The role of menopause in cognitive disorders and Alzheimer’s disease

Background. This article explores the under-investigated topic of how declining levels of female sex hormones affect brain aging, the onset of cognitive impairment, and the development of dementia and Alzheimer’s disease. Although menopause is still widely associated in public discourse with hot flashes and violation of psychoemotional state, cognitive complaints have become a common reason for middle-aged women to seek care from family physicians, neurologists, psychiatrists, and gynecologists. Purpose – To draw the attention of doctors of various specialties to timely provide scientifically based recommendations on improving cognitive functions in women during the menopausal transition to postmenopause. To encourage the scientific and medical community to provide recommendations on modifiable risk factors for cognitive decline such as obesity, diabetes mellitus, smoking, hypercholesterolemia and hypertension. To focus the attention of gynecologists on the possible prescribe of hormone replacement therapy after the onset of surgical menopause to reduce the risk of Alzheimer’s disease and Parkinson’s disease in women. Materials and Methods. Based on a review of current data on the topic of our study, original articles, meta-analyses, and literature sources were analyzed. We used neuroendocrinological, biochemical, and neuroimaging studies. Results. During the menopausal transition, approximately half of women report difficulties with memory and attention. Studies have demonstrated that verbal memory and learning decline during the transition from premenopause to perimenopause, independent of age and other potential confounding variables. Other studies examining the relationship between follicle-stimulating hormone (FSH) levels and cognitive function have found that psychomotor speed, working memory, task switching, and visual memory performance improve in the postmenopausal phase compared to early or late perimenopause, while verbal fluency remains unchanged. Neuroimaging-confirmed atrophic changes in the brains of women undergoing natural or surgical menopause have prompted clinicians to consider hormone replacement therapy (HRT) and cognitive screening. Women who experience surgical menopause exhibit more pronounced atrophy of the amygdala and hippocampus compared to those with physiological menopause – changes that may serve as biological markers. Postmenopausal women account for more than 60% of all Alzheimer’s disease (AD) cases worldwide. Emerging evidence highlights a synergistic effect between the APOE4 genotype and female sex, which together significantly increase the risk of developing AD. Conclusions. Menopause, as a marker of the end of the reproductive period in a woman’s life, is not limited to vasomotor symptoms and mood changes. It is also accompanied by cognitive difficulties, which are associated with fluctuations in estradiol hormone levels. Surgical menopause is also linked to an increased risk of Alzheimer’s disease, depression, and Parkinson’s disease. Neuroimaging studies demonstrate that women who have undergone surgical menopause exhibit structurally distinct brain changes compared to those experiencing natural menopause, notably atrophy of the amygdala and hippocampus.