Menopause Associated Factors and Cognition in Ageing Women

Abstract

The transition to menopause typically takes place in the female body during midlife and results in permanent changes in the availability of estrogen and other sex steroids. The impact of both lifetime estrogen exposure and the decline in estrogen following menopause is of interest due to estrogen's widespread effects, including its role in modulating cognitive function and mood. This thesis explores the association between menopause associated factors, including menopause symptoms, anxiety and depression, and cognitive performance in a population-based sample of midlife and late life women. Data from a sample of women from the Personality and Total Health (PATH) Through Life study, initially aged in their 40s and 60s, with up to 12 years of follow up are used in this thesis. A series of studies including both cross-sectional and longitudinal analyses were conducted to examine the association between indicators of estrogen exposure including menopause status, the presence of menopause symptoms and psychological symptoms, and cognitive performance as measured by a range of neuropsychological tests. This thesis begins with an overview of the literature describing cognitive ageing, the role of estrogen in the modulation of cognitive function and mood, and the endocrine changes that take place due to reproductive ageing. This is followed by a review of exploring the association between a range of indicators of estrogen exposure and cognition. Evidence from this review revealed a need for additional studies with the capacity to examine longitudinal changes in cognitive performance. Symptoms associated with menopause were examined in Chapter 5, in addition to factors predicting severe symptoms. The results from this study revealed the prevalence and severity of symptoms varied by menopause status. The association between menopause status and symptoms of anxiety and depression was examined in Chapter 6, and symptoms were also shown to differ by menopause status. The association between menopause status and cognitive performance in a sample of midlife women was explored in Chapter 7. Findings from this longitudinal study reveal no significant evidence of an association between advancement in stage and cognitive performance. In Chapter 8, the severity of menopausal symptoms and their association with cognitive performance was examined, with psychological symptoms including depression and anxiety associated with cognitive performance. In Chapter 9, findings from the final study which investigated the association between multiple indicators of lifetime endogenous and exogenous estrogen exposure and later-life cognitive function are presented. This study revealed evidence of an association between age at menopause and shorter reproductive span and cognitive performance. This thesis concludes with a discussion of study findings, strengths, limitations, and future directions. Together, these findings make a significant contribution to the evidence base related to menopause associated factors, psychological and cognitive health among ageing women. There is a need for further research that continues to investigate menopause related factors and ageing. In addition, continued examination of these factors may improve awareness within clinical settings.