Cognitive Impairment In Women Research Articles

A mechanistic cohort study evaluating cognitive impairment in women treated for breast cancer.

Some women report cognitive impairment after adjuvant chemotherapy (CTh) for breast cancer. Here we explore cognitive function, and underlying mechanisms with blood tests and functional magnetic resonance imaging (fMRI). Women treated for early breast cancer were recruited to three groups based on self-reported cognitive symptoms (CS) using FACT-Cog scores. CTh+CS+ (n=44) had received chemotherapy and self-reported cognitive symptoms; CTh+CS- (n=52) had chemotherapy but did not report cognitive problems; CTh- (n=30) had not received chemotherapy. Clinical and computer-based neuropsychological tests were performed. Blood tests included 10 cytokines, sex hormones, coagulation factors, and apolipoprotein-E genotype. fMRI (n=101) was performed while subjects performed an n-back memory task. Participants had median age 50 (range: 29-60) years and were a median of 17months post-diagnosis. On clinical neuropsychological tests 19% had cognitive impairment using Global Deficit Score, and 36% using International Cancer and Cognition Task Force criteria with no significant differences in cognitive impairment rates between groups. CTh+CS+ had significantly more fatigue, anxiety/depression and poorer quality-of-life than other groups. There was no association between FACT-Cog and neuropsychological scores. There were significant differences in frontal and parietal regions on fMRI scans: CTh- showed hyperactivation compared to chemotherapy-treated groups, CTh+CS+ had more frontal activation than CTh+CS-. Elevated IL-1, IL-2 were associated weakly and IL-8 more strongly with neuropsychological impairment (rho>0.20). There were no differences in global cognitive impairment between groups. Cognitive symptoms were associated with fatigue and anxiety/depression, but not with objective cognitive impairment. fMRI scans differed among the three groups.

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study.

BackgroundThere is a close association between frailty and cognitive impairment. However, the underlying contribution of sarcopenia to the development of cognitive impairment is unclear. We investigated the possible association between muscle mass decline and cognitive impairment in a cross‐sectional study of 1518 subjects aged 55 years or above. We also evaluated arterial stiffness and white matter hyperintensities (WMHs) as possible underlying mechanisms for this association.MethodsTwo sarcopenic indices were measured: thigh muscle cross‐sectional area (CSA; calculated by computed tomography) and skeletal muscle mass (bioelectric impedance). Muscle mass decline was defined as either the bottom 10% or 20% of participants for each sex. Cognitive function was assessed using the Touch Panel‐type Dementia Assessment Scale, and brachial–ankle pulse wave velocity was measured as an index of arterial stiffness.ResultsBoth sarcopenic indices were modestly but significantly associated with brachial–ankle pulse wave velocity in male and female subjects. The presence of WMHs was significantly associated with low thigh muscle CSA in men and with low skeletal muscle mass in women. The Touch Panel‐type Dementia Assessment Scale score was modestly but significantly and positively associated with thigh muscle CSA in men and skeletal muscle mass in women. Muscle mass decline in the bottom 10% of participants on both sarcopenic indices was significantly and independently related to cognitive impairment in women.ConclusionsLower sarcopenic indices are significantly related to lower cognitive scores. Arterial stiffness and WMHs could account, at least in part, for this association.

Abstract P4-19-03: A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy

Abstract Background: Cognitive impairment in women with breast cancer has long been attributed to chemotherapy, but the evidence for this has been inconsistent, and more recent research suggests that additional cancer- and treatment-related factors also impact cognition. To systematically evaluate and describe “chemobrain,” a multilevel meta-analysis of objective cognitive function in breast cancer survivors treated with chemotherapy was conducted to estimate the magnitude of impairment across 9 cognitive domains and explore moderating variables. Method: PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and PsycINFO were searched from their inception to May 2016 to identify studies that compared the cognitive performance of survivors treated with chemotherapy to a control group or to their own prechemotherapy testing. Multilevel modelling was used to account for the interdependence among effect sizes obtained within the same study. Results: Seventy-seven studies involving 3417 cancer patients treated with chemotherapy yielded 1548 effect sizes. Cross-sectional comparisons revealed worse overall cognitive performance in survivors treated with chemotherapy relative to healthy controls (d = -0.27, 95% CI [-0.32, -0.21]) but not disease-specific controls (d = -0.07, 95% CI [-0.14, 0.00]). Relative to all controls, cognitive impairment in survivors treated with chemotherapy was observed in tests assessing language (d = -0.25), executive function (d = -0.21), processing speed (d = -0.15), delayed recall (d = -0.15), and attention/concentration (d = -0.14), but not in visual/spatial perception, immediate recall, recognition memory, or psychomotor domains. Because patients and controls were not well matched in many studies on age, education, and IQ, which are known to impact cognitive test performance, group differences in these variables were explored as moderators of observed cognitive deficits in post hoc analyses. Results showed that chemotherapy patients and controls performed equivalently when the controls were 6 years older or had 1 less year of education. Longitudinal comparisons showed improved postchemotherapy performance relative to prechemotherapy baseline, but practice effects were not accounted for in these comparisons. Conclusion: Breast cancer survivors treated with chemotherapy show subtle yet diffuse cognitive impairment. Their cognitive performance was equivalent to that of women in comparison groups who were 6 years older, which suggests that chemotherapy accelerates cognitive aging. Results from breast cancer patients who were not treated with chemotherapy, however, indicate that chemotherapy is not the only determinant of cognitive dysfunction. Group differences in age and education moderated the magnitude of cognitive impairment. The cognitive reserve framework, which posits that individuals differ in the degree of neural disruption they can withstand before exhibiting cognitive deficits, should be considered in future studies in order to better understand moderating effects on cancer-related cognitive dysfunction. In particular, both cross-sectional and longitudinal studies should ensure that comparison cohorts are closely matched on age, education, and other relevant cognitive reserve variables. Citation Format: Bernstein LJ, McCreath GA, Rich JB. A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-03.

Gender Differences in Cognitive Functioning in Older Alcohol-Dependent Patients

ABSTRACTBackground: Alcohol dependence is associated with impairments in cognition, especially in later life. Previous studies suggest that excessive drinking has more negative impact on cognition in women than in men. Objectives: In this study, differences in cognition between male and female older, alcohol-dependent patients were examined. Method: Older alcohol-dependent inpatients (N = 164, 62.2% men, mean age 62.6 ± 6.4) underwent neuropsychological tests of sensitivity to interference, mental flexibility, and visual processing. Results: No gender differences were found in age, educational level, estimated premorbid verbal intelligence, and sensitivity to interference. Duration of alcohol dependence was longer for men than for women. Men performed better than women on visual processing, and women better than men on mental flexibility. The superior mental flexibility of women remained significant after adjustment for duration of alcohol dependence. Conclusions/Importance: Older alcohol-dependent inpatients performed below average on cognitive tasks, which suggests that long-term excessive alcohol use negatively affects cognition. Our study does not demonstrate more severe cognitive impairment in women than in men.

Síndrome de Rett con un manejo cuestionado

El síndrome de Rett es un trastorno neurodegenerativo, caracterizado por una evolución normal inicial, con un cuadro clínico característico de neurorregresión, con una incidencia de 1:10.000 niñas. Es considerado una de las enfermedades genéticas más comunes de déficit cognitivo en las mujeres. Se presenta el caso de una niña de 4 años de edad con un cuadro clínico de regresión del desarrollo, movimientos estereotipados, compatible con síndrome de Rett, a la cual la madre como terapia le está administrando 2 gotas de aceite de marihuana. En la actualidad no hay estudios que recomienden el uso medicinal de la marihuana en el síndrome de Rett, pues el tratamiento es sintomático y de apoyo, y requiere un equipo de manejo interdisciplinario.

Dietary glycemic load and risk of cognitive impairment in women: findings from the EPIC-Naples cohort.

Cognitive impairment is a common cause of morbidity in the elderly. The relationship between dietary habits and cognitive impairment in a female population living in the metropolitan area of Naples, in the Mediterranean part of Italy, has been evaluated in the Naples EPIC prospective cohort study. The study cohort, enrolled between 1993 and 1997, is composed of 5062 women aged 30-69 years. At time of enrolment anthropometric measures were performed and information about socio-demographic details, clinical data, lifestyle and dietary habits were collected. During 2008 and 2009, women 65 years of age or older received a telephone interview to evaluate cognitive status (TICS); the derived score was used as proxy of cognitive impairment. Analyses were carried out on 1514 participants. Linear regression model showed negative association between TICS score and, respectively, age at baseline (β = -.31, 95% CI -.34, -.24), body mass index (BMI) (β = -.08, 95% CI -.16, -.01), and glycemic load (GL) (β = -.02, 95% CI -.03, -.01), whereas education level (β = 0.62, 95% CI .56, .69) showed positive association. A logistic regression model, used to evaluate determinants of the low cognitive score (TICS score ≤ 15, 1st tertile), confirmed association for previous variables [age (OR 1.1, 95% CI 1.08, 1.15); BMI (OR 1.03, 95% CI 1.001, 1.07); GL (OR 1.005, 95% CI 1.001, 1.011); education level (OR .82, 95% CI .79, .84)] with, in addition, type II diabetes (OR 1.85, 95% CI 1.014, 3.4). This study indicates that GL may play a role in determining risk of cognitive impairment, besides age, BMI, education and diabetes.

Oxidative Stress in HIV Patients Receiving Antiretroviral Therapy

Oxidative stress, defined as the imbalance between the oxidant and antioxidant systems, is thought to be associated with the progression of human immunodeficiency virus (HIV) infection. It has been observed that perturbations in antioxidant defense systems, and consequently redox imbalance, are present in many tissues of HIV-infected patients. Existing evidences suggest that oxidative stress may contribute to different stages of viral life cycle including viral replication and its consequences such as inflammatory response and decreased immune cell proliferation. The level of production of free radical species in HIV-1 infected individuals receiving antiretrovirals (ART) including highly active antiretroviral therapy (HAART) was reported to be higher than those who harbor HIV-1 infection without receiving any treatment or normal and healthy subjects. These observations suggest that the HIV-1 infection alone or in combination with introduction of ARV/HAART may induce oxidative stress and further augment HIV-1 pathogenesis. HIV-1 infection and the treatment with antiretrovirals have been found to cause antioxidant enzyme dysfunction in monocytes and central spinal fluid (CSF) leading to cognitive impairment in women. However, the exogenous application of some natural plant products or recent synthetic antioxidants might be useful in scavenging the free radicals. It is expected that their application as an additional strategy may facilitate ARV therapy or HAART for the effective treatment of HIV-1 infected persons or AIDS patients. This review offers a perspective on the current account of oxidative stress in HIV-1 infected individuals and its possible amelioration using suitable antioxidants, plant products and herbal preparations.

A cross sectional study to examine the association between dietary patterns and cognitive impairment in older Chinese people in Hong Kong.

Dietary patterns can be identified using a priori and a posterior approaches. Few studies have related dietary patterns with cognitive impairment in Chinese population. This study examined the risk of cognitive impairment associated with dietary patterns identified by both approaches. Baseline data on 1,926 Chinese men and 1,744 Chinese women aged > 65 years participating in a cohort study examining the risk factors for osteoporosis in Hong Kong were analyzed. Dietary data were collected using a validated food frequency questionnaire. Adherence to a priori dietary patterns, namely the Mediterranean Diet Score (MDS) was assessed. Factor analysis (FA) identified three a posterior dietary patterns: "vegetables-fruits" pattern which was rich in vegetables, fruits, soy products and legumes, "snacks-drinks-milk products" pattern which was a mixture of healthy and unhealthy food groups including fast food, sweets and desserts, nuts, milk products and whole grains, and "meat-fish" pattern which included frequent intake of meat, fish and seafood. Cognitive function was assessed by the Community Screening Instrument for Dementia (CSI-D). Multivariate logistic regression examined the risk of cognitive impairment with adjustment for potential confounders. A total of 221 men and 656 women was classified as cognitive impaired. Neither the MDS nor the dietary patterns identified by FA were associated with risk of cognitive impairment in men. In women, higher "vegetables-fruits" pattern score was associated with reduced risk of cognitive impairment [Adjusted OR=0.73 (95% CI: 0.54-1.00) of the highest quartile of "vegetables-fruits" pattern score compared with the lowest quartile, ptrend=0.018]. Similar inverse trend was observed for "snacks-drinks-milk products" pattern score [Adjusted OR=0.65 (95% CI: 0.47-0.90) of the highest quartile of "snacks-drinks-milk products" pattern score compared with the lowest quartile, ptrend=0.003]. There was no association of "meat-fish" pattern or the MDS with risk of cognitive impairment in women. Higher "vegetables-fruits" and "snacks-drinks-milk products" pattern scores were associated with reduced risk of cognitive impairment in Chinese older women in Hong Kong.

Relationship Between Depression and Cognitive Disorders in Women Affected with Dementia Disorder

The most common disorders of aging, depression, cognitive impairment (dementia), phobic disorder and alcohol use disorders are. The effect of aging on cognitive processes and metacognitive knowledge significantly affects the probability of failure increases one of the most common disorders associated with severe and progressive disability in old age, cognitive impairment (dementia) is. A 85-year lifetime risk for men and women out of every three people is probably about the same. Epidemiological studies show that about 5 percent of people 65 years and older to suffer obvious cognitive impairment. Dementia in the family as well as increased anxiety, depression and maintenance costs and time to be patient. The annual cost of dementia imposes on society is enormous. This study investigated the relationship between depression and cognitive impairment in women with dementia is a disease. MethodsAll women have a population of Tehran is a dementia disease of these, 64 patients with dementia randomly chosen and tested method. Instrument: Questionnaire RUDAS: (THE ROWLAND UNIVERSAL DEMENTIA ASSESMET) by Roland & Associates was built in 2004. Depression questionnaire GDS: was built in 1986 by Sheikh or Savage. Is composed of 15 questions and the group under study into three groups with moderate depression (5 to10), depression (10 to15) and healthy subjects were divided into a basic form consists of 30 questions each mechanism is a response (yes and if) there. The findings showed that the correlation between depression and cognitive dysfunction in women with dementia versus -./67 Significant at the level of ./001 Was there. Results are negative and significant relationship between depression and cogniti ve impairment shows that depression is through what is much more cognitive impairment And the cognitive tools used by any person to take better score less cognitive impairment and depression scores decreased.

Effect of beef consumption on body iron and cognitive function in iron‐deficient women

Iron depletion is associated with cognitive impairment in women of reproductive age. This project investigates the effect of moderate beef intake on total body iron and cognitive function in university undergraduate women. At baseline, women (n=17) were classified by body iron tertile and randomly assigned to a beef or nonbeef meat lunch group (85 g, 3x weekly) for 16 weeks. Computerized neurocognitive tests were administered at baseline and week 16. Changes in calculated body iron and cognitive performance from baseline to endpoint were analyzed using generalized linear models and Spearman correlations. Women in the 1st (lowest) vs. 2nd and 3rd iron tertile responded to either lunch intervention with significant increases in body iron (ANOVA, P<0.01) and significant improvements in tests of spatial working memory (decrease in errors and improvement in strategy, P<0.05). Change in body iron was inversely associated with change in spatial working memory error rate (r=−0.49; P<0.05). These preliminary findings suggest that working memory improves in association with increased iron status in iron‐deficient women consuming moderate amounts of beef or nonbeef meat. Funded by the Idaho Beef Council.

Physical activity, obesity, and cognitive impairment among women with systemic lupus erythematosus

To examine relationships of obesity and physical inactivity to cognitive impairment in women with systemic lupus erythematosus (SLE). Body composition was measured with dual x-ray absorptiometry (DXA) for 138 women with SLE. Obesity was defined by total percent body fat. Physical activity was ascertained with the self-reported International Physical Activity Questionnaire; inactivity was defined as expenditure of <600 metabolic equivalent minutes/week. Cognitive function was assessed with a 12-index neuropsychological battery. Impairment was defined as age-adjusted Z scores ≤1.5 SDs below the mean on 1 of 3 of tests completed. Scores were obtained for the total battery and for memory and executive function components. Multivariate analyses examined the relationship of obesity and physical activity, individually and combined, to cognitive impairment, controlling for education, race/ethnicity, disease activity, glucocorticoid use, and depression. Fifteen percent of subjects were cognitively impaired, 28% were physically inactive, and 50% were obese. Five percent of active women were impaired on the executive function battery compared to 23% of those who were inactive (P = 0.003). Obese women were more likely to be impaired on the total battery (6% versus 23%; P = 0.007) and on the executive function portion (2% versus 19%) than nonobese women. In multivariate analysis, both inactivity and DXA-defined obesity were significantly associated with impairment in executive function (inactivity: odds ratio [OR] 9.4, 95% confidence interval [95% CI] 1.7-52.8; obesity: OR 14.8, 95% CI 1.4-151.0). Both obesity and inactivity were significantly and independently associated with impairment in cognitive function. If longitudinal studies show that physical inactivity and obesity are precursors to cognitive impairment, these may become important targets for intervention.

Cognitive function and predictors for mild cognitive impairment in women receiving adjuvant hormone therapy.

e11082 Background: Women with breast cancer (BC) often complained memory loss and attention deficit after cancer treatment. However, cognitive function deficit was multivariate issues. The purpose ...

Cognition in Older Women: The Importance of Daytime Movement

To determine whether an objective measure of daytime movement is associated with better cognitive function in women in their 80s. Cross-sectional. A study of health and aging. Two thousand seven hundred thirty-six older women without evidence of dementia. Daytime movement was assessed using actigraphy, which involved wearing a watch-like device that objectively quantified accelerometer motion over a mean of 3.0+/-0.8 days. Cognitive function was measured using the Trail-Making Test, Part B (Trails B) and the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as performing 1.5 standard deviations (SDs) worse than the mean on a given test. Participants had a mean age of 83+/-4; 10% were African American. After adjustment for age, race, and education, women in the highest movement quartiles had better mean cognitive test scores (20+/-0.3 seconds faster on Trails B and 0.3+/-0.2 points higher on MMSE, both P<.001) than those in the lowest quartile and were less likely to be cognitively impaired (odds ratio (OR)=0.61, 95% confidence interval (CI)=0.41-0.92 for Trails B; OR=0.68, 95% CI=0.44-1.07 for MMSE). Associations were similar in different subgroups and were independent of self-reported walking, medical comorbidities, physical function, and other health-related behaviors. Daytime movement as measured objectively using actigraphy was associated with better cognitive function and lower odds of cognitive impairment in women in their 80s. Additional studies are needed to clarify the direction of the association and to explore potential mechanisms.

Preexisting Cognitive Impairment in Women Before Cardiac Surgery and Its Relationship with C-Reactive Protein Concentrations

Preoperative cognitive state is seldom considered when investigating the effects of cardiac surgery on cognition. In this study we sought to determine the prevalence of cognitive impairment in women scheduled for cardiac surgery using nonhospitalized volunteers as a reference group and to examine the relationship between C-reactive protein levels and cognitive impairment. Psychometric testing was performed in 108 postmenopausal women scheduled for cardiac surgery and in 58 nonhospitalized control women. High sensitivity C-reactive protein levels were measured in the surgical patients. Preoperative cognitive impairment was defined as >2 sd lower scores on > or =2 tests compared with the controls. Cognitive impairment was present in 49 of 108 (45%) patients. C-reactive protein levels were higher for patients with compared with those without cognitive impairment (median, 8.1 mg/L versus 4.7 mg/L; P = 0.04). Based on multivariate logistic regression analysis, patient age, lower attained level of education, type 2 diabetes mellitus, and prior myocardial infarction identified risk for cognitive impairment (P < 0.05) but C-reactive protein levels did not (P = 0.09). In conclusion, cognitive impairment is prevalent in women before cardiac surgery. C-reactive protein levels are increased in women with this condition but the relationship between this inflammatory marker and preexisting cognitive impairment is likely secondary to the acute phase reactant serving as a marker for other predisposing conditions.

Apolipoprotein E ε4 and impaired episodic memory in community-dwelling elderly people: a marked sex difference. The Hordaland Health Study

Background: Among elderly people without dementia, the apolipoprotein E ε4 allele (APOE4) has been associated with cognitive deficit, particularly in episodic memory, but few reports are available on whether this...

Chemotherapy-Induced Cognitive Impairment in Women With Breast Cancer: A Critique of the Literature

To review and critique the studies that have investigated chemotherapy-induced impairments in cognitive function in women with breast cancer. Published research articles and textbooks. Although studies of breast cancer survivors have found chemotherapy-induced impairments in multiple domains of cognitive function, they are beset with conceptual and methodologic problems. Findings regarding cognitive deficits in women with breast cancer who currently are receiving chemotherapy are even less clear. Although data from published studies suggest that chemotherapy-induced impairments in cognitive function do occur in some women with breast cancer, differences in time since treatment, chemotherapy regimen, menopausal status, and neuropsychological tests used limit comparisons among the various studies. Further studies need to be done before definitive conclusions can be made. The potential for chemotherapy-induced impairments in cognitive function may influence patients' ability to give informed consent, identify treatment toxicities, learn self-care measures, and perform self-care behaviors.

Gender-related effect of clinical and genetic variables on the cognitive impairment in multiple sclerosis

Cognitive impairment may occur at any time during the course of multiple sclerosis (MS), and it is often a major cause of disability in patients with the disease. The APOE-epsilon4 allele is the major known genetic risk factor for late onset familial and sporadic Alzheimer's Disease (AD), and it seems to be implicated in cognitive decline in normal elderly persons. To investigate the clinical and genetic variables that can be associated with the cognitive decline in patients with MS. Five-hundred and three patients with clinically definite MS underwent a battery of neuropsychological tests and, according to the number of failed tests, were divided into cognitively normal and impaired. All patients were genotyped for APOE gene polymorphisms. Fifty-six percent of MS patients showed, to different extents, cognitive impairment. Cognitive decline was predominant in men and was associated with disease duration, Kurtzke Expanded Disability Status Scale (EDSS) score, a low level of education, and, interestingly, the epsilon4 allele of the APOE gene. By contrast, cognitive impairment in women was independent of any investigated variable. The findings demonstrate that clinical and genetic factors play a role in men affected by MS developing cognitive impairment.

Estrogen replacement therapy, Alzheimer's disease, and mild cognitive impairment.

This article highlights the latest findings regarding estrogen replacement therapy in the treatment and prevention of Alzheimer's disease (AD) and mild cognitive impairment in women. Despite considerable evidence from observational studies, recent randomized clinical trials of conjugated equine estrogens, alone and in combination with progestin, have shown no benefit for either the treatment of established AD or for the short-term prevention of AD, mild cognitive impairment, or cognitive decline. Based on the evidence, there is no role at present for estrogen replacement therapy in the treatment or prevention of AD or cognitive decline, despite intriguing results from the laboratory and from observational studies. However, numerous questions remain about the biologic effects of estrogens on brain structure and function. Additional basic and clinical investigations are necessary to examine different forms and dosages of estrogens, other populations, and the relevance of timing and duration of exposure.

Critical appraisal of estrogen (replacement) therapy on mood and cognition

The occurrence of depressive symptoms in the perimenopause is associated with a variety of factors. A previous history of either depression and or pre-menstrual syndrome as well as cognitive factors explain most of the variance. There are no consistent findings of a correlation between any serum hormone level and severity or presence of mood symptoms. Neurobiological studies show, with regard to an antidepressant effect, promising effects of estradiol on serotonergic, noradrenergic, cholinergic, dopaminergic and GABAergic functions. Progestogens seem to oppose many of these effects. The role of adrenergic hormones and DHEA(S) is less clear. Most clinical trials showed a modest effect on symptoms of depression. However, the predominantly poor methodological quality does not allow generalisation and recommendations. A “tonic“ effect on well-being in non- or mild depressed women should not be regarded as true antidepressant effect. Results yielded in studies of surgically menopausal women may not be applicable to women with natural menopause. With regard to the domino theory, future studies should also focus on the mediation of treatment effects through alleviation of vasomotor symptoms or sleep quality. With regard to the dementias, the large Womens' Health Initiative revealed an increased risk of cognitive impairment in women 65 y and older treated with estrogen plus progestin. The estrogen only trial is still going on. Even before starting this trial, the available clinical and epidemiological database revealed no relevant effects (except for some verbal functions) in already demented patients and on normal neuropsychological symptoms of ageing. Whether estrogen treatment in earlier periods (e.g. perimenopause) or the endogenous hormone production reduce the risk of dementia in later life, is not clear yet. Overall, pathophysiological interactions of a variety of biological, psychological and social factors must be taken into account when studying the effects on mood and cognition.