In a cross-sectional observational study of 896 postmenopausal participants (895 women, 1 two-spirit) from the Canadian Platform for Research Online to Investigate Health (CAN-PROTECT), researchers found that greater menopausal symptom burden was significantly associated with poorer cognitive function and increased mild behavioral impairment symptoms in later life.
The analysis included 667 participants with spontaneous menopause, 162 with menopause due to hysterectomy/oophorectomy, and 67 with menopause due to other medical reasons. Participants completed questionnaires on menopause history, cognitive status (via the 41-item Everyday Cognition [ECog-II] scale), and behavioral symptoms (via the 34-item Mild Behavioral Impairment Checklist [MBI-C]).
Each additional menopausal symptom was linked to a 5.37% higher ECog-II total score, indicating poorer cognitive function. Similarly, each symptom was associated with a 6.09% higher MBI-C score, suggesting increased neuropsychiatric changes.
"The experience of multiple menopausal symptoms may estimate dementia risk in a way not accounted for by analysis of a single menopausal symptom," said Jasper F.E. Crockford from the University of Calgary.
Participants had a mean age of 64.2 years (SD, 7.3) and an average education level of 15.5 years (SD, 5.0). The mean age of menopause onset was 49.4 years. Of the cohort, 74.3% reported experiencing at least one menopausal symptom. The most commonly endorsed were hot flashes (88%) and night sweats (70%).
Cognitive function was assessed using the ECog-II scale, which includes 41 items spanning memory, language, planning, and other domains. Behavioral symptoms were assessed using the MBI-C, a 34-item checklist measuring apathy, affect, impulse control, social cognition, and psychosis, among other domains.
Hormone therapy (HT) use was reported by 24.9% of participants. Although HT use was not significantly associated with cognitive function, it was associated with significantly lower MBI-C scores, indicating fewer later-life behavioral symptoms.
No significant associations were found between cognitive or behavioral outcomes and menopause type (spontaneous, surgical, or medical) or age of menopause onset. Additionally, no interaction effects were observed between HT use or age of onset and the relationship between menopausal symptom burden and ECog-II or MBI-C scores.
The authors noted that their symptom burden metric captured presence but not severity of symptoms, and the cross-sectional nature of the study precludes causal inferences. However, the results suggest a dose-response pattern between the number of menopausal symptoms experienced and later-life cognitive and behavioral changes.
"Every additional menopausal symptom was associated with a 6.09% higher MBI-C total score," the authors reported, underscoring a cumulative burden effect.
The study was supported by the Gordie Howe CARES Foundation and the Evans Family Fund via the Hotchkiss Brain Institute, with ethical oversight from the University of Calgary.
No conflicts of interest were reported.
Source: PLOS ONE