For almost as long as women have been living beyond their childbearing years, many have complained about a mental "fog" that seems to descend at about the time of menopause. And you would think those complaints might prompt some smart scientist (a woman herself, perhaps) to seriously investigate those complaints.
The questions most women would probably ask are not whether these complaints are real (since they are clearly very real in the experience of the women who report them): it might be nice to know what factors contribute to the perception of mental slippage, what such cognitive complaints might mean for our daily functioning and our future mental health, and whether the problem will go away on its own or can be fixed with some treatment or lifestyle change.
A new study published this week in the journal Menopause makes a start at finding answers to those questions, and leaves many more still to be explored. It finds that when menopausal women complain of memory problems, they are most likely having trouble with two specific cognitive skills: maintaining their focus -- especially on tasks that are complex or tedious -- and holding short bits of information -- say, a telephone number or a shopping list -- in memory for less than a few minutes.
In the language of neuropsychologists, the mental skills that bedevil menopausal women with cognitive complaints are called complex attention/vigilance and working memory. Even among those who complained of memory troubles, the study's authors found no evidence of problems with verbal memory (the ability to remember the names of places or things). In this sample, about 67% of perimenopausal women reported some degree of memory loss, and four in 10 considered their memory problems "at least moderately serious."
The study also finds that the menopausal women most likely to report they feel foggy are the ones who also report they have sleep troubles, symptoms of depression, or physical ills such as headache, stomach problems or back pain.
The researchers, from the University of Rochester, N.Y. and University of Illinois in Chicago, recruited 75 women between 40 and 60 whose menstrual cycles were becoming erratic but who had menstruated in the past year. In addition to asking the subjects to assess changes in their cognitive functioning, researchers put the women through an exhaustive battery of tests to gauge their performance objectively.
The study underscores that for women going through the years-long transition of menopause, mood and mental fitness are inextricably linked. But it leaves unanswered several important questions. Among them:
-- Is mental fog linked to -- or caused by -- the dramatic shift in hormone levels a woman is undergoing at this stage of life? (Like many studies before it, this study took a one-time measure of women's hormone levels and found no pattern that linked those levels with memory changes.)
-- Is it depression, which is more common in women of this age, that causes mental slippage, and if a woman's mood disorder is treated, will her cognitive performance bounce back? (This study found that depressive symptoms were a good predictor that a woman would report memory troubles, but did not gauge whether subjects had a history of depression or were undergoing treatment for the condition.)
-- If these reported memory problems are indeed new, do they resolve once the menopausal transition is done? Or are they a reliable harbinger of dementia? (This study did not take baseline measurements of women's mental skills before perimenopause, and did not track the women as they emerged from the transition. But other studies have hinted that for a subset of women who complain of memory changes around menopause, mental fog could be the earliest signs of mild cognitive impairment or dementia.)
University of Vermont neuropsychologist Julie Dumas was not among the authors of this study, but also conducts research on menopause and mental performance. "It's a nicely done study," said Dumas, adding that its strong "take-home message" for women is that depression and sleep problems are likely to cause ripple effects far beyond sleepy days and sadness. Even in the absence of evidence that fixing those problems will restore mental acuity, said Dumas, women should get help for them.