Main Article Content
Menopause is a condition in which the menstrual periods have stopped for the last 12 months due to cessation of ovarial functions causing estrogen hormones to decrease. Various studies find that many factors affect cognitive function at post-menopausal age among others the decrease in estrogens, age at menopause, duration of menopause, and education. However, the effects have been subject to controversy. The aim of this study was to determine the relationship of age, age at menopause, estradiol level, and education with cognitive function among healthy post-menopausal women.
A cross-sectional study was conducted involving 31 post-menopausal women between 50 to 75 years old. Data on age, age at menopause, and education were collected using a questionnaire. The estradiol levels were measured using an electrochemiluminescent immunoassay (ECLIA). The Indonesian version of the Montreal Cognitive Assessment (MoCA INA) was used to assess the cognitive function. Multiple linear regression was used to analyze the data. A p<0.05 was considered statistically significant.
Age (b=-0.086; 95% C.I.=-0.263-0.090; p=324) and estradiol levels (b=0.106; 95% C.I.=-0.018 -0.230; p=0.092) were not significantly associated with cognitive function. However, education (b=1.537; 95% C.I.=0.176-2.898; p=0.028) and age at menopause (b=0.364;0.056-0.671; p=0.022) were significantly associated with cognitive function. Age at menopause was the most influential factor of cognitive function (Beta=0.402) compared to education (Beta=0.394).
Later age at menopause could increase cognitive function in post-menopausal women. Our findings are that modifiable factors that delay age at menopause should receive attention, in order to promote cognitive function.
Keywords: Age at menopause, estrogens, cognitive function, post-menopausal women
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
Kementerian Kesehatan Republik Indonesia. Data dan informasi: profil kesehatan Indonesia 2016. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan R.I.;2017.
Luine VN. Estradiol and cognitive function: past, present and future. Horm Behav 2014;6;602-18. doi: 10.1016/j.yhbeh.2014.08.011.
Gasbarri A, Tavares MC, Rodrigues RC, Tomas C, Pompili A. Estrogen, cognitive function and emotion. An overview on humans, non-human primates and rodents in reproductive years. Rev Neurosci 2012;23:587-606. DOI: https://doi.org/10.1515/revneuro-2012-0051.
Henderson VW. Cognitive changes after menopause: influence of estrogen. Clin Obstet Gynecol 2008;51:618-26. doi:10.1097/GRF.0b013e318180ba10.
Fritz MA, Speroff L, editors. Clinical endocrinology and infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
Georgakis MK, Kalogirou EL, Diamantaras AA, et al. Age at menopause and duration of reproductive period in association with dementia and cognitive function: a systematic review and meta- analysis. Psychoneuroendocrinology 2016;73:224-43 DOI: https://doi.org/10.1016/j.psyneuen.2016.08.003.
Kuh D, Cooper R, Moore A, Richards M, Hardy R. Age at menopause and lifetime cognition: findings from a British birth cohort study. Neurology 2018;90:e1673-81.doi:10.1212/WNL.0000000000005486.
Lavi R, Doniger GM, Simon E, Hochner-Celnikier D, Zimran A, Elstein D. The effect of hormone replacement therapy on cognitive function in post-menopausal women. Q J Med 2007;100:567-73.doi:10-1093/qjmed/hcm065.
Lubis MIP. Hubungan fungsi kognitif berdasarkan informant questionaire on cognitive decline in the elderly dengan kadar estradiol serum pada tenaga medis usia menopause di RSUP Adam Malik (thesis). Medan: Program Pendidikan Dokter Spesialis Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sumatera Utara; 2017.
Ismail Z, Rajji TK, Shulman KL. Brief cognitive screening instruments: an update. Int J Geriatr Psychiatry 201;25:111-20. doi: 10.1002/gps.2306.
Rambe AS, Fitri FI. Correlation between the Montreal Cognitive Assessment Indonesian version (MoCA INA) and the Mini-mental State Examination (MMSE) in elderly. Open Access Maced J Med Sci 2017;5:915-9. doi: 10.3889/oamjms.2017.202.
Smith T, Gildeh N, Clive H. The Montreal Cognitive Assessment validity and utility in a memory clinic setting. Can J Psyciatry 2007;52:329-32. https://doi.org/10.1177/070674370705200508.
Morison JH, Baxter MG. The aging cortical synapse: and multiplications for cognitive decline. Nat Rev Neurosci 2014;240-50. doi: 10.1038/nrn3200.
Harada CN, Natelson MC, Triebel K. Normal cognitive. Clin Geriatr Med 2013;29:737-52. doi: 10.1016/j.cger.2013.07.002.
Ghoziladeh S, Sadatmahalleh SJ, Ziael S. The association between estradiol levels and cognitive function in postmenopausal women. Int J Reprod Biomed 2018;16:455-8.
McLay RN, Maki PM, Lyketsos CG. Nulliparity and late menopause are associated with decreased cognitive decline. J Neuropsychiatry Clin Neurosci 2003;15;161-7.
Bove R, Secor E, Chibnik LB, et al. Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women. Neurology 2014;82:222-9. doi: 10.1212/WNL.0000000000000033.
Kurita K, Henderson VW, Gatz M, et al. Association of bilateral oophorectomy with cognitive function in healthy, postmenopausal women. Fertil Steril 2016;106:749-56.e2. doi: 10.1016/j.fertnstert.2016.04.033.
Ryan J, Scali J, Carriere I, et al. Impact of a premature menopause on cognitive function in later life. BJOG 2014;121:1729–39.DOI:10.1111/1471-0528.12828.
Sherwin BB. Estrogen and cognitive functioning in women: lessons we have learned. Behav Neurosci 2012;126:123-7. doi:1 0.1037/a0025539.
Cutter WJ, Norbury R, Murphy. Oestrogen, brain function, and neuropsychiatric disorders. J Neural Neurosurgn Psychiatry 2009:837-40. http://dx.doi.org/10.1136/jnnp.74.7.837.
Yoon BK ,Chin J ,Kim JW, et al. Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial. Menopause 2018;25:870-6. DOI: 10.1097/GME.0000000000001140.
Ryan J, Carriere I, Scali J, et al. Characteristics of hormonal therapy, cognitive function, and dementia, the prospective 3C study. Neurology 2009; 73:1729-37. doi: 10.1212/WNL.0b013e3181c34b0c.
Herlitz A1, Thilers P, Habib R. Endogenous estrogen is not associated with cognitive performance before, during, or after menopause. Menopause 2007;14:425-31. DOI: 10.1097/01.gme.0000247019.86748.e3.