrocytic phenotypes, leading to tau hyperphosphorylation, β-amyloid oligomerization, complement activation, and the breakdown of neurotransmitters into potentially harmful bioactive metabolites [ 3 ]. Depletion of estrogen due to menopausal transition is also associated with a decline in cognitive health in women [ 4 , 5 ]. This happens since estrogen benefits hippocampal and prefrontal cortical function, potentially enhancing verbal memory and executive function [ 6 ].…”

A Cross-Sectional Comparison of Arterial Stiffness and Cognitive Performances in Physically Active Late Pre- and Early Post-Menopausal Females

“…Indeed, central arterial stiffness is associated with reduced cerebral blood flow and consequently hypoperfusion of the brain [ 4 ] and is considered as an independent predictor of cognitive decline and cerebrovascular diseases [ 5 , 6 ]. In middle-aged females, several data suggest that menopause could be a critical period in the natural progression of cognitive decline and potentially in future vascular and/or degenerative dementias such as Alzheimer’s disease [ 7 ]. First, the drop of estrogen levels during menopause has been hypothesized to contribute to increased blood pressure and arterial stiffness [ 8 ], which exposes post-menopausal females to a higher risk of cardiovascular diseases and cognitive decline than their male counterparts [ 9 , 10 ].…”

A review of the impact of hormone therapy on prefrontal structure and function at menopause

“…Meanwhile, there is also increasing evidence that the menopause transition can have an impact on women's cognitive functioning [2,8]. In spite of the controversial nature of the available findings, accumulating evidence suggests that the menopause transition is associated with increased vulnerability to cognitive dysfunction that is consistently manifested by decreased performance on verbal fluency and verbal memory tests [9][10][11]. These issues may pose a major challenge for the health-care system worldwide that aims to provide effective care for women experiencing menopause symptoms and cognitive health, thus resulting in an increasing financial burden on global economies.…”