Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women
- 21 January 2014
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 82 (3), 222-229
- https://doi.org/10.1212/wnl.0000000000000033
Abstract
Objective: To determine the association between age at surgical menopause and both cognitive decline and Alzheimer disease (AD) pathology in 2 longitudinal cohorts. Methods: Female subjects from 2 longitudinal studies of cognitive decline (Religious Orders Study and Rush Memory and Aging Project) were included (total n = 1,884). The primary analysis examined the association between age at surgical menopause and decline in a global cognition score. Secondary analyses examined additional outcomes: 1) decline in 5 cognitive subdomains and 2) a global measure of the burden of AD pathology. In exploratory analyses, we examined the effect of hormone replacement therapy (HRT). We adjusted all models for age, education, smoking, and cohort and stratified by surgical vs natural menopause. Results: For the 32% of subjects with surgical menopause, earlier age at menopause was associated with faster decline in global cognition (p = 0.0007), specifically episodic memory (p = 0.0003) and semantic memory (p = 0.002). Earlier age at menopause was also associated with increased AD neuropathology (p = 0.038), in particular neuritic plaques (p = 0.013). HRT use for at least 10 years, when administered within a 5-year perimenopausal window, was associated with decreased decline in global cognition. No associations were seen in women who had natural menopause. Conclusions: Early age at surgical menopause was associated with cognitive decline and AD neuropathology. Ongoing studies should clarify the potential effect of HRT on this relationship.Keywords
This publication has 42 references indexed in Scilit:
- Neuroprotection mediated through estrogen receptor-α in astrocytesProceedings of the National Academy of Sciences of the United States of America, 2011
- Oophorectomy, menopause, estrogen treatment, and cognitive aging: Clinical evidence for a window of opportunityBrain Research, 2011
- Cognitive Functioning in Elderly Women Who Underwent Unilateral Oophorectomy Before MenopauseInternational Journal of Neuroscience, 2011
- Endogenous and Exogenous Estrogen, Cognitive Function, and Dementia in Postmenopausal Women: Evidence from Epidemiologic Studies and Clinical TrialsSeminars in Reproductive Medicine, 2009
- Chronic distress and incidence of mild cognitive impairmentNeurology, 2007
- Alzheimer's disease and other neurological disordersClimacteric, 2007
- The Rush Memory and Aging Project: Study Design and Baseline Characteristics of the Study CohortNeuroepidemiology, 2005
- The Women's Health Initiative Memory Study: findings and implications for treatmentThe Lancet Neurology, 2005
- Individual differences in rates of change in cognitive abilities of older persons.Psychology and Aging, 2002
- Clinical diagnosis of Alzheimer's diseaseNeurology, 1984