Is it menopause or is it aging? Dr. Weinblatt explores the changes
in memory that occur with age. He gives an excellent description of what
is normal, what isn't and some simple things to do to improve and
preserve memory. — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
In the not too distant past we knew certain facts regarding menopause,
hormonal replacement therapy and aging as they related to memory.
Everyone knew that menopause makes women forgetful. Everyone knew that
hormonal replacement therapy helped these forgetful postmenopausal
women. Everyone knew that the actress Rita Hayworth suffered from a rare
disease when she developed the symptoms of Alzheimer’s disease at age
54. Everyone knew that it was perfectly normal to lose memory as we got
older. We were wrong!
Menopause and Memory
It is a commonly held notion that women become scatterbrained and
forgetful along with the other symptoms of menopause. This perception
arose from cross-sectional scientific studies in which women
self-reported increased forgetfulness in the transition to menopause.
However, two recent scientific studies examined memory function
longitudinally over time. One study reported from Chicago in 2003 found
that perceptual speed and working memory (manipulating two or more
pieces of data simultaneously) actually improved slightly over time! How
then do we explain the perception of memory loss in menopause? Other
factors such as anxiety, depression, work and marital stress,
distraction and an overload of things to remember likely contribute to
what has been popularly called menopause minutes.
Hormones and Memory
Menopause involves the loss of the hormone estrogen. There are abundant
estrogen receptors within the brain. When estrogen acts in the brain it
can lead to production of nerve growth factors as well as enzymes that
facilitate the transmission of nerve signals. It would therefore seem
intuitive that estrogen replacement would improve memory function and
protect against developing dementia. However, this was not what the
Women’s Health Initiative Memory Study (WHIMS) found. WHIMS is an arm of
the larger Women’s Health Initiative (WHI) study that was started in
1992 to study the effects of estrogen and estrogen-progesterone
combination therapy in protecting postmenopausal women from heart
disease, breast and colorectal cancer and osteoporosis. The scientists
of the WHI study stopped the combination therapy in July 2002 because
women taking estrogen and progesterone had higher risks of heart
attacks, breast cancer, strokes and blood clots (although lower risks of
colorectal cancer and fewer fractures).
In May 2003 the scientists taking part in WHIMS reported that women over
age 65 taking combination estrogen-progesterone were twice as likely to
have symptoms of dementia compared to those women not taking hormones.
The study also found that combination therapy did not protect against
the development of mild cognitive impairment (MCI), a less severe form
of memory loss. In February 2004 the women participating in WHI who were
taking estrogen alone were instructed to stop estrogen due to an
increase in stroke risk and no benefit for heart disease. Most recently
a similar but slightly weaker trend toward an increased risk of dementia
was found in the group of women taking estrogen alone. In the light of
these studies, if you are taking hormone replacement therapy you should
contact your prescribing physician to discuss the reasons that you have
been prescribed menopausal hormones and your individual risk profile.
Mild Cognitive Impairment (MCI) Versus Alzheimer’s Disease (AD)
Mild forgetfulness and slower mental processing may be a normal part of
aging. Older individuals may need more time to learn a new fact or
remember an old one. It may be perfectly normal to forget where you put
your car keys; it is distinctly abnormal to forget what to do with them!
Scientists are becoming increasingly interested in MCI. MCI is
characterized by marked forgetfulness but no other manifestations of
dementia. Scientists initially felt that MCI was benign and did not
progress to Alzheimer’s disease (AD). More recently, however, we believe
that MCI is a very strong risk factor for AD, with 10% of MCI patients
converting over to AD each year. We currently have medications that
improve memory, behavior and functioning for AD patients. Since
scientists believe that the pathological changes of AD begin 20 years
prior to the onset of symptoms, it would be ideal to have some marker
that would predict which individuals with MCI are destined to evolve
into AD. This would allow physicians to decided which patients would
possibly benefit from early intervention with medication.
The two strongest risk factors for AD have been age and a positive
family history in a first-degree relative. Now scientists have reported
the predictive value of testing smell in patients with MCI. The study
reported in December 2004 found that MCI patients who failed to identify
10 particular odors (lilac, lemons, leather, pineapple, strawberry,
smoke, soap, menthol, clove and natural gas) were more likely to develop
Alzheimer’s disease than people who could smell them. Additional studies
are needed to confirm these important observations.
Recently one of the medications used to treat AD was found to
delay but not prevent the progression from MCI to AD. As noted earlier,
the WHIMS study found no evidence that estrogen with or without
progesterone was of any benefit in MCI but did suggest that estrogen
increased the risk of AD. Since estrogen and estrogen-progesterone in
combination have been shown to increase the risk of stroke in menopausal
women it follows that they would also increase the risk of vascular
dementia due to one or more strokes. We can control some of our risk
factors but not others (such as age and family history).
What else can be done to help memory?
Write things down; keep lists
Put frequently used items in the same place each time
Repeat important information over again and again
Place objects in spots that trigger memory
Review photo albums when you expect to see people after a long
Stay active physically and mentally
What are the possible warning symptoms of Alzheimer’s disease?
Memory loss that affects job skills
Difficulty performing familiar tasks
Disorientation to time and to place
Problems with abstract thought
Misplacing things repeatedly
Changes in mood, behavior or personality
Lack of initiative
If you or a family member is concerned about your memory or thinking in
general, make an appointment to see your doctor and take someone with
you to help provide information that you may not remember. While only
some forms of memory loss can be cured, many are treatable.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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