MDNews - Greater Boston

"Our understanding of what happens across the menopause transition is evolving, and we're just beginning to understand what happens with cognition." — Miriam Weber, Ph.D., assistant professor of neurology at the University of Rochester Medical Center Dr. Dumas, who presented her study at the Society for Neuroscience annual meeting in November 2011, examined 22 postmenopausal women, each of whom completed questionnaires about cognitive complaints and underwent magnetic resonance imaging while completing a test of working memory. Dr. Dumas found that women who reported cognitive difficulties after menopause used more areas of the brain to perform a working memory test compared with those who didn't cite cognitive challenges. While previous studies have shown older adults utilize more brain regions than younger adults, the research found that women with cognitive dysfunction have brains that function like those of older people and may be at greater risk for dementia. Dr. Dumas says administration of estrogen after menopause is associated with better cognitive functioning and, looking long term, a lower risk of Alzheimer's disease. "I think estrogen keeps your brain functioning young," Dr. Dumas says. "Studies show if you start postmenopausal hormone therapy within three years of menopause, you have protection against dementia about 15 years later." That is not to say postmenopausal women should be on estrogen therapy, Dr. Dumas says. She says the one therapy that appears to help menopausal women with cognitive complaints is exercise. Dr. Dumas feels it's important to validate postmenopausal women's frustrations. "I think the subjective complaints of women after menopause are important," she says. "There's a tendency to say there's no medical thing you can measure. 'Your memory's not as good? That's just aging.' I think what women are experiencing is real." pursuing Further Study Other studies have shown similar results. The largest, the Study of Women's Health Across the Nation (SWAN), a longitudina l study designed to examine the health of women during their middle years, found that perimenopause was associated with a decline in cognitive performance, but cognition returned to premenopausal levels in postmenopause. Furthermore, in a Rush University Medical Center study presented at the American Academy of Neurology's annual meeting in March 2013, it was reported that women who underwent surgical menopause — the removal of both ovaries before natural menopause — at an earlier age may have an increased risk of cognitive decline. Dr. Weber says ongoing studies and clinical trials are looking at early initiation of hormone therapy and its effects on cognition. Like Dr. Dumas, she says exercise may be helpful. Because her sample was limited to predominantly white, well-educated women, Dr. Weber says she w ill conduct further research to see if her findings stand up to a larger, more diverse sample. She'll also study causes and risk factors of menopause-related cognitive decline. D r. D u m a s w i l l cont i nue her studies by look ing at t he cog nitive effects of menopause on the dopaminergic system. For now, Dr. Weber says, there's no need for alarm. "It's important to stress that there is something to women's complaints, but at the same time make sure the point is understood that these are subtle declines we're seeing," Dr. Weber concludes. "It's not as if women are all of a sudden performing in an impaired range. They may just be reporting that they're struggling a little bit more to perform at the same level they're used to." How do you medically address your patients' concerns regarding cognitive deficit during and after menopause? Let us know on Twitter using the hashtag #thechangeMDN. ■ MdneWS.coM ■ MD News Greater Boston | 15

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