Cognitive changes and dementia

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Midlife women commonly experience changes in their cognitive function as they transition through menopause, and express concern about whether these changes represent the initial stages of a more serious cognitive disorder.1

A white paper commissioned by the International Menopause Society1 provides menopause practitioners with a framework for decision making and counselling on cognition in menopause, including:

  • specific cognitive changes occurring in menopause
  • the role of estrogen and menopause symptoms
  • guidance for clinical counselling.

Midlife is an ideal time to provide education and support on general modifiable risk factors for dementia and optimising cognitive health.1

Menopause brain fog

“Menopause brain fog” is defined as the constellation of cognitive symptoms (most frequently related to memory and attention) experienced by women around menopause.1 Research studies validate patients’ cognitive complaints and while these changes at menopause are troublesome, they generally do not indicate dementia.1

Cognitive difficulties at midlife are linked to changes in the hormone estradiol (E2), vasomotor symptoms, sleep and mood. Treating these symptoms may benefit cognition.1

Dementia risk with premature and early menopause

Some large-scale studies have found premature (before the age of 40) or early (between ages 40-44) menopause to be associated with an increased risk of dementia.2,3 Similarly, surgical menopause induced by bilateral oophorectomy before the age of 45 is linked to an increased risk of dementia and cognitive decline.4,5 Women who experience early or premature menopause may need close monitoring of cognitive decline.1

Menopause hormone therapy and dementia

There is some concern in the community that menopause hormone therapy (MHT) can increase the risk of dementia.1 This risk is currently unknown,6 however there is an opportunity for all patients to address the known modifiable risk factors for dementia.

Modifiable risk factors for dementia

All patients who are concerned about dementia risk later in life would benefit from education and support to address certain health issues, which can help to postpone or prevent the onset of dementia.1 These include obesity, hypertension, diabetes, lack of physical activity, smoking, alcohol use, social interaction, hearing impairment and depression.1

A multipronged approach to lowering dementia risk is recommended, as dementia risk has been found to increase by 20% with one risk factor, 65% with two factors and 200% with three risk factors.7

Clinician resources

Menopause - assessment of dementia risk (PDF 186.7 KB)
Evidence brief summarising considerations and evidence for the assessment of dementia risk in menopause.
Source: Agency for Clinical Innovation

References

  1. Maki PM, Jaff NG. Brain fog in menopause: a health-care professional's guide for decision-making and counseling on cognition. Climacteric. 2022;25(6):570-578. DOI: 10.1080/13697137.2022.2122792
  2. Hao W, Fu C, Zhu D. Abstract EP67: Early menopause is linked to increased risk of presenile dementia before age 65 years. Circulation. 2022;145(Suppl_1):AEP67-AEP. DOI: 10.1161/circ.145.suppl_1.EP67
  3. Coughlan GT, Betthauser TJ, Boyle R, et al. Association of Age at Menopause and Hormone Therapy Use With Tau and β-Amyloid Positron Emission Tomography. JAMA Neurology. 2023. DOI: 10.1001/jamaneurol.2023.0455
  4. Georgakis MK, Beskou-Kontou T, Theodoridis I, et al. Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis. Psychoneuroendocrinology. 2019;106:9-19. DOI: 10.1016/j.psyneuen.2019.03.013
  5. Uldbjerg CS, Wilson LF, Koch T, et al. Oophorectomy and rate of dementia: a prospective cohort study. Menopause. 2022;29(5):514-522. DOI: 10.1097/GME.0000000000001943
  6. National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management. United Kingdom: NICE; 2019 [cited Nov 2022].
  7. Peters R, Booth A, Rockwood K, et al. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ Open. 2019;9(1):e022846. DOI: 10.1136/bmjopen-2018-022846
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