7/12/13
by Charles Bankhead
Staff Writer, MedPage Today
Action Points
Certain aspects of cognitive function related to memory declined significantly in women during the transition from pre- to postmenopausal status, a comprehensive neuropsychiatric assessment showed.
Specifically, the ability to remember word lists declined significantly on tests of immediate and delayed recall (P=0.03 for both outcomes). The decline was greatest during the early stages of transition to menopausal status.
Race significantly influenced performance on all but one of the tasks, as African-American women consistently had lower scores, even though the association between menopausal status and recall was similar in African-American and Caucasian women, as reported online in the Journal of Clinical Endocrinology and Metabolism.
“These data confirm that the natural transition to menopause exerts a negative impact on immediate and delayed verbal recall,” C. Neill Epperson, MD, of the University of Pennsylvania in Philadelphia, and co-authors concluded. “Whether this decline can be generalized to other types of verbal memory and whether it stabilizes in the early years of the postmenopausal period is not yet known.”
“The differences in cognitive performance between African-American and Caucasian women were not explained by factors examined in this study, but are of important public health concern that warrants further investigation,” they added.
Many women have reported a subjective decline in memory during menopause. Whether the decline can be confirmed by objective measures, remains controversial.
Estradiol affects brain chemistry and function, suggesting decreased ovarian hormone production as a potential contributor to worsening memory, irrespective of aging, the authors noted in their introduction.
Accumulating evidence suggests that hormone replacement therapy (HRT) begun early in menopause may attenuate the risks and accentuate the potential benefits of estrogen-responsive tissues. A “window of opportunity” for HRT’s cognitive benefits has received support from several studies. On the other hand, a meta-analysis highlighted limitations of published studies to address the issues adequately, they added.
To generate objective data for consideration, Epperson and colleagues retrospectively examined cognitive, endocrine, and behavioral data for participants in the 14-year Penn Ovarian Aging Study (POAS). They limited their focus to verbal memory and psychomotor processing.
Data came from six assessment periods about 8 months apart through year five, then annually thereafter. The analysis comprised 403 women who completed at least two POAS assessments.
Cognitive components included the Buschke Selective Reminding Test (BSRT), which evaluates immediate and delayed recall of a list of words; Digit Symbol Substitution Test (DSST), a 100-item task that involves matching symbols with corresponding numbers; and Symbol Copy Task (SCT), which requires participants to complete as much of a 100-item task as possible within 90 seconds.
A battery of behavioral tests assessed levels of depression, anxiety, and stress.
The participants provided blood samples for hormonal evaluations on two occasions during each assessment, during menstruation for premenopausal women and at least 1 month apart for women who were no longer menstruating.
At each assessment, the women were assigned to one of five menopausal categories on the basis of bleeding status: premenopausal (normal menstrual cycles); late premenopause (change in cycle length of 7 days or more in either direction); early transition (change in cycle length of ≥7 days for at least two cycles or amenorrhea for 60 days); late transition (amenorrhea for 3 to 11 months); postmenopausal (≥12 months of amenorrhea).
On average, the 403 women in the analysis participated in 10 assessments. In models adjusted for age and race, both immediate and delayed recall deteriorated from premenopause to postmenopause. Decline in early recall was greatest during the transition period (P<0.002).
Race significantly affected performance (P<0.0001) for all tasks except delayed verbal recall (P=0.06).
In unadjusted analyses, higher levels of dihydroepiandrosterone sulfate (DHEAS) and lower levels of follicle stimulating hormone and luteinizing hormone were associated with measures of cognitive function across time (P<0.01).
Higher levels of estradiol and inhibin B were associated with better performance on all measures (P<0.01) except DSST and SCT.
After adjustment for age, race, education, body mass index, and baseline performance, only the relationship between DHEAS and DSST remained significant (P=0.01).
Race had a significant, independent association with immediate verbal recall and DSST after adjustment for menopause stage, age, education, baseline performance, and BMI.
“There was no race by menopause stage interaction, suggesting that menopausal stage did not differentially impact cognitive performance in African-American and Caucasian women,” the authors noted.
The study was supported by the National Institute on Aging, National Institute of Mental Health, and the Office of Research on Women’s Health.
Epperson disclosed relationships with Shire and Novartis. One or more co-authors disclosed relationships with Forest Laboratories, Bionovo, Xanodyne Pharmaceuticals, and Swiss Precision Diagnostics.
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