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Cognition and the Midlife Woman

One of the common complaints of the middle age woman is changes in the ability to think, remember, and process thoughts. Forgetfulness is one of the most common complaints that the menopausal woman expresses to her physician. The events that occur in the brain from mid-age until death can be divided into three processes:

  • Mild cognitive impairment (MCI) – a slow gradual decline in cognition. It has been defined as episodes of memory loss without changes in the brain that are associated with dementia. It sometimes precedes the development of dementia but not always. In a recent study by Mayo Clinic, elderly men and women who were diagnosed with MCI were at higher risk of developing a form of dementia or Alzheimer’s but the study did not show the same results with midlife MCI. This form of memory can be tested by deliberate recollection of recent events or episodes. MCI is looked upon as being forgetfulness with preservation of other cognitive abilities and daily activities are not disturbed.
  • Cognitive aging – represents an erosion of existing abilities, beginning in mid life and advancing through elderly age groups. The rate of change in abilities varies between individuals with many elderly people continuing to maintain cognition.
  • Dementia – a major cognitive disturbance or decline that interferes with normal daily life and activities. As the population ages, dementia increases, with studies revealing that by age 95, one half of the population of that age will have some degree of dementia. In midlife dementia is rare with a reported incidence of less than one per ten thousand people. Nerve cells in the brain undergo changes that are not always easily shown on standard studies at this time. A recent research study suggests that approximately two-thirds of dementia after age 60 may be caused by Alzheimer’s disease.

Menopause forgetfulness is not necessarily a sign of continued degeneration with later age. It can sometimes be related to vascular diseases, stress, or shifts hormone levels. The perception of memory loss in middle age is not associated with measurable memory loss at later ages. The awareness of memory changes in midlife should never be misconstrued as a sign of dementia developing later in life. For the middle age woman, forgetfulness is more often a factor of depressed mood, stress and anxiety. Other factors may effect memory including fatigue, sleep disorders, hot flashes, medication effects and medical illness especially thyroid disease.

The evaluation of cognitive symptoms during middle age is different than evaluation of the elderly. The following considerations have to be evaluated:

  • What is the functional impact of the symptoms? Does the forgetfulness impact job performance, social interactions, or daily life?
  • Is there a family history of any dementia or Alzheimer’s disease?
  • Do others identify the forgetfulness and perceive it to be a problem in their interactions with the individual?
  • Are personality and behavioral changes appearing?

How can the evaluation of the forgetfulness be carried out? Usually testing of the individual should initially include memory screening and testing of episodic memory which can include providing lists of words or names for recall later in the evaluation. With more advanced signs of cognitive decline, evaluation by a neurologist or psychiatrist may be helpful. When doing the evaluation, midlife stressors must be kept in mind as they may alter the ability of the woman to function as before. These stressors can include demands of her job, dealing with adolescent children, caring for an aging parent, empty nest syndrome, personal health problems and financial concerns. These stressors can affect mood and sleep leading to impaired memory, daytime sleepiness, and altered ability to carry out normal daily function.

Studies have strongly suggested that maintaining physical activity, mental activity and social interaction with others may boost brain reserve capacity, enhance the efficiency of the brain and enable coping mechanisms. Proper nutrition is essential to maintaining normal brain function. So eat right, exercise (physical and mental exercise), sleep well and minimize stress.

If you have concerns, consult your physician and discuss your concerns with him or her.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.