A common concern during menopause is how it effects memory.  Science is not always clear as to what changes are from menopause and what is from aging.  Further complicating the issue is the significant effect of sleep and mood on our memory abilities.  Has menopause effected your memory?

The third and final lecture in the HFHS Neuroscience Institute’s “Program for Women- Science for a Healthy Brain” on October 30 was well attended by about 100 people.  Dr. Rhonna Shatz, board certified by American Board of Psychiatry and Neurology, spoke about how memory worked.  She reassured the audience that most concerns about memory have more to do with normal lapses in attention than with serious memory disorders.  For example, it is normal to temporarily forget a person’s name but not normal if one cannot remember the name or the person later.  It is normal to forget for a moment where you are going but not normal to forget how to get home and start to restrict your driving routes.  Other symptoms of dementia include frequent hesitations in word finding or using improper substitutions; frequent errors or extreme slowness in number calculations and forgetting to pay bills; marked and sudden changes in personality or tiring of hobbies with no interest in new pursuits. 

We process different types of memories in different parts of our brains.  Parkinson’s disease effects procedural memory or the ability to remember how to do things.  Alzheimer’s disease effects associative memory or the ability to remember facts or put whole memories together.  Both diseases cause dementia, just different kinds.

Dr. Shatz pointed out that since estrogen is a significant hormone in processing memory, the decrease during menopause certainly may effect memory.  Hmm-the estrogen-memory connection may explain a lot about men, birthdays and anniversaries. Do you think so?  Anyway, mental-pause, as I have heard it refered to, may not be all in our heads.  But in research studies, scores on memory tests do not significantly decrease after menopause.  This suggests that the brain, just like other processes in our body adjust to the changing hormones.   Memory loss is not an inevitable consequence of aging.  Memory declines are largely effected by health.  Since health risks increase with age so do risks for memory disorders.  Health problems which increase risk for memory problems are obesity, depression, high blood pressure, high cholesterol and diabetes.  Lifestyle issues which increase risk for memory problems are lack of sleep, lack of exercise and poor diet. 

 Dr. Shatz was very adamant about the delirious effects of anticholinergic medications on memory and advised avoiding them if possible.  Examples of these are some allergy medications and treatments for active bladder.  She advised talking to your doctor about substitutes.  Also, not surprisingly smoking and alcohol intake is not good.

There are many things we can do to preserve our memory abilities.  Prompt diagnosis and proper management of high blood pressure, high cholesterol, diabetes and depression is so important. Weight management is also very crucial in good brain function. As with so many other health issues, exercise, diet and stress management is key.    Dr. Shatz recommends one hour of aerobic exercise per day.  A diet rich in antioxidants keeps the brain healthy.  Good foods for this include almonds, apples, bluberries, broccoli, grapes, red beans, spinach, sweet potatoes, wheat germ.  The yummy good news is the great benefit of  dark chocolate (milk chocolate doesn’t work).  Maintain good sleep hygiene (see 10/  entry).  Finally, it is recommended to stay engaged in life, maintain social contact with others and to continue to learn and try new things.

Everything seems to be related to everything else.  We expand on this whole theme with this month’s Menopause Support Group Meeting on Wednesday, November 12. Topic- “Screaming Meemees and Other Stress Management Techniques”.  What tried and true methods for coping with the holidays would you like to share?

written by Deborah McBain, CNM MSN

What symptoms are normal and what is not normal during menopause?
During the perimenopause, irregular menstrual periods which may be longer or shorter, heavier or lighter, skipped periods or periods starting every three weeks are all within the norm. Periods coming less than every 21 days or lasting over 7 days should be reported to a health care practitioner.   Spotting between periods or after intercourse should also be evaluated.  Once menopause is reached, any vaginal bleeding should be investigated by a health care practitioner.  Often these irregularities are a result of  hormonal changes but occasionally they can herald more serious problems which should be ruled out.

Some women sail through perimenopause and menopause with nary a problem. Some have all the symptoms in the book.  Hot flashes, mood swings, trouble sleeping, skin changes, dizziness, heart palpitations have all been attributed to the hormonal changes of perimenopause and menopause.  Many women find these things manageable and do not need treatment.  It is best to discuss symptoms with a health care provider.  He or she can determine if any symptoms are suspicious for diseases like thyroid disease which may minic menopausal symptoms.

Symptoms of depression, weight gain, decreased sex drive, sleep disorders and memory loss are commonly atributed to menopause.  Studies do not show a strong relationship between these symptoms and hormonal levels.  These symptoms are often more related to stress or aging.  Unplanned weight gain or loss for which there is no explanation should be looked into.  Any symptom effecting one’s ability to function at home or at work should be investigated.

Coming- Part 3- ”Ok so now what do I do?”- Remedies and Solutions.

written by Deborah McBain, CNM MSN

At our MSG meeting 9/18 several women mentioned that they were unable to get to the 9/11  Neurology Institute sponsored lecture on sleep given by Dr. Kathy Yaremchyuk, chair of the Department of Otalaryngology-Head and Neck Surgery, Sleep Medicine.  I was able to attend and since there is much interest in this subject, I will share my notes with you.  My comments in italics.

• During sleep we cycle back and forth between light sleep and deep sleep.   It is unknown how important each type of sleep is. Normally, as we age the time we spend in light sleep increases and deep sleep decreases.  Arousals and awakenings increase.
• Desire to sleep is driven by a natural circadian rhythm influenced by light exposure, exercise, timing of meals and medications.
• Desire to sleep is also driven by “homeostatic pressure”.  The longer you stay up the more sleep debt you accumulate and the more pressure there is to go to sleep. ( I call this fatigue)
• Most  people need about 8 hours of sleep per night.  Greater than 8 or less than 6 is assoiciated with increased illnesses.  Older people need less sleep.  Men have more sleep disruption than women as they age. (surprising, but maybe we just complain more!)
• Sleep deprivation is associated  with lower pain tolerance, reduced glucose tolerance, increased accidents, decreased ability to learn or remember new information.  Nearly every body system is affected by sleep loss.
• Causes of sleep deprivation include over-stimuation from television, stress, shift work, lifestyles, some illnesses, some medications, body aches and pains (hot flashes?), poor sleep hygiene. (I love the concept of sleep hygiene, it sounds so clean)
• Sleeping pills are a temporary solution to insomnia.  Cognitive or Stimulus Control Therapy has been shown in studies to be as effective as sleeping pills but has the advantage of showing long term results. (HFHS offers Cognitive Therapy sessions. 313-916-4417 for more information)  Tai Chi exercise has also been shown to have long term benefit.
• The goal of therapy is to teach coping skills (and encourage good sleep hygiene) to prevent or minimize recurrance of sleep disturbances.

SLEEP HYGIENE HABITS

• Do not go to bed until you are drowsy.
• Maintain a consistent wake time, including weekends.
• Do not take naps
• Get regular exposure to outdoor or bright lights, especially in late afternoon.
• Keep bedroom quiet, dark and comfortable temperature (cooler is better, if you ask me. Also I suspect a good mattress and pillow are important.)
• Eliminate TV, radio, computer, books or other stimulus (like pets, kids, snoring men?)  
• Remove or turn your bedroom clock around.
• Use your bed only for sleep and sex. (ok, so he can stay )
• Exercise regularly but avoid 4 hours prior to bedtime.
• Avoid excessive fluids or large meals at least 2 hours prior to bedtime.
• Do not snack if you wake up at night.
• Avoid bright lights in the evening and before bedtime.
• Eliminate caffeine at least 6 hours before bedtime
• Stop drinking alcohol and smoking completely or avoid at least 4 hours prior to bedtime,
• Take medications as directed. Never take borrowed prescription medications. 
•  Avoid over-the-counter sleep aids.
• Never command yourself to go to sleep.  Identify sources of stress that affect sleep and address it.

Sweet dreams.

written by Deborah McBain, CNM MSN