Despite being one of the most commonly-reported symptoms of perimenopause and menopause, we know remarkably little about “brain fog” – forgetfulness, difficulty concentrating and challenges with multi-tasking.
Associate Professor Caroline Gurvich is exploring these cognitive challenges, which can wreak havoc on women’s workforce participation, their resilience as they navigate multiple responsibilities such as kids, work and ageing parents, and general wellbeing.
The information vacuum is stark, says the clinical neuropsychologist and deputy director of Monash University’s HER Centre Australia.
“There are no specific or sensitive assessments for this group to measure functions like memory, attention and language; no specific clinical guidelines; and no evidence-based treatments.
“A lot of menopause clinical management has revolved around hot flushes and night sweats,” says Associate Professor Gurvich. “But the cognitive challenges need urgent attention through screening and management. With many women worldwide reporting these as their No.1 symptom, it really is time.”
In a series of three recent journal publications focusing on awareness, measurement and treatment, Associate Professor Gurvich and her PhD candidates and colleagues have explored questions such as:
- Does women’s experience of brain fog match what scientists have found?
- What’s the interplay between plummeting estrogen and the pressures of “sandwich generation” life that sees many women juggling kids, jobs, elderly parents and “The Change”?
- Can we tell the difference between this usually transient condition and telltale signs of incipient dementia?
In an invited editorial for the Australiasian Journal on Ageing, Associate Professor Gurvich and her colleague and collaborator Professor Aimee Spector (UCL) noted that too many women receive inappropriate dementia referrals.
The team is working with the British and Australian menopause societies to develop objective measures and guidelines for doctors to assess brain fog in the menopausal transition.
“We don’t have any neuropsychological tests right now that are sensitive enough to detect brain fog, per se, that could be rolled out easily in GP clinics,” Associate Professor Gurvich says. “But there are several areas GPs should consider that might be contributing to cognitive symptoms, such as sleep and mood, as well as conditions that may not be related to the hormonal changes of menopause, such as low iron and autoimmune conditions, that can be picked up through blood tests, such as low iron and autoimmune conditions.”
Getting to the heart of brain fog
In a study published in the journal Menopause, Associate Professor Gurvich and her co-authors looked at challenges women aged 40-60 faced in retrieving information and attention.
They cautiously suggest that while “subjective” (or self-reported) brain fog can be devastating, it usually resolves soon after menopause (the day of the final menstrual period).
Diet, caffeine and alcohol consumption, exercise and attitudes to menopause had both direct and indirect effects. “There’s a lot for researchers to explore in the interactions between these modifiable lifestyle factors.”Fewer than a third of women in the study were on menopausal hormone treatment (MHT) or hormone replacement therapy (HRT), and it’s unclear whether MHT helps cognition – this is an area that needs further research. Surprisingly, given earlier longitudinal research, age did not emerge as a major factor in cognitive challenges. The big differentiator turned out to be mindfulness.
“This opens the way for further research on the effectiveness of mindfulness interventions, especially for women who are diagnosed with attention deficit disorder at this stage of their lives,” Associate Professor Gurvich says.
Read more: I’m a woman approaching middle age – do I need to get my hormones checked?
In a review published in the Journal of the International Neuropsychological Society, her and her colleagues argued for work on a “theory of brain fog” to take it out of the realm of the purely subjective, and help clinicians differentiate it from dementia and ADHD, as well as measure severity and identify the impact of different treatments.
“This period of life is often described as a window of vulnerability,” wrote Associate Professor Gurvich and her co-authors. “We’re proposing that it’s also a window of opportunity to build brain health and reduce longer-term dementia risk.”
