A longitudinal study of cognition change during early menopausal transition in a rural community

Tzu Chi University, Hua-lien, Taiwan, Taiwan
Maturitas (Impact Factor: 2.94). 04/2006; 53(4):447-53. DOI: 10.1016/j.maturitas.2005.07.009
Source: PubMed


To characterize changes in cognition that occur during the hormonal transitions of menopause.
We conducted a longitudinal population-based study in Kinmen, Taiwan, recruiting all women age 40-54 years who were premenopausal and without a history of hormone replacement therapy (HRT) or hysterectomy. The cognitive measures used to assess function included the Auditory-Verbal Learning Test, visual memory, verbal fluency, Trail Making Test and digit span.
A total of 694 eligible women participated in the baseline study, and 573 women (83%) completed follow-up 18 months later. After excluding 78 women who received hysterectomy or HRT, the final sample was composed of 495 subjects, of whom 114 (23%) progressed to perimenopause during follow-up. Women who remained premenopausal were younger than those who became perimenopausal (44.7 +/- 2.3 years versus 47.1 +/- 3.0 years, p < 0.01). All follow-up cognitive scores in women who entered perimenopause were slightly better than baseline measures except for Rey Auditory-Verbal Learning Test, which decreased by 0.23 (S.D. = 2.9, p = 0.3). At follow-up, cognitive function except for verbal fluency did not differ significantly between women who stayed premenopausal and those became perimenopausal after controlling for age, education, and baseline cognitive scores. Women who entered perimenopause have an average of 1.3 items (S.D. = 0.4) less in verbal fluency measures as compared with their premenopausal peers at the follow-up period.
The menopausal transition might not accompany significant cognitive decline except for verbal fluency.

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Available from: Jong-Ling Fuh
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    • "Several lines of clinical evidence suggest a rationale for the use of hormone therapy to prevent or reduce age-related cognitive decline in women. First, the loss of circulating ovarian sex steroid hormones (estrogens and progestogens) at menopause has been associated with impaired memory and executive functioning (Amore et al., 2007; Elsabagh, Hartley, & File, 2007; Fuh, Wang, Lee, Lu, & Juang, 2006; Gold et al., 2000; Halbreich et al., 1995; Thilers, Macdonald, Nilsson, & Herlitz, 2010), as well as an increased risk of Alzheimer's disease (Launer et al., 1999; Sherwin, 1999; Wolf & Kirschbaum, 2002; Yaffe et al., 2000; Yaffe, Sawaya, Lieberburg, & Grady, 1998; Zandi et al., 2002). Second, the use of estrogens in observational studies of menopausal women is associated with better verbal memory, working memory, and visuospatial function (Duff & Hampson, 2000; Duka, Tasker, & McGowan, 2000; Grodstein, Chen, Pollen, & Albert, 2000; Hogervorst, Boshuisen, Riedel, Willekes, & Jolles, 1999; Kampen & Sherwin, 1994; Maki, Zonderman, & Resnick, 2001; Matthews, Cauley, Yaffe, & Zmuda, 1999; Steffens , Norton, Plassman, & Tschanz, 1999), and with a lower risk of dementia, particularly among women who initiated treatment during, or soon after, the menopause (LeBlanc, Janowsky, Chan, & Nelson, 2001; Sherwin & Henry, 2008; Yaffe et al., 1998). "
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    • "However, forgetfulness is a common symptom at other ages as well, and self-reported poor memory is often more strongly linked to low mood than to objective loss of memory per­ formance (Weber and Mapstone, 2009). Crosssectional and longitudinal findings from midlife cohorts in Australia, the United Kingdom, Taiwan, Sweden and the United States are con­ sistent in suggesting that the natural menopausal transition probably has no important effect on episodic memory or on other cognitive skills (Fuh et al., 2006; Henderson et al., 2003; Herlitz et al., 2007; Kok et al., 2006; Luetters et al., 2007). Analyses from the multi-ethnic Study of Women's Health Across the Nation (SWAN) sample suggests a mild learning deficit during the menopausal transition compared to pre­ menopause, inferred from annual trends in prac­ tice effects (Greendale et al., 2009). "
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