Early menopause linked to poorer cognitive function later in life

Early menopause linked to poorer cognitive function later in life

A team of researchers from the Tokyo Graduate School of Medicine and Medicine and physicians from Tohoku University found that women who entered menopause before age 40 had worse cognitive outcomes than women who entered after age 50. This finding is useful for clinicians in assessing the patient's risk of developing dementia.

These results were published in Alzheimers & Dementia: The Journal of the Alzheimer’s Association on April 15, 2025.

The research team chose to investigate this link because dementia disproportionately affects women worldwide, suggesting that dementia may have risk factors specific to women. Additionally, early menopause is associated with a higher risk of depression later in life, which is a known risk factor for dementia. However, direct evidence on the effects of earlier menopause on the age-related trajectories of depressive symptoms and cognitive function is scarce.

The team used data from the English Longitudinal Study of Ageing, age at menopause in three categories: <40, 40-49 and ≥50 years. The study included 4,726 women and 4,286 men who were assessed on measures of cognitive function such as orientation, immediate and delayed recall, and verbal fluency. The team tested the association between gender and age at menopause and cognitive function two years later, after adjusting for modifiable risk factors for dementia.

When looking for associations, we want to rule out as many other modifiable risk factors for dementia. Because early menopause increases the risk of depression, which then increases the risk of dementia, we needed to control for this factor to determine whether early menopause was itself a direct risk factor. “

Miharu Nakanishi, senior author, Tohoku University Graduate School of Medicine

After controlling for baseline outcome measures and other covariates (such as other modifiable dementia risk factors), menopause at <40 years was significantly associated with poorer 2-year follow-up and immediate and delayed recall compared with ≥50 years. Cognitive function in women who entered menopause at ≥50 years was actually better than the comparison group of men. Hormone replacement therapy (HRT) (a treatment to minimize menopause symptoms) was not associated with cognitive function.

The results imply that women experiencing early menopause may represent a gender-specific group at high risk for cognitive decline. Further research is needed to elucidate the underlying mechanisms of the relationship between female hormones and cognitive functions.

“Understanding this relationship can potentially help us design treatments that delay the onset of dementia in at-risk patients,” says Nakanishi.

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