ó After C. Neill Epperson, a psychiatrist who directs the
Penn Center for Womenís Behavioral Wellness, listened to
many patients complain about their brains as they approached
and entered menopause, she had an idea.
would tell her that they couldnít juggle as much as they
used to. They had to write something down instantly or the
thought would disappear. They felt foggy and disorganized.
Some worried that they had dementia.
symptoms didnít sound like dementia to Epperson, but they
did sound like something else: attention deficit disorder.
thought, "Wow, these issues are really similar to what
you see in ADHD. We need to do something about this."
the women didnít really have ADHD ó a developmental
disorder that starts in childhood ó but she wondered if
drugs for attention-deficit patients might also help
tried one of them, lisdexamfetamin (Vyvanse), in a small study
funded by the drugís maker, Shire. On average, the 32
patientsí scores rose by 20 points on the 120-point Brown
Attention-Deficit Disorder Scale after four weeks on the drug.
think that a psychostimulant might boost anyoneís
performance, Epperson said the drug didnít help everyone.
"The people it helped, it really helped," she said.
of the patients didnít want to stay on the drug because
insurers wouldnít cover the cost.
can increase heart rates and blood pressure, so theyíre not
discussed her study at two professional meetings last week. It
has not yet been published.
doesnít know what percentage of women develop executive
function symptoms or whether aging men get them at the same
time. She studies only women.
attributes the cognitive changes to the drop in estrogen
during menopause. The hormone supports chemical signaling in
the brain and promotes healthy brain cells. It is present in
both male and female brains.
Maki, a psychologist at the University of Illinois at Chicago
who studies cognition during the transition to menopause, said
Eppersonís approach is unusual. "Itís definitely
novel," she said. "Itís a hypothesis thatís
certainly worth studying."
said recent studies have found changes in age and memory as
women go through menopause. She is "cautiously
optimistic" that most women return to baseline within
three or four years after official menopause. Thinking seems
most disrupted in the two years before and the two years after
worries that the prolonged period of hormonal disruption may
somehow make women more vulnerable than men to Alzheimerís
disease. She is studying whether early, limited estrogen
treatment can help women emerge from this transition with
causes changes that are independent of normal brain aging,
which also is associated with a decline in executive function.
Maki said that going through menopause is the equivalent of
feeling about four years older than you are, brain-wise.
most women will feel themselves again. Researchers donít yet
know whether the brain begins producing more estrogen or
begins solving problems in different ways.
LaCroix, a menopause expert at the University of California,
San Diego, said the average age for periods to stop is 51.
Typically, women have symptoms from, say, 45 to 55.
some women may have trouble thinking because hot flashes keep
them from sleeping. The hormonal transition also occurs at a
time when many women are seriously stressed. Theyíre at peak
earning potential and may be helping children, parents, and
think weíre in general overloaded with stimuli these
days," she said. "Midlife women have an awful lot to
said the women in her study were considerably smarter than
average. In her practice, she said, the women who are noticing
these changes are doctors, professors, CEOs, doing
intellectually challenging work that requires lots of
women who notice this are the ones that are pushing the
cognitive load really hard," she said.
study looked at five domains: organization and activation for
work; sustaining attention; sustaining alertness, effort, and
processing speed; being able to work while distracted by
strong emotions; and using memory and working memory, which is
the ability to hold thoughts in your head while working with
with emotional interference were not affected by the drug, but
the other domains were.
who went into menopause four years ago at age 46, takes
estrogen herself. She says treatment for cognitive symptoms
needs to be tailored to each patient. "No one treatment
is good for everybody," she said.
worried that her research will make others question older
women. "We canít pussyfoot around," she said.
"Iím just trying to figure out how to help women, who
are going to live longer than men, live the best life they
can. I donít think thatís stigmatizing."
in no hurry to medicalize menopause, but thinks medicines have
a role for women who are struggling: "If women are doing
all the right stuff and theyíre still not thinking clearly,
why not go for a little chemical help?"
others, she said the best thing anyone can do to protect the
brain is to exercise.