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Researchers investigate theory linking severe menopausal symptoms to dementia

Dr. Zahinoor Ismail, a professor of psychiatry, neurology, epidemiology and pathology at the Hotchkiss Brain Institute, smiles in this undated handout photo. A University of Calgary study suggests that severe symptoms of menopause can act as early warning signs for dementia. THE CANADIAN PRESS/HO, Riley Brandt, University of Calgary *MANDATORY CREDIT*

CALGARY — A University of Calgary study is looking into whether 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 CAN-PROTECT project began in March and involves an ongoing cross-sectional look at brains and aging. 

The overall wide-ranging 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. 

Ismail's research on the effects of menopause on the brain involves health data from 800 of them, all womenwith an average age of 64. 

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 said. 

"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." 

A baseline paper on the data was presented in November at the Canadian Conference on Dementia in Toronto, of which Ismail was chair. Results are to be updated annually. 

The study, "Menopausal Symptom Burden as a Predictor of Mid-to-Late-Life Cognitive Function and Mild Behavioral Impairment," remains in its early stages and is currently being peer reviewed. 

Ismail said he hopes the findings will be published this spring. They have not yet been released. 

"Females who experience more mid-life menopausal symptoms tend to report poorer cognition and greater mild behavioural impairment severity later in mid-to-late-life," reads an abstract of the study. 

"These findings indicate that the burden of undertreated menopausal symptoms may extend beyond menopause, and act as an early marker for susceptibility to cognitive and behavioural decline, both markers of dementia." 

Ismail said the study captures post-menopausal symptoms, "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." 

"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."

Post-menopausal women who had taken an estrogen-based treatment during menopause had fewer neuropsychiatric symptoms than those who didn't take them, he said.

Dr. Iris Gorfinkel, the founder and principal investigator at PrimeHealth Clinical Research in Toronto, said the study makes sense because many menopausal symptoms are directly related to what's happening in the brain.

But 800 participants is a small number and may not be representative of a larger group of people, she said.

"Just because you have two items that are both true, it doesn't necessarily mean that they relate or having symptoms of natural, predictive symptoms of menopause is going to predict later dementia."

Gorfinkel said there are a number of contributing causes of dementia, including Alzheimer’s disease, diabetes and smoking.

"It's not at all clear how many are going to relate to having gone through a really tough change of life. I think it's an interesting start and a research that needs to be conducted over a broader population, over larger numbers of women to see if it holds up," she said.

Menopausal hormone therapy has been a controversial issue since the 1990s, when a major study found an association with higher rates of breast cancer and stroke. 

But many experts have said that study overstated the risks, which were mainly associated with women over 60 — when the risks for those conditions would go up anyway due to age. 

Gorfinkel said estrogen can be useful, especially in helping women dealing with some symptoms of menopause, such as hot flashes and night sweats. But it's a discussion that should be had between a woman and her doctor, she said.

A paper published last year in the Canadian Medical Association Journal found more women suffering from debilitating symptoms of menopause should be presented with the option of hormone therapy. 

The paper's lead author, Dr. Iliana Lega, an endocrinologist at Women's College Hospital in Toronto, said women in their 40s and 50s are raising children and could be at the peak of their careers while trying to live with severe symptoms. 

This report by The Canadian Press was first published Feb. 12, 2024. 

Bill Graveland, The Canadian Press

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