2023 Sex and Gender in Alzheimer’s (SAGA) Grant (SAGA)
Evaluating Memory as Part of Women's Routine Care
How would screening for memory issues during routine well woman (OB/GYN) visits improve treatment and diagnosis for cognitive impairments?
Stephanie Cosentino, Ph.D.
Columbia University Medical Center
New York, NY - United States
Background
Women are at increased risk for Alzheimer’s, constituting more than two thirds of all individuals living with Alzheimer’s in the United States. Women also experience earlier and more Alzheimer’s-related brain changes and show faster cognitive and psychological decline.
Because studies have shown that women often see their OB/GYN as their sole healthcare provider, some experts believe cognitive screenings should be included as part of well-women care for older women. In a small study, Dr. Consentino and colleagues launched a cognitive screening initiative for 500 post-menopausal women at well woman visits. Using a brief cognitive screener at well woman visits, 17% of women showed possible memory issues, and half of those women pursued appointments with a memory specialist.
It is important to understand whether cognitive screening would benefit women earlier than typical cognitive tests are administered because cognitive complaints are frequent in women during midlife and across the menopause transition—the stage preceding the last menstrual period (also known as peri-menopause). Studies also suggest that the hormonal changes during the menopause transition are a critical window of vulnerability to the onset of Alzheimer’s.
Research Plan
Dr. Consentino will recruit 400 women who are experiencing menopause transition (around age 45) who will complete a brief, subjective cognitive screening in the waiting room prior to a well woman exam. Following the exam, individuals will be asked to complete the tablet-based clinical cognitive test, and demographic and health surveys. They will also recruit 200 women ages 45-60 to assess features of the menopause transition, including hormone levels (measured with a blood test) and self-reported menopausal symptoms.
They will study the number of peri-menopausal women who show possible memory issues compared to their data from menopausal women. They will also determine whether the subjective cognitive screening was an accurate predictor of results on the tablet-based version of a clinical screening. Finally, they aim to examine the links between poorer cognitive performance and hormone levels, menopausal symptoms, and other demographic information.
Impact
The results of this study may help improve diagnosis of cognitive impairment in women and provide a better understanding of the role menopause plays in cognitive decline.