Issue: April 2021
Perspective from Kejal Kantarci, MD, MS
Disclosures: Maki reports she has received consulting honoraria from AbbVie, Balchem and Pfizer. Another study author reports she has received funding from Gilead, Merck and Viiv.
January 14, 2021
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Cognitive impairment may worsen with menopause stage

Issue: April 2021
Perspective from Kejal Kantarci, MD, MS
Disclosures: Maki reports she has received consulting honoraria from AbbVie, Balchem and Pfizer. Another study author reports she has received funding from Gilead, Merck and Viiv.
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A cohort of women with and without HIV experienced declines in three cognitive domains associated with menopause stage, independent of age and other factors, according to findings published in Menopause.

“On average, women show a measurable decline in learning, memory and attention/working memory as they transition from premenopause to postmenopause,” Pauline Maki, PhD, senior director of research at the Center for Research on Women and Gender and professor of psychiatry and psychology at the University of Illinois at Chicago, told Healio. “For 4% to 13% of women, the minority of women, the menopause-related decline in cognitive performance reaches the level of impairment. This reveals the considerable individual differences in the menopause experience.”

Maki is the senior director of research at the Center for Research on Women and Gender and a professor of psychiatry and psychology at the University of Illinois at Chicago.

Studies such as the Study of Women’s Health Across the Nation (SWAN) and the Penn Ovarian Aging Study (POAS) have also shown changes in learning and memory across the menopause transition; however, this study, which has greater socioeconomic diversity, suggests that working memory and attention are also affected, Maki said.

“These findings were in a sample comprised primarily of low-income women of color, two-thirds of whom had HIV,” Maki said. “HIV did not play a role here — HIV-seropositive women had the same magnitude of change as seronegative women.”

More diverse cohort

Maki and colleagues analyzed data from 443 women participating in the Women’s Interagency HIV Study (WIHS), a longitudinal cohort study of the natural and treated history of women with and without HIV (median age, 42 years; 69% Black; 18% Hispanic). Within the cohort, 291 women had HIV. Women completed tests of verbal learning and memory/attention, processing speed, verbal fluency, motor skills and executive function at an index premenopausal visit and then once every 2 years for up to six visits (mean follow-up, 5.7 years). Menopause stage was assessed during an in-person interview and classified according to definitions used in the SWAN study. Researchers used linear mixed-effects regression models to estimate associations between menopause stages and cognition.

Researchers found that the overall cohort and women with HIV showed longitudinal declines in continuous measures of learning, memory and attention/working memory domains from premenopause through early perimenopause (P < .05 to P < .001) and from premenopause to postmenopause (P < .01 to P < .001).

“Together, these data indicate overall declines in learning are sustained through the entire transition, whereas declines in memory and attention/working memory were limited in the transition from pre- to the early perimenopause and postmenopause,” the researchers wrote.

Declines similar with, without HIV

In analyses restricted to women with HIV, researchers observed similar declines in learning and memory (P < .001) and “significant but milder” declines in attention/working memory (P < .05) in the transition from pre- to early perimenopause.

Effects on those same domains were also evident in categorical scores of cognitive impairment with the increased odds of impairment ranging from 41% to 215% (P < .05 to P < .001). The increase in predicted probability of impairment by menopausal stage (% affected) ranged from 4% to 13%.

In analyses assessing cognitive impairment scores and adjusted for age and HIV status, researchers found that from pre- to early perimenopause, odds of impairment in learning, memory and attention/working memory increased by 60%, 71% and 41%, respectively (P < .05 for all). From pre- to postmenopause, odds of impairment in memory and attention each increased 76% (P < .05).

“Women are often aware of these symptoms and worry that they might be developing Alzheimer’s disease, a condition that is more common in women than men,” Maki said. “This study links memory problems in midlife women to ovarian aging rather than to a dementing process. Clinicians can help women by validating and normalizing this experience and by guiding them to evidence-based approaches to optimizing brain health. Those include exercise, Mediterranean diet, sleep hygiene and engagement in novel cognitive activities.”

Maki said she and colleagues are examining the extent to which these cognitive changes are associated with hormonal factors and menopausal symptoms like sleep and mood.

“We need to know what predicts who will develop cognitive impairment as distinct from more subtle cognitive changes, and we are following these women prospectively so that we can determine cognitive performance as women enter the later postmenopause stages,” Maki said.

For more information:

Pauline Maki, PhD, can be reached at pmaki1@uic.edu.