Dementia affects approximately one million individuals in the UK, with women comprising 62% of those diagnosed. This imbalance is not solely due to women’s longer life expectancy; hormonal changes, particularly during menopause, significantly influence cognitive health. Understanding the relationship between oestrogen, menopause, and cognitive decline is crucial for women aiming to maintain optimal brain health.
The Role of Oestrogen in Brain Function
Oestrogen is a vital hormone that influences various bodily functions beyond reproduction. In the brain, oestrogen plays a critical role in:
- Neuronal Growth: It helps with the development and survival of neurons, ensuring the brain can process and transmit information efficiently.
- Synaptic Plasticity: Oestrogen enhances the connectivity between neurons, a function essential for learning and memory.
- Neurotransmitter Regulation: It regulates key neurotransmitters like serotonin, dopamine, and acetylcholine, which influence mood, memory, and cognitive function.
- Blood Flow and Inflammation Reduction: Oestrogen improves blood circulation to the brain and helps reduce inflammation, which can contribute to cognitive decline.
A decline in oestrogen levels, as seen in menopause, can disrupt these processes, leading to symptoms often referred to as brain fog or memory lapses. Over time, these changes may contribute to an increased risk of dementia.
Menopause and Cognitive Decline: Understanding the Connection
Menopause typically occurs between the ages of 45 and 55, marking the end of a woman’s reproductive years. As well as common symptoms like hot flushes, mood swings, and sleep disturbances, many women report cognitive challenges such as:
- Memory lapses – Forgetting words or struggling to recall names.
- Difficulty concentrating – Finding it harder to focus on tasks.
- Mental fatigue – Feeling mentally drained more easily.
- Slower cognitive processing – Taking longer to complete mental tasks.
While these symptoms may be temporary, research suggests that the age at which menopause begins can have long-term effects on brain health. A study found that women who experience early menopause and have higher cardiovascular risk factors show greater cognitive decline. This suggests that managing heart health alongside menopause symptoms is crucial for reducing dementia risk.
The Controversy Around Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) is commonly prescribed to relieve menopause symptoms, including cognitive difficulties. However, its impact on dementia risk is still debated.
Potential Benefits of HRT
Some research suggests that starting HRT close to menopause may offer protective effects on brain health. A study found that HRT was associated with improved cognitive function and larger brain volumes in at-risk women. The theory is that oestrogen supplementation shortly after menopause could help preserve brain function.
Potential Risks of HRT
Other research has indicated that certain HRT regimens, particularly combined oestrogen-progestin therapies, may increase dementia risk. A study found a possible association between prolonged menopausal hormone therapy and an increased likelihood of developing dementia, even among women who started treatment at a younger age.
With these conflicting findings, it’s essential for women to consult their healthcare providers to assess whether HRT is the right option based on their personal health history and risk factors.
The Importance of Preventative Health Assessments
Since menopause and oestrogen decline are unavoidable, preventative health measures become crucial. The NHS offers free Health Checks for adults aged 40 to 74, helping to detect early signs of conditions that could increase dementia risk, such as:
- High blood pressure – A key risk factor for vascular dementia.
- High cholesterol – Can contribute to blocked arteries, restricting blood flow to the brain.
- Diabetes – Strongly linked to an increased risk of Alzheimer’s disease.
- Lifestyle risk assessment – Evaluating diet, exercise, smoking, and alcohol intake.
Attending these check-ups and making proactive health choices can significantly lower the risk of developing dementia later in life.
Lifestyle Changes to Support Cognitive Health
While some risk factors for dementia, such as genetics and hormonal changes, cannot be controlled, lifestyle modifications can make a significant difference.
1. Regular Physical Activity
Exercise is one of the most effective ways to support brain health.
Recommended activities:
- Brisk walking or jogging
- Swimming or cycling
- Yoga and strength training
2. A Brain-Healthy Diet
Nutrition plays a key role in cognitive health. The Mediterranean diet, rich in fruits, vegetables, whole grains, and healthy fats, has been linked to a lower risk of dementia.
Foods that support brain health:
- Leafy greens (spinach, kale)
- Omega-3-rich fish (salmon, sardines)
- Nuts and seeds (walnuts, flaxseeds)
- Berries (blueberries, strawberries)
3. Mental Stimulation
Challenging the brain regularly can help build cognitive resilience. Activities such as:
- Learning a new language
- Playing musical instruments
- Engaging in puzzles and strategy games
- Reading and writing
4. Managing Stress and Sleep
Chronic stress and poor sleep quality are linked to increased dementia risk. Managing stress through mindfulness, meditation, and deep breathing exercises can benefit long-term brain health.
5. Social Engagement
Maintaining strong social connections helps protect against cognitive decline. Engaging in group activities, volunteering, or staying in touch with friends and family can help preserve mental agility.
Addressing the Gender Health Gap in Dementia Diagnosis
Despite the higher prevalence of dementia in women, research shows that women are often diagnosed later than men. This may be due to:
- A tendency to dismiss early symptoms as stress or menopause-related issues.
- A lack of gender-specific research on dementia risk factors.
- Differences in how cognitive decline manifests in women versus men.
To bridge this gap, healthcare providers need to:
- Improve awareness of the unique dementia risks women face.
- Encourage earlier cognitive assessments.
- Advocate for more gender-specific research in brain health.
Women should also advocate for themselves by discussing memory concerns with their GP and requesting cognitive assessments if necessary.
Prevention is Better Than Cure
By staying informed and adopting preventative measures, women can significantly lower their risk of dementia. Making lifestyle changes, attending regular health check-ups, and understanding the role of hormones in brain health can help preserve cognitive function well into later life.
What Happens During a Dementia Assessment?
Echelon Health have developed the gold standard in detecting your risk of developing dementia.
Our Dementia Assessment offers clarity and accuracy in detecting the earliest signs of the disease, looking underneath the surface to unearth underlying causes of cognitive decline, for effective management and potential treatment.
The Dementia Assessment includes the following:
1. Clients would undergo in-depth blood tests for those risk factors which have been implicated in the development of cognitive impairment. These include haematology, renal and liver function, tests for diabetes, cholesterol and its sub-types, thyroid gland function, levels of vitamin D, B12 and folic acid as well as markers of inflammation.
2. Clients will undergo an advanced 3T MRI brain scan to provide incredibly detailed views of the brain. This scan will be reported by the lead neuroradiologist at Queens Square (National Hospital for Neurology).
3. The client will undergo an in-depth cognitive and formal neuropsychological assessment by a consultant specialist in cognitive decline.
The memory assessment involves a detailed history and a neurocognitive test called the Addenbrookes cognitive assessment (ACE-III). This is a sensitive test used to assess memory disorders and a gold standard for established memory clinics. The assessment can be delivered online but facilities are available for a face to face session, particularly where a neurological examination is felt to be helpful. The ACE-III is sensitive to the early stages of dementia and is composed of tests of attention, memory, language, visual and spatial skills of the brain’. This test has a sensitivity score of up to 97%.
The mental functions tested include:
· General intellect.
· Reading/reading comprehension.
· Language usage and understanding of what others say.
· Attention/concentration.
· Processing speed.
· Learning and memory.
· Reasoning.
· Executive functions, which are higher-level skills you use to organise and plan, manage your time, problem-solve, multi-task, make judgments and maintain self-control.
· Visuospatial skills.
· Motor speed and dexterity.
· Mood and personality.
4. Nuclear Medicine CT-PET Scan:
If our specialist observes any concerning signs, a nuclear medicine CT-PET scan targeting amyloid may be recommended. This advanced imaging test can identify amyloid deposits in the brain, a key characteristic of Alzheimer’s disease, providing additional diagnostic information.
5. Bespoke Support:
Following the assessment, clients receive personalised counselling on the most recent treatments for dementia, including newly approved drugs that target amyloid proteins.
For a confidential conversation with our Head of Private Clients, contact our team today. We will always be delighted to help give you more information and answer any questions you may have.
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Sources:
https://www.alzheimersresearchuk.org/
https://www.health.harvard.edu/blog/menopause-and-memory-know-the-facts-202111032630
https://www.nhs.uk/conditions/nhs-health-check/
https://www.alzheimers.org.uk/
https://www.alzheimers.org.uk/blog/why-dementia-different-women
