Cognitive changes in menopause: with and without HIV

Women with HIV are no more vulnerable to menopause-related cognitive declines compared to other women, according to a longitudinal cohort study in the journal Menopause.

The odds of impairment in learning, memory and attention/working memory were all significantly increased during the menopause transition.

Senior author Pauline Maki, PhD, a professor of psychiatry, psychology and ob/gyn at the University of Illinois at Chicago, was inspired to undertake the study because she desired to know if low-income women of color and/or women with cognitive vulnerabilities, such as those with HIV, experience higher-than-expected cognitive difficulties during menopause.

“More generally, I wanted to understand the magnitude of cognitive declines associated with the menopause transition, and to quantify the percentage of women whose cognitive declines reach the level of cognitive impairment,” Maki told Contemporary OB/GYN®.

The study analyzed 443 women (median age 42 years) from the Women’s Interagency HIV Study, of whom 34% were women without HIV, 69% African American and 18% Hispanic.

All the women completed baseline testing of verbal learning and memory, attention/working memory, processing speed, verbal fluency, motor skills and executive function on or after Oct. 1, 2008, then had two or more follow-up office visits spaced 2 years apart (mean follow-up 5.7 years). All women were premenopausal at the baseline assessment.

“For memory, there was a two-fold increased odds of impairment during the transition from pre- to early menopause transition, but that resolved in the postmenopausal stage,” Maki said. “For learning, there was a two- to three-fold increased odds of impairment that was sustained across the menopause transition into the postmenopause.”

A similar pattern was observed for attention/working memory.

Effects on the same domains were also evident in categorical scores of cognitive impairment, with the increased odds of impairment ranging from 41% to 215% (Ps < 0.05 to < 0.001).

The increase in predicted probability of impairment by menopausal stage – from premenopause to the menopause transition or postmenopause – ranged from 4% to 13%.

“While the majority of women did not experience a clinically significant menopause-related decline in learning and memory, up to 11% of women showed a clinically significant worsening of cognitive performance associated with the menopause transition,” Maki said.

Despite other studies showing that the average performance on cognitive tests of learning and memory worsen as women transition through menopause, “we are the first to determine what percent of women showed worsening of cognitive performance that reached the threshold of impairment,” Maki said. “I was surprised that this was observed for about one in 10 women. I was also surprised that there was no difference between women with HIV and those without HIV in cognition changes across the menopause.”

Many women fear that the memory changes they experience are an early sign of Alzheimer’s disease or HIV-related cognitive impairment, according to Maki. “But our research shows that they are related to a different cause: the menopause transition,” she said.

Clinicians should help to normalize the cognitive complaints of women. “Evidence-based approaches for sustaining brain health include exercise, Mediterranean diet, sleep hygiene and novel cognitive activities,” Maki said. “We also need to know who is most vulnerable to cognitive impairment associated with menopause.”

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Disclosure

Maki has served as a consultant to AbbVie, Astellas, Balchem and Pfizer.

Source

Maki PM, Springer G, Anastos K, et al. Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV. Menopause. Published online Jan 13, 2021. doi:10.1097/GME.0000000000001725