Cailin Conner

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According to a study in Neurology, “Endocrine and vascular processes may synergistically contribute to increased risk of cognitive decline in female adults.”
The study investigated the influence of age at menopause, vascular risk, and history of hormone therapy (HT) containing estrogens on cognition over a 3-year follow-up period.
“Mounting evidence supports sex differences in Alzheimer disease risk,” the investigators wrote. They hypothesized that early menopause and heightened vascular risk would synergistically lead to lower cognitive scores, with HT containing estrogens potentially mitigating this association to preserve cognitive function.
The study utilized data from postmenopausal female participants and age-matched male counterparts. Vascular risk was quantified through a composite score encompassing factors like elevated blood pressure, cholesterol levels, diabetes, smoking, and obesity. Cognitive function was assessed using a global cognitive composite both at baseline and after a 3-year follow-up. Linear models were employed to examine the independent and interactive effects of age at menopause, vascular risk, and HT history on cognition at the 3-year mark, while adjusting for baseline cognitive performance, age, education level, and language of testing.
The study cohort comprised 8360 postmenopausal women (mean age at baseline, 65.0 years; mean age at menopause, 50.1 years) and an equal number of age-matched male participants.
“There was an interaction between age at menopause and vascular risk, such that earlier menopause and higher vascular risk were synergistically associated with lower cognitive scores at follow-up (β=0.013; CI, 0.001-0.025; P=.03),” the investigators reported.
Further analyses revealed that vascular risk was significantly associated with lower cognitive scores, specifically in women who experienced earlier menopause (ages 35-48 years), with this negative association being more pronounced when compared with age-matched male counterparts (CI, −0.066 to −0.022; P&lt;.001). This association was not observed in women who experienced menopause at the average age (49-52 years; CI, −0.027 to 0.012; P=.46) or later menopause (ages 53-65 years; CI, −0.020 to 0.025; P=.82).
Additionally, the results of the study suggested that “HT history did not further modify the synergistic association of age at menopause and vascular risk with follow-up cognition (CI, −0.032 to 0.021; P=.69).”
The investigators concluded “these findings have implications for the development of sex-specific dementia prevention strategies.”
Source: <a href="https://www.neurology.org/doi/10.1212/WNL.0000000000209298" target="_blank" rel="noopener">Neurology</a>

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