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April 2002

Memory and Menopause

Attitudes towards menopause in a group of women followed in a public service for menopause counseling.

This preliminary study addressed some specific attitudes towards menopause, and behavioral styles in menopausal women. The study was conducted during the period January to May 1998 at the Menopausal Service of the Magenta Hospital (Milano) in 88 women, representing almost one half of the patients followed during that period; 43 women were treated with HRT. Some traits characterizing women’s life during menopause were examined, such as presence of disturbing physical symptoms, changes in interests and discovery of new interests, and feelings of loss and uselessness. We used different psychological tests in order to evaluate anxiety and depression, in particular, the STAI (State-Trait Anxiety Inventory), the SDS (Self-rating Depression Scale), and 16 cartoon-like images representing stereotypes of menopause. The answers of our subjects showed high individual variation, with negative symptoms (e.g., hot flashes, memory loss) frequently associated with positive experiences (e.g., new hobbies, new life-styles). However, even the most frequent negative symptom (memory loss) was reported only by 70%. The experience of a change represented by menopause was described both in terms of objective change (e.g., weight increase, hot flashes, memory loss), and of subjective change (e.g., character, feeling of not being attractive, new life-styles). Treatment with HRT seems to reduce the onset of hot flashes considerably. The occurrence of anxious-depressive states was comparable to that observed in other studies; it was not associated with HRT, but rather to losses (loss of desire, memory loss, insomnia). In conclusion, menopause represents a transitional moment in which physical and psychological changes are generally integrated by the persons experiencing them. In order to preserve a good quality of life in menopause, it seems relevant to check memory loss and stabilize the mood in persons who are most “at risk” of psychological disease.

Aging (Milano) 2001 Aug;13(4):331-8

Depressive symptoms, menopausal status and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women’s reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic- regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Psychosom Med 2001 Jul-Aug;63(4):603-8

Midlife women’s attributions about perceived memory changes: observations from the Seattle Midlife Women’s Health Study.

Memory changes are of increasing interest as midlife women approach menopause. Recent studies of relationships between estrogen and Alzheimer’s disease have prompted interest in memory experiences around the time of menopause. The purpose of this analysis, part of the larger Seattle Midlife Women’s Health Study (SMWHS), was to describe the types of memory changes women perceived during midlife, to describe their attributions about the memory changes, and to describe the relationship among these types and attributions of memory changes and age, menopausal transition stage, hormone replacement therapy (HRT) use, stress, and major life roles. Women (n = 230) with a mean age of 46.7 years, enrolled in the SMWHS, described whether they had noticed any changes in their memory, when they noticed them first, the nature of the changes, and what they thought were the reasons for the changes. Types of memory changes were collapsed into five categories, which included difficulty recalling words or numbers, forgetting related to everyday behavior, concentration problems, need for memory aids, and forgetting events. Six categories describing attributions about the memory changes were increased role burden and stress, getting older, physical health, menstrual cycle changes/hormones, inadequate concentration and emotional factors. Stress, physical health and aging as attributions, rather than the menstrual cycle or hormone use, were linked to most types of memory change.

J Womens Health Gend Based Med 2001 May;10(4):351-62

Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey.

OBJECTIVE: The main purpose in organizing this survey was to collect information relevant to The North American Menopause Society’s (NAMS) educational mission and to document women’s knowledge of, and attitudes toward, menopause. DESIGN: During June to July 1997, The Gallup Organization conducted 750 telephone interviews with a randomly selected sample of women 45 to 60 years of age from across the United States. Women were asked about their sources of information on menopause, what changes in health they anticipated as a result of menopause, why they used hormone therapy, and their attitudes toward menopause as a natural or a medical event. RESULTS: Women are more likely to believe that depression and irritability are associated with menopause than heart disease, but only a few associate menopause with an increasing vulnerability to either memory loss or Alzheimer’s disease. Relief of physical symptoms of menopause was mentioned as the reason for starting hormone therapy more often than to protect against osteoporosis (25% relative to 15%), or to prevent stroke or a heart attack (10%), or to reduce the risk of developing Alzheimer’s disease (2%). The single main source of women’s information on menopause was a health professional (49%). The majority of women who were already menopausal or experiencing menstrual changes expressed an attitude toward menopause that was either neutral (42%) or positive (36%). CONCLUSIONS: Women are divided in their views of menopause, some seeing it as a medical condition requiring medical treatment, whereas others see it as a natural transition to be managed by “natural” means. Providing women with accurate, up-to-date information and enhancing communication between healthcare providers and menopausal women remain the challenges for NAMS.

Menopause 1998 Winter;5(4):197-202

Chronic administration of docosahexaenoic acid improves the performance of radial arm maze task in aged rats.

1. In the present study, we investigated the effect of docosahexaenoic acid (DHA) on spatial memory related learning ability in aged (100 weeks) male Wistar rats. 2. Rats were fed a fish oil-deficient diet through three generations and were then randomly divided into two groups. Over 10 weeks, one group was per orally administered 300 mg/kg per day DHA dissolved in 5% gum Arabic solution and the other group was administered the vehicle alone. Five weeks after the start of the administration, rats were tested with the partially baited eight-arm radial maze to estimate two types of spatial memory related learning ability displayed by reference memory error and working memory error. 3. Chronic administration of DHA significantly decreased the number of reference memory errors and working memory errors. 4. The level of lipid peroxide (LPO) in the hippocampus tended to decrease with chronic DHA administration and demonstrated a positive correlation with the number of reference memory errors. 5. These results suggest that the accumulation of hippocampal LPO reduces spatial memory related learning ability in aged rats. Moreover, chronic administration of DHA was effective in decreasing the level of hippocampal LPO, then improving learning ability.

Clin Exp Pharmacol Physiol 2001 Apr;28(4):266-70

Behavioral deficits associated with dietary induction of decreased brain docosahexaenoic acid concentration.

Docosahexaenoic acid (DHA), an n-3 fatty acid, is rapidly deposited during the period of rapid brain development. The influence of n-3 fatty acid deficiency on learning performance in adult rats over two generations was investigated. Rats were fed either an n-3 fatty acid-adequate (n-3 Adq) or -deficient (n-3 Def) diet for three generations (F1-F3). Levels of total brain n-3 fatty acids were reduced in the n-3 Def group by 83 and 87% in the F2 and F3 generations, respectively. In the Morris water maze, the n-3 Def group showed a longer escape latency and delayed acquisition of this task compared with the n-3 Adq group in both generations. The acquisition and memory levels of the n-3 Def group in the F3 generation seemed to be lower than that of the F2 generation. The 22:5n-6/22:6n-3 ratio in the frontal cortex and dams’ milk was markedly increased in the n-3 Def group, and this ratio was significantly higher in the F3 generation compared with the F2 generation. These results suggest that learning and cognitive behavior are related to brain DHA status, which, in turn, is related to the levels
of the milk/dietary n-3 fatty acids.

J Neurochem 2000 Dec;75(6):2563-73

The safety of herbal medicines in the psychiatric practice.

The use of alternative medicines is increasing world-wide and in Israel. These drugs, considered by the Ministry of Health as food supplements, are to be obtained at pharmacies and health stores and are being sold freely, without any professional advice. Many of the herbs are used by patients to treat psychiatric disorders. These herbs have a pharmacological activity, adverse effects and interactions with conventional drugs, which can produce changes in mood, cognition, and behavior. We present the most commonly used herbal drugs, and discuss their safety and efficacy in psychiatric practice. Hypericum-used as an antidepressant and as an antiviral medicine, was reported in 23 randomized clinical trials reviewed from the MEDLINE. It was found to be significantly more effective than placebo and had a similar level of effectiveness as standard antidepressants. Recent studies almost clearly prove that this herb, like most of the conventional antidepressants, can induce mania. Valerian-is used as an anti-anxiety drug, and reported to have sedative as well as antidepressant properties. In contrast to the significant improvement in sleep that was found with the use of valerian, compared to placebo, there are several reports on the valerian root toxicity. This includes nephrotoxicity, headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet. Ginseng-another plant that is widely used as an aphrodisiac and a stimulant. It has been associated with the occurrence of vaginal bleeding, mastalgia, mental status changes and Stevens-Johnson syndrome after it’s chronic administration. It has interactions with digoxin, phenelzine and warfarin. Ginkgo--in clinical trials the ginkgo extract has shown a significant improvement in symptoms such as memory loss, difficulties in concentration, fatigue, anxiety, and depressed mood. Long-term use has been associated with increased bleeding time and spontaneous hemorrhage. Ginkgo should be used cautiously in patients receiving aspirin, NSAIDs, anticoagulants or other platelet inhibitors. Health care professionals can no longer ignore the widespread use of alternative medicines and cannot continue with the “don’t ask, don’t tell” policy. Clinicians should ask the patients about their use of herbs in a non-judgmental way, and should document the patient’s use of these drugs. Finally, we must be more aware of the side effects and the potential drug interactions of these herbs, and advise our patients to avoid long term use of these drugs due to lack of information regarding the safety of these medicines.

Harefuah 2001 Aug;140(8):780-3, 805

Phosphatidylserine reverses reserpine-induced amnesia.

The effects of phosphatidylserine (PS) were studied in rats treated with reserpine (1 mg/kg) immediately after training in the passive avoidance task. In experiment I, phosphatidylserine (25 mg/kg) was administered 30 min before or immediately after training. Acute pre- or post-treatment with phosphatidylserine was effective in reversing the amnestic effect of reserpine in test trials performed 24 h and 1 week after training. Experiment II was performed to determine if the long-term pretreatment with phosphatidylserine (25 mg/kg) for 7 days is able to protect the rats against the amnestic effects of reserpine in this task. The data show that phosphatidylserine reverses the impairment induced by reserpine in trials performed 24 h and 1 week after training. These results indicate that the memory deficits associated with catecholamine depletion caused by reserpine can be attenuated by acute pre- or post-training or by long-term pretreatment with this phospholipid.

Eur J Pharmacol 2000 Sep 15;404(1-2):161-7

Chronic administration of docosahexaenoic acid improves reference memory-related learning ability in young rats.

Wistar rats were fed a fish oil-deficient diet through three generations. The young (five-week-old) male rats of the third generation were randomly divided into two groups. Over 10 weeks, one group was perorally administered docosahexaenoic acid dissolved in 5% gum Arabic solution at 300 mg/kg/day; the other group received a similar volume of vehicle alone. Five weeks after starting the administration, the rats were tested for learning ability related to two types of memory, reference memory and working memory, with the partially (four of eight) baited eight-arm radial maze. Reference memory is information that should be retained until the next trial. Working memory is information that disappears in a short time. Entries into unbaited arms and repeated entries into visited arms were defined as reference memory errors and working memory errors, respectively. Docosahexaenoic acid administration over 10 weeks significantly reduced the number of reference memory errors, without affecting the number of working memory errors, and significantly increased the docosahexaenoic acid content and the docosahexaenoic acid/arachidonic acid ratio in both the hippocampus and the cerebral cortex. In addition, the ratio demonstrated a significantly negative correlation with the number of reference memory errors. These results suggest that chronic administration of docosahexaenoic acid is conducive to the improvement of reference memory-related learning ability, and that the docosahexaenoic acid/arachidonic acid ratio in the hippocampus or the cerebral cortex, or both, may be an indicator of learning ability.

Neuroscience 1999;93(1):237-41

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