Before my mother’s diagnosis with Alzheimer’s disease at the age of 57, her cognitive issues were attributed to menopause by both myself and her doctors. This period was challenging as we tried to navigate and comprehend the changes in her memory and cognitive abilities. Unfortunately, her diagnosis came later than anticipated, and during her transition into menopause, she was prescribed Premarin, a commonly used hormone therapy for menopausal symptom relief.

By 2050, it is projected that 13.8 million people in the US will likely have Alzheimer’s disease, with two-thirds of them being women. The economic cost of this disease is staggering, estimated to exceed $2 trillion. Women are particularly affected, given their increasing influence in the global economy and their role as the majority of unpaid caregivers. Preserving intact memory from early midlife, during the transition to menopause, is crucial not only for women themselves but also for their families, society, and our economic well-being.

Preventing memory decline should start in early midlife. Cognitive decline is not limited to neurodegenerative diseases like Alzheimer’s; it is also a part of healthy aging and has consequences for our overall quality of life. Most studies on aging and cognitive decline, including Alzheimer’s disease, focus on individuals in their 70s. However, understanding factors that occur earlier in life and their impact on age-related brain changes is crucial for developing prevention strategies for one of the major public health challenges of our time.

The impact of menopause on women’s brains during the transition into menopause is significant. Reproductive aging occurs in early midlife, with menopause leading to a gradual depletion of ovarian hormones like estradiol, the primary form of estrogen that plays a role in brain function. Studies have shown that estradiol levels directly relate to changes in memory performance and the reorganization of brain circuitry involved in memory function. Therefore, cognitive aging is not solely a matter of chronological aging but also reproductive aging, which is particularly critical for women during early midlife. It is essential to recognize cognitive aging as a women’s health issue, as viewing brain aging from early midlife and understanding the impact of menopause on the brain can pave the way for strategies to prevent memory loss in women.

While women generally perform better than men in verbal memory tasks from post-puberty onwards, this advantage diminishes during menopause. Many women report increased forgetfulness and “brain fog” during the menopausal transition. Although all women will experience menopause at some point, the timing varies (late 40s to early 60s), as does the impact experienced by individuals.

Over the past 15 years, numerous studies have shed light on how menopause affects the brain and what can help maintain intact memory. Menopause can affect the generation and connectivity of brain cells and even lead to cell death, impacting regions crucial for memory. It also lowers glucose levels in the brain, the primary fuel for brain cells. As a result, the brain adapts to the new hormonal environment to maintain its functioning.

Women with other medical conditions like diabetes and hypertension are at an increased risk of cognitive decline. Research is focusing on understanding the shared processes between the brain and the body related to energy production (metabolism) and vascular system functions.

Hormone replacement treatment (HR) has shown positive effects on brain activity and memory function when initiated during perimenopause or early menopause. However, systematic HR trials during perimenopause have not been conducted yet. Late initiation of HR may have adverse effects on the brain and increase the risk of disorders like Alzheimer’s disease. Research is needed to determine the most effective timing, hormonal formula, dosage, route of administration, and duration of HR. Additionally, research has primarily focused on healthy women, and little is known about its impact on women with chronic diseases like diabetes and hypertension. Precision medicine is necessary to identify which women may benefit the most from HR. Alternative mechanisms may need to be identified for women who cannot undergo HR, such as targeting glucose levels and other effects associated with estradiol regulation of the brain.

To maintain brain health and intact memory, three pillars are essential: effortful physical activity, effortful cognitive activity, and social contact. Research has shown that these pillars have direct beneficial effects on the brain, even at the cellular level. Dietary habits, such as following the Mediterranean diet or consuming omega-3 fatty acids found in fish oil, have also shown positive effects on memory function. These modifiable lifestyle habits are particularly important for women with hypertension or diabetes, who are at higher risk of cognitive decline.

Adequate sleep, approximately seven hours per night, is critical for brain health. Sleep plays a key role in consolidating learning and maintaining the information we acquire during the day. It also aids in clearing the brain of amyloid, one of the potential markers of Alzheimer’s pathology. Further research is required to fully understand the benefits of these modifiable lifestyle factors, but incorporating them into our lives early on is crucial.

In conclusion, the time to focus on maintaining brain health and preventing memory decline is now. By understanding the impact of menopause on the brain and implementing lifestyle habits that support cognitive well-being, we can promote healthy aging and reduce the risk of cognitive decline. This is not only beneficial for women themselves butalso for their families, society, and our overall economic health. It is essential to recognize the significance of memory preservation and cognitive well-being in early midlife, as it sets the foundation for healthy aging and mitigates the risk of cognitive disorders like Alzheimer’s.

Sources:

1. Weber MT, Rubin LH, Maki PM. Cognition in perimenopause: the effect of transition stage. Menopause. 2013 May;20(5):511-7. PubMed PMID:23615642.
2. University of Rochester Medical Center. (2012). “‘Brain Fog’ of Menopause Confirmed.” Retrieved from https://www.urmc.rochester.edu/news/story/3436/brain-fog-of-menopause-c…
3. Alzheimer’s Association. (2015). “New Research Summary: Lifestyle Changes Help Reduce Risk Of Cognitive Decline” [Press Release]. Retrieved from http://www.alz.org/documents_custom/national_abam_press_release.pdf