Losing your train of thought, struggling to recall familiar words, or even forgetting why you walked into a room can lead older adults to question whether they might be experiencing early signs of Alzheimer’s or dementia. However, experts suggest that these memory slips may often be linked to hormonal changes that occur later in life, particularly in women who experience a decline in estrogen during perimenopause and menopause.
Dr. Rhonda Voskuhl, a neurology professor at UCLA and co-founder of Cleopatra RX in Los Angeles, noted that women dealing with memory issues in midlife should reflect on their cognitive performance compared to how it was in the past before jumping to conclusions about serious ailments. “I think they should listen to themselves,” Voskuhl advised during the Livelong Women’s Health Summit in New York City. “They know. Just ask yourself.”
The 10-year assessment
To help assess if current memory lapses are related to hormonal changes, Voskuhl suggests a quick benchmark: comparing one’s mental state now to ten years ago. “The first question is, are you worse than you were 10 years ago?” she explained, referring to the Voskuhl Brain Fog Menopause Assessment used at UCLA’s Comprehensive Menopausal Program.
“Ten years is a pretty good spot. And they think, ‘What was I doing 10 years ago? Was I having trouble finding words? Could I multitask? Was I slower in processing?’ And they’ll recall,” she added. This comparison might help women and their physicians determine if cognitive changes are indeed related to menopause while establishing a baseline for monitoring symptoms over time.
The NFL analogy
Standard memory tests often miss subtle shifts in cognitive function, a phenomenon known in the medical field as subjective cognitive decline, where patients notice changes even though their neurological tests come back normal. The CDC reports that about one in nine adults mention experiencing subjective cognitive decline, but fewer than half ever discuss these memory issues with healthcare providers.
Voskuhl used the analogy of a high-performing athlete to illustrate this issue. “If an NFL player says, ‘I’m weaker than I used to be,’ and my tests say, ‘Oh no, you’re still strong,’ it doesn’t change what the player feels,” she pointed out. The same applies to women who might recognize cognitive shifts based on their past performance and should trust those intuitions.
Experts agree that differentiating between hormonal brain fog and neurodegenerative diseases involves looking at how memory loss affects daily life. Typically, menopausal brain fog consists of temporary and inconsistent lapses, like misplacing items, with reasoning skills and independence remaining intact. However, early signs of dementia lead to continuous memory loss that disrupts basic activities, such as managing finances or navigating familiar routes.
If cognitive concerns arise, experts recommend a thorough medical evaluation to rule out other conditions, including brain scans or screenings for blood vessel diseases and thyroid imbalances. Dr. Voskuhl emphasized, “When they have doctors who don’t listen to them, they need to find another doctor.”
