Prevention of Cognitive Decline and Dementia Following Menopause

**Disclaimer, this article is a lay summary of ‘Cognitive decline and dementia in women after menopause: Prevention strategies’ and therefore follows the terminology used in the original paper, however the information provided applies to anyone who experiences menopause**

Life expectancy has increased worldwide, as reflected in our ageing population. Considering cognitive decline is more prevalent among older people it is important to establish protective measures.

Cognitive Decline in Women

Women account for two-thirds of clinically confirmed dementia cases. Numerous factors contribute to the onset of cognitive decline and dementia, including genetic background, socioeconomic issues, geographic location, environmental influence, metabolic and vascular risks, and sex hormone deficiency. Research suggests that many women report changes in cognition over the menopause transition.

Menopause Symptoms

Most reported symptoms of menopause include hot flushes, night sweats, insomnia, mood disorders and joint pain. These symptoms can be accompanied by cognitive changes, including ‘brain fog’, forgetting the location of items, issues with recalling information and worsening of verbal fluency.

Estrogen & The Brain

Amyloid-beta proteins are overproduced or less effectively cleared from the brains of people with Alzheimer’s disease, leading to the build-up of plaques. Estrogen has antioxidant and protective properties, including protection against plaque buildup in the brain, and aids in the regulation of neuroplasticity (the brains ability to form new connections and adapt). It circulates widely in regions of the brain responsible for memory and cognition, but declines around the menopause transition, and therefore may play a role in the onset of cognitive decline.

Reduced estrogen levels are responsible for metabolic changes in women’s brains after menopause, resulting in glucose hypometabolism in the cortex. Research links the drop in glycose with mitochondrial dysfunction, excessive oxidant stress, and amyloid beta development. All these factors may promote the onset of Alzheimer’s disease.

However, as far as we know, decreases in estrogen levels alone are not solely responsible for cognitive changes during the menopausal transition, but further research is required.

Secondary effects of estrogen deficiency

Cognitive decline can also be triggered by other menopausal symptoms, such as sleep disturbances and depression. However, there is no substantial evidence that women who report cognitive impairment during perimenopausal period have greater risk of developing dementia compared to those who do not report those symptoms.

Prevention Strategies

Some risk factors of cognitive decline in women are more significant during midlife, such as smoking, diabetes, hypertension, and dyslipidemia, these also negatively impact cardiovascular health. Therefore, managing these conditions are key in mitigating the risk of dementia.

A study found that cardiovascular fitness in women during midlife was associated with reduced risk of dementia, with high cardiovascular fitness delaying the onset of dementia by 9.5 years, and time of onset by 5 years compared to medium cardiovascular fitness.

Cardiovascular fitness can be achieved by:

  • Reaching a healthy weight
  • Consuming a balanced diet
  • Reduced alcohol intake
  • Smoking cessation
  • Physical activity
  • Social activity

As dementia is influenced by many factors, the most reasonable prevention is simultaneous intervention.

A study found when individuals monitoring diet, physical activity, cognitive training, and cardiovascular risk reported improvement in cognition over two years. The improvement was seen regardless of sex, age, education, socioeconomic status and baseline cardiovascular health and cognition.

Research is ongoing in whether hormone therapy is effective in preventing cognitive decline and dementia, with some studies suggesting that intervention administered shortly after menopause could have more effective neuroprotective factors compared to those that start late treatment. However, further investigation is needed.

Article by Abigail Davies

Full paper available to read: Stefanowski, B., Kucharski, M., Szeliga, A., Snopek, M., Kostrzak, A., Smolarczyk, R., … & Meczekalski, B. (2023). Cognitive decline and dementia in women after menopause: Prevention strategies. Maturitas168, 53-61.

You Are Not Alone

Remember, you are not alone. If you have concerns about your memory, care for someone with dementia or are looking for additional information and advice the Dementia Hwb is here for you. You can visit the Hwb 7 days a week between 11am-3pm, call us on 01792 304519 or email us on We can also offer memory assessments with the Community Memory Support Team for Swansea Bay University Health Board. This is not a diagnosis but instead designed for people without a diagnosis who are worried about their memory to see if they need further referral to a GP or alternate memory test.

Article by Abigail Davies