Surgical menopause linked to cognitive decline

Analysis of data from 2 longitudinal studies shows a link between early surgical menopause-but not natural menopause-and cognitive decline. The research, supported by the National Institutes of Health, is to be presented at the American Academy of Neurology (AAN) conference in March.

More than 1800 women from the Religious Orders Study (ROS) and the Memory and Aging Project (MAP) were represented in the abstract, submitted by investigators from Rush University Medical Center and Brigham and Women’s Hospital. ROS is a multicenter collaboration involving more than 1100 religious clergy who are medically and psychologically evaluated on an annual basis and have agreed to donate brain tissue after death. MAP is a longitudinal, epidemiologic clinical-pathologic cohort study of common chronic conditions of aging, emphasizing decline in cognitive and motor function and risk of Alzheimer’s disease (AD).

The analysis in the AAN abstract was an assessment of 3 types of cognition-related outcomes: (1) longitudinal measures, using a linear mixed-effects model of 5 cognitive domains and global cognition; (2) neuropathologic measures from brain samples obtained at death using a linear regression model; and (3) clinical diagnosis of AD. The goal was to examine the association between age and menarche and menopause, number of cycling years, and ever using and duration of hormone replacement therapy (HRT).

Faster decline in semantic memory (P<0.002), episodic memory, and global cognition (P<0.001) were associated with early age at menopause in the 33% of women with surgically induced menopause. Age at menopause also was significantly associated with neuropathologic measures, primarily neuritic plaques (P=0.01) and global pathology score (P=0.04). No association was seen, however, between age at menopause and incident AD. Slower decline in global cognition (P=0.037) was associated with duration of HRT.

“Ongoing evaluation of the neuroprotective effects of HRT after early surgical menopause,” the researchers said, “is warranted.”