For eras women’s physical and mental suffering has been trivialized when it is associated with the condition of menopause. But the reality of hot flashes, fatigue, sleep disturbance, moodiness, and discomfiting cerebral performance during menopause is virtually tangible. Various traditional and alternative therapies are used to address these symptoms, from hormone replacement therapy at the allopathic end to black cohosh and essential fatty acids at the complementary end. The brain fog, on the other hand, has been viewed with less fervor until recently.
The Department of Neurology at the University of Rochester, In New York, reported that the memory problems described by women as menopause approaches are real (Weber, Mapstone, et al, 2012). Of course, this is nothing new to the millions of women who have had periods of forgetfulness or fogginess in their 40s and 50s. Their experiences have been validated by a rigorous battery of cognitive tests administered by researchers at Rochester and the U. of Illinois at Chicago. The goal of the study was to find a relationship between subjective reports of memory complaints and objective tests of cognitive function, described as the intellectual process by which a person perceives and comprehends ideas. Included here are all aspects of thought, reason, and recollection. Antipodal is the brain misstep that affects all ages and is characterized by confusion, decreased clarity of thought, and forgetfulness. In some folks this can lead to minor depression on the one hand and delinquency on the other. For as often as this happens to women all over the globe, it still is barely seen as a “real” condition.The subjects who participated in the study completed a comprehensive neuropsychological battery of tests that measured attention, working memory, verbal memory and fluency, visual-spatial skills, and fine motor dexterity. Self-report inventories of perceived memory symptoms were included. The findings indicated a link between the subjective memory faults and actual memory deficits in some, but not all, realms. Working memory and complex attention tasks were most affected. Working memory is the ability to hold information in the mind long enough to perform a complex task regardless of interfering processes and distractions. If this operation is hindered, the person is frustrated. If this recurs, the presentation of depressive symptoms should not be a complete surprise. The physical changes of menopause are identifiable, but the mental changes are not to be identified with the mental aberrations of dementia. Menopausal women can rate their own memory skills; demented ones cannot.
Brain fog can be triggered by physical, psychological, biochemical and even spiritual factors. Some of these are adrenal exhaustion, food and chemical reactions, stress, and nutritional deficiencies. There are, however, age-related cognitive changes that, though of non-dementia origin, can interfere with a person’s daily functioning, which makes this a relevant clinical issue. Overcoming this situation may be as simple as getting enough sleep, exercising, or eating the right foods. Meditation and prayer have been used as first-line treatment in some venues. While the complex relationship of mood, memory and hormones is not identical in every case, it is inferred that the amount of attention paid to a novel situation or perception influences the persistence of memory (Weber & Mapstone, 2009). Overall, if a woman says she experiences disconcerting bouts of forgetfulness, she deserves confirmation that these cognitive signs are part of the array of menopause symptoms (Schaafsma, 2010).
There are factors in the aging process that interact with menopause itself, among them homocysteine values, hypercholesterolemia, metabolic syndrome or type 2 diabetes, hypertension, and depression. If drugs are used to address any of these concerns, and if a drug has anticholinergic properties, there likely will be cognitive impairment to some degree. This compounds the matter, and may lead to improper diagnoses and unneeded treatment for a condition that does not really exist. This class of drugs—the anticholinergics—is used to treat gastric disturbances, urinary problems, respiratory matters, and insomnia, among others disorders that may display themselves as menopause signs in the first place.
The use of hormones to improve mental function in menopause has been hit and miss. Observational studies say one thing, while randomized clinical trials report something else. In a Wake Forest University study it was concluded that using estrogen with progestin to mediate global cognitive function in women over age 65 was less effective than the placebo. In fact, it increased cognitive decline (Rapp, 2003). While no clinically relevant adverse effects were reported, the trial was stopped because of “certain increased health risks for women” (Ibid.). Hedging its bets, another study, following a similar protocol, found a negative effect on verbal memory, but a “trend to” a positive impact on figural memory, with other domains unaffected by the combination of estrogen and progestin (Resnick, 2006). For those who put all their eggs into one basket—the basket of allopathic medicine and Big Pharma—this is an eye-opener.
Walking down the primrose path, we stumble upon complementary medicine or functional medicine or integrative medicine, all of which are supported by evidence-based science, none of which is a sham. Because it can’t be a money-maker for mega-corporations, since natural substances cannot be patented, complementary medicine raises a jaundiced eye. And because your physician has little time to examine the research for himself, being directed by the verbal testimonies of the pharmaceutical representative, he knows little or nothing about the efficacy of alternative modalities.
It’s uncertain whether money, time, compassion, or philosophy drives the Euro-Asian medical community to study alternatives to allopathic treatment more earnestly than happens in the States. Studies on ginkgo biloba that were performed in the last century in the UK have determined that this extract has profound impact on working memory and psychomotor performance at doses of 120 mg a day, with those between ages 50-59 reaping the most benefit (Rigney, 1999). An earlier study, employing 600 mg of ginkgo extract, found significant improvement in memory one hour after administration (Subhan, 1984). If there is concern that these studies are too old to carry any weight, work done in this century agrees (Scholey, 2002) (Kennedy, 2000) In order to “kick it up a notch,” scholars of neuroscience and cognition, also in the UK, decided to combine ginkgo with Panax ginseng—the adaptogen that purportedly increases the body’s resistance to stress, anxiety and fatigue—and to measure the combined efficacy on cognitive benefit in tests of serial arithmetic tasks with varying cognitive load and in tests of memory quality. Two studies found this phytopharmaceutical blend to offer substantial cognitive profit (Wesnes, 2000) and (Scholey, 2002)
Why settle for cognitive improvement alone when the whole body can capitalize on a protocol? Ever hear of phosphatidylcholine? It’s the number one phospholipid from which you are made. It’s a component of each of the trillions of cells that make you, you. You’ve heard the expression, “When Mama’s happy, everybody’s happy?” When the cells are healthy, everything is healthy. That’s what phosphatidylcholine (PC) does: it restores and elevates cellular function and stability. And it enhances learning and memory, and improves cognitive disorders (Nagata, 2011) (Fioravanti, 2005) As an unseen but additional benefit, PC is accompanied in its extraction by phosphatidylethanolamine, a phospholipid that helps to manufacture phosphatidylserine, an ingredient known to attenuate many neuronal effects of aging, and to restore normal memory on a variety of tasks (McDaniel, 2003) It’s possible to lift that fog, after all.
Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000269.
Kennedy DO, Scholey AB, Wesnes KA. The dose-dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers. Psychopharmacology (Berl). 2000 Sep;151(4):416-23.
McDaniel MA, Maier SF, Einstein GO. "Brain-specific" nutrients: a memory cure? Nutrition. 2003 Nov-Dec;19(11-12):957-75.
Nagata T, Yaguchi T, Nishizaki T. DL- and PO-phosphatidylcholines as a promising learning and memory enhancer. Lipids Health Dis. 2011 Jan 28;10:25.
Park DC, Smith AD, Lautenschlager G, Earles JL, Frieske D, Zwahr M, Gaines CL. Mediators of long-term memory performance across the life span. Psychol Aging. 1996 Dec;11(4):621-37.
Rapp SR, Espeland MA, Shumaker SA, Henderson VW, Brunner RL, Manson JE, Gass ML, Stefanick ML, Lane DS, Hays J, Johnson KC, Coker LH, Dailey M, Bowen D; WHIMS Investigators. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003 May 28;289(20):2663-72.
Resnick SM, Maki PM, Rapp SR, Espeland MA, Brunner R, Coker LH, Granek IA, Hogan P, Ockene JK, Shumaker SA; Women's Health Initiative Study of Cognitive Aging Investigators. Effects of combination estrogen plus progestin hormone treatment on cognition and affect. J Clin Endocrinol Metab. 2006 May;91(5):1802-10. Epub 2006 Mar 7.
Rigney U, Kimber S, Hindmarch I. The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers. Phytother Res. 1999 Aug;13(5):408-15.
Schaafsma M, Homewood J, Taylor A. Subjective cognitive complaints at menopause associated with declines in performance of verbal memory and attentional processes. Climacteric. 2010 Feb;13(1):84-98.
Scholey AB, Kennedy DO. Acute, dose-dependent cognitive effects of Ginkgo biloba, Panax ginseng and their combination in healthy young volunteers: differential interactions with cognitive demand. Hum Psychopharmacol. 2002 Jan;17(1):35-44.
Subhan Z, Hindmarch I. The psychopharmacological effects of Ginkgo biloba extract in normal healthy volunteers. Int J Clin Pharmacol Res. 1984;4(2):89-93.
Weber M, Mapstone M. Memory complaints and memory performance in the menopausal transition. Menopause. 2009 Jul-Aug;16(4):694-700.
Weber MT, Mapstone M, Staskiewicz J, Maki PM.
Reconciling subjective memory complaints with objective memory performance in the menopausal transition.
Menopause. 2012 Mar 12.
Wesnes KA, Ward T, McGinty A, Petrini O. The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers. Psychopharmacology (Berl). 2000 Nov;152(4):353-61.
Wilson RS, Beckett LA, Barnes LL, Schneider JA, Bach J, Evans DA, Bennett DA. Individual differences in rates of change in cognitive abilities of older persons. Psychol Aging. 2002 Jun;17(2):179-93.
*These statements have not been evaluated by the FDA. These products are not intended to treat, diagnose, cure, or prevent any disease.