Extended Hormone Therapy During Menopause Aids Cognition

Emerging research suggests a longer period of estrogen replacement therapy provides a prolonged cognitive benefit. However, investigators acknowledge that the risk-to-benefit balance of hormone therapy use is complicated and must be individualized.

Research has determined that estrogen has a significant role in overall brain health and cognitive function. This knowledge has fostered various studies on the prevention of cognitive decline as related to reduced estrogen levels during the menopause transition.

The new study suggests a cognitive benefit from a longer reproductive window complemented with hormone therapy. The study, “Lifetime estrogen exposure and cognition in late life: The Cache County Study,” appears online in Menopause, the journal of The North American Menopause Society (NAMS).

Because women comprise two-thirds of the 5.5 million cases of Alzheimer disease in the United States, researchers have long suspected that sex-specific factors such as estrogen may contribute to women’s increased risk for the disease. Moreover, multiple studies have suggested a role for estrogen in promoting memory and learning.

In this newest study involving more than 2,000 postmenopausal women, researchers followed participants over a 12-year period to examine the association between estrogen and cognitive decline.

More specifically, they focused on the duration of a woman’s exposure to estrogen, taking into account such factors as time of menarche to menopause, number of pregnancies, duration of breastfeeding, and use of hormone therapy.

Investigators concluded that a longer duration of estrogen exposure is associated with better cognitive status in older adult women. Furthermore, they documented that these beneficial effects are extended with the use of hormone therapy, especially in the oldest women in the sample.

Women who initiated hormone therapy earlier showed higher cognitive test scores than those who started taking hormones later, providing some support for the critical window hypothesis of hormone therapy.

“Although the assessment of the risk-to-benefit balance of hormone therapy use is complicated and must be individualized, this study provides additional evidence for beneficial cognitive effects of hormone therapy, particularly when initiated early after menopause.

This study also underscores the potential adverse effects of early estrogen deprivation on cognitive health in the setting of premature or early menopause without adequate estrogen replacement,” says Dr. Stephanie Faubion, NAMS medical director.

Source: The North American Menopause Society (NAMS)

Slower Walkers Have Older Brains and Bodies at 45

A new study shows that people with a lower walking speed at the age of 45 have accelerated aging of both their bodies and their brains.

Using a 19-measure scale, researchers at Duke University found that in slower walkers, their lungs, teeth and immune systems tended to be in worse shape than the people who walked faster. MRI exams showed several indications that their brains were also older.

“The thing that’s really striking is that this is in 45-year-old people, not the geriatric patients who are usually assessed with such measures,” said lead researcher Line J.H. Rasmussen, a post-doctoral researcher in the Duke University Department of Psychology and Neuroscience.

“Doctors know that slow walkers in their seventies and eighties tend to die sooner than fast walkers their same age,” said senior author Terrie E. Moffitt, the Nannerl O. Keohane University Professor of Psychology at Duke University, and Professor of Social Development at King’s College London. “But this study covered the period from the preschool years to midlife and found that a slow walk is a problem sign decades before old age.”

The data come from a long-term study of nearly 1,000 people who were born during a single year in Dunedin, New Zealand. The 904 research participants in the current study have been tested, quizzed, and measured their entire lives, mostly recently from April 2017 to April 2019 at age 45.

Researchers note that neurocognitive testing that these individuals took as children predicted who would become slower walkers. At age 3, their scores on IQ, understanding language, frustration tolerance, motor skills, and emotional control predicted their walking speed at age 45, according to the researchers.

MRI exams during their last assessment showed the slower walkers tended to have lower total brain volume, lower mean cortical thickness, less brain surface area and higher incidence of white matter “hyperintensities,” small lesions associated with small vessel disease of the brain. In short, their brains appeared somewhat older, they said.

Adding insult to injury, the slower walkers also looked older to a panel of eight screeners who assessed each participant’s “facial age” from a photograph, the researchers reported.

Walking speed has long been used as a measure of health and aging in geriatric patients, but what’s new in this study is the relative youth of these study subjects and the ability to see how walking speed matches up with health measures the study has collected during their lives, the researchers explained.

“It’s a shame we don’t have gait speed and brain imaging for them as children,” Rasmussen said. (The MRI was invented when they were five, but was not given to children for many years after.)

Some of the differences in health and cognition may be tied to lifestyle choices these individuals have made, the researchers noted.

But the study also suggests that there are already signs in early life of who would become the slowest walkers, Rasmussen said.

“We may have a chance here to see who’s going to do better health-wise in later life.”

The study was published in JAMA Network Open.

Source: Duke University

Photo: A long-term study has found that signs of aging may be detected by a simple walking test at age 45, and that the brains of slower walkers were different at age 3. Credit: Duke University Communications.

Two-Year-Olds From Poor Neighborhoods More Likely to Have Language Difficulties

Two-year-olds from disadvantaged backgrounds are three times more likely to develop difficulties with language than those from more affluent areas, according to a new Scottish study published in the journal JAMA Network Open.

Researchers say the findings highlight the need for policy makers to address the social factors that can hinder speech, language and communication (SLC) development.

Failing to do so means children might not fully develop the language skills necessary for emotional development, wellbeing and educational and employment opportunities.

“Growing up in a disadvantaged neighbourhood where there is poverty and reduced access to services is closely associated with problems with preschool language development,” said Professor James Boardman of Neonatal Medicine at the University of Edinburgh’s MRC Centre for Reproductive Health.

“These results suggest that policies designed to lessen deprivation could reduce language and communication difficulties among pre-school children.”

For the study, a research team from the University of Edinburgh and NHS Lothian in Scotland looked at more than 26,000 records of children who had received a routine health review between 27 and 30 months between April 2013 and April 2016.

The findings show that two-year-olds living in the most economically deprived neighborhoods were three times more likely to have SLC concerns compared to those brought up in better-off areas.

It is believed that growing up in neighborhoods with low income and unemployment — which is related to problems with education, health, access to services, crime and housing — can increase the risk of setbacks.

The researchers also discovered that being born prematurely had an impact on language issues. The findings show that each week a child spent in the womb from 23 to 36 weeks was associated with an 8.8% reduction in the likelihood of the children having an SLC concern reported at 27 months.

A pregnancy is considered full term between 39 weeks and 40 weeks, 6 days, while preterm birth is defined as delivery before 37 weeks of gestation. Socioeconomic disadvantage has also been associated with a greater risk for preterm birth.

Although the research team looked at birth data from children born in the Lothians, experts say similar results might be expected across the United Kingdom.

Source: University of Edinburgh

Young Adults’ Income Slump May Hike Risk of Middle-Aged Cognitive Issues

A new study suggests that experiencing an annual income drop of 25 percent or more during young adulthood may increase the risk of developing thinking problems and reduced brain health in middle age.

“Income volatility is at a record level since the early 1980s and there is growing evidence that it may have pervasive effects on health,” said study senior author Adina Zeki Al Hazzouri, Ph.D., assistant professor of epidemiology at Columbia Mailman School of Public Health.

“Our study followed participants in the United States over 30 years, including the recession time in the late 2000s when many people experienced financial instability. Our results provide evidence that higher income volatility during peak earning years are associated with worse brain aging in middle age.”

The study, which appears online in Neurology®, involved 3,287 people who were 23 to 35 years old at the start of the study. Participants were enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study, which includes a racially diverse population.

Study members reported their annual pre-tax household income every three to five years for 20 years, from 1990 to 2010.

Researchers examined how often income dropped as well as the percentage of change in income between 1990 and 2010 for each participant. Based on the number of income drops, participants fell into three groups: 1,780 people who did not have an income drop; 1,108 who had one drop of 25 percent or more from the previous reported income; and 399 people who had two or more such drops.

Participants were given thinking and memory tests that measured how well they completed tasks and how much time it took to complete them. For one test, participants used a key that paired numbers 1 to 9 with symbols. They were then given a list of numbers and had to write down the corresponding symbols.

Researchers found that people with two or more income drops had worse performances in completing tasks than people with no income drops. On average, they scored worse by 3.74 points or 2.8 percent.

“For reference, this poor performance is greater than what is normally seen due to one year in aging, which is equivalent to scoring worse by only 0.71 points on average or 0.53 percent,” said first author Leslie Grasset, Ph.D., of the Inserm Research Center in Bordeaux, France.

Participants with more income drops also scored worse on how much time it took to complete some tasks.

The results were the same after researchers adjusted for other factors that could affect thinking skills, such as high blood pressure, education level, physical activity and smoking.

There was no difference between the groups on tests that measured verbal memory.

Of the study group, 707 participants also had brain scans with magnetic resonance imaging (MRI) at the beginning of the study and 20 years later to measure their total brain volume as well as the volumes of various areas of the brain.

Researchers found when compared to people with no income drops, people with two or more income drops had smaller total brain volume. People with one or more income drops also had reduced connectivity in the brain, meaning there were fewer connections between different areas of the brain.

According to the researchers, there may be several explanations as to why an unstable income may have an influence on brain health. Potential influences may include that people with a lower or unstable income could have reduced access to high quality health care. This could result in worse management of diseases like diabetes, or management of unhealthy behaviors such as smoking and drinking.

While the study does not prove that drops in income cause reduced brain health, it does reinforce the need for additional studies examining the role that social and financial factors play in brain aging.

Source: Columbia University Mailman School of Public Health/EurekAlert

Menopausal Night Sweats Linked to Impaired Cognitive Performance

A new study suggests that women who experience night sweats are more vulnerable to cognitive dysfunction as their sleep duration increases.

Previous studies have shown a link between daytime hot flashes and worse memory performance.

In this new study involving women with a history of breast cancer, however, researchers focused on night sweats and how they relate to total sleep time. Surprisingly, more frequent night sweats were associated with greater sleep duration, according to the researchers.

Even more surprising, they said, was the finding that these same women experiencing night sweats became more vulnerable to prefrontal cortex deficits, including decreased attention and executive function, as their sleep duration increased.

Total sleep time, however, was unrelated to memory performance, they noted.

The researchers also discovered that daytime hot flashes had no impact on total sleep time.

“This work presents novel insights into the influence of menopause symptoms on cognitive performance among women with a history of breast cancer and raises the possibility that hot flash treatments could benefit cognition in these women through effects on sleep,” said lead author John Bark, doctoral student in behavioral neuroscience the University of Illinois at Chicago.

“Studies like this are valuable in helping health care providers develop effective treatment options for menopausal women complaining of cognitive decline as they focus on modifiable risk factors,” added Dr. Stephanie Faubion, medical director for The North American Menopause Society.

The study findings were presented during 2019 North American Menopause Society (NAMS) annual meeting.

Source: The North American Menopause Society

Seafood in Early Pregnancy May Improve Attention in Kids

A new study finds that eating a seafood-rich diet during early pregnancy is associated with better attention outcomes in children.

A team of scientists from the Barcelona Institute for Global Health (ISGlobal) evaluated 1,641 mother-child pairs from the INMA Environment and Childhood Project, a Spanish cohort study focused on the role of pollutants during pregnancy and their effects on children.

Over the course of their pregnancies, the mothers completed numerous food-frequency questionnaires which assessed how often they ate more than a hundred different food items, including various types of seafood, including fatty fish, lean fish, canned tuna and shellfish.

Data on the children’s dietary habits were also collected using the same questionnaire at one, five and eight years of age. At eight years of age, the children also completed the Attention Network Task (ANT), a computer-based neuropsychological test designed to assess attention function.

The researchers found that children whose mothers ate a diet rich in various types of seafood scored very well on the attention tests, as did children of women with a diet rich only in fatty fish. However, scores were lower in children whose mothers relied on canned tuna or shellfish for their seafood intake.

Brain development takes place primarily during pregnancy. Essential nutrients such as polyunsaturated fatty acids (PUFAs) play a fundamental role in this development.

“Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are the main omega-3 PUFAs involved in neurological development, and seafood is the main source of both of them,” said Dr. Jordi Júlvez, researcher in the Childhood & Environment programme at ISGlobal and lead author of the study.

“The consumption of seafood during the first trimester of pregnancy had a greater effect on children’s attention capacity than the consumption of seafood later in pregnancy or at five years of age, by which time some neurodevelopmental processes have already been completed.”

Because these nutrients participate in the development of fetal brain structure and function, they have a large impact on later neuropsychological development. Attention is a complex behavior that all children must learn, since it precedes other crucial functions such as memory.

“We focused on the attention function because attention-deficit hyperactivity disorder is common in school-age children,” commented Dr. Jordi Sunyer, head of the Childhood & Environment programme at ISGlobal.

Despite the promising results of this study, the authors of previous research have reported a link between the consumption of fish during pregnancy and childhood obesity and increased blood pressure.

As a result, experts insist on the need for more research on this subject to determine exactly which species of fish and what quantities may be beneficial to fetal development.

The findings are published in the International Journal of Epidemiology.

Source: Barcelona Institute for Global Health (ISGlobal)