‘Risk factors’: Study suggests severe menopausal symptoms linked to dementia

By Bill Graveland, The Canadian Press

A University of Calgary study suggests that severe symptoms of menopause can act as early warning signs for dementia.

Dr. Zahinoor Ismail, a professor of psychiatry, neurology, epidemiology and pathology at the Hotchkiss Brain Institute, said the result comes from an ongoing cross-sectional study about Canadian brains and aging from CAN-PROTECT.

Ismail said his initial interest in the effects of menopause was sparked years ago in his medical practice.

“I remember a case from early 2001 with a woman who presented in the emergency room with a whole host of brain symptoms, both cognition and psychiatric, and it turned out she was just in early menopause,” Ismail told The Canadian Press.

“So instead of treating her for these neurological and psychiatric conditions, we normalized her estrogen and her symptoms resolved.

“That was the genesis of this study.”

The overall study involves 2,400 people across Canada, who are asked a number of questions about their cognition, behaviour, function, health, wellness, lifestyle, diet, exercise, vitamin supplements, medications, medical and psychiatric conditions and quality of life.

Data from 800 of those subjects is being used to study the effects of menopause on the brain. A baseline paper on that data was presented at the Canadian Conference on Dementia in Toronto in November, and results are to be updated annually. 

“We took women who were post-menopausal and captured the number of symptoms they had during menopause … so everything from those hot flashes that people talk about, neuropsychiatric symptoms such as irritability, mood changes, anxiety and then also neurocognitive symptoms like inattention and poor memory,” he said.

“I focused on the neuropsychiatric and cognitive symptoms. Because when those emerge and persist in mid-life and later, they are risk factors for dementia. 

“What we found was that the greater number of menopausal symptoms that they had, the more impaired they were and the more symptoms they had.”

Ismail said it also became clear that if the post-menopausal women had taken an estrogen-based treatment during menopause, they had fewer neuropsychiatric symptoms compared to those who didn’t take them. 

He said earlier studies showing that hormone replacement therapy increases the risk of stroke by about a third, later found to be somewhat overstated, resulted in an entire generation of women being deprived of the benefits.

“There’s been kind of a rebellion in a way with advocacy for menopausal women to actually be offered hormone therapy replacement again,” he said.

“It’s clear there’s a groundswell of interest once again, and this certainly has been reflected in my clinical experience and from the data of our study.”

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