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The US National Health Institute defines cognitive health through clear thinking capacity together with learning and memorial abilities. The medical field considers progressive cognitive deterioration within older adults to be an escalating issue. Healthy aging remains an uphill battle for most individuals because of cognitive decline. The stages of mental decline reduce our brain functions for perception, attention, reasoning and more importantly learning and memory processes which rely specifically on regions like the hippocampus and frontal cortex. A minimal decrease in brain operation becomes noticeable in physically healthy aged people particularly after they turn sixty.

Approximately 53% of women undergoing menopause underestimate the mental and physical challenges surrounding the perimenopause and menopausal stages, Cognitive challenges may arise In the older women due to

• Chronic health conditions
• Age related emerging diseases
• Injuries due to trauma and minor accidents
• Side effects of various medications

Symptoms of Cognitive Decline

The mental health symptoms faced by the aging women may be

• Anxiety
• depression
• Difficulty with daily chores
• Binge eating
• mood swings and outbursts
• Inability to engage in social activities
• Panic attacks
• Sleep difficulties
• Sexual disharmony due to reduced libido or extreme dryness
• An overwhelming feeling of sadness and demotivation towards any activities

Shifts in the hormonal levels, mainly estrogen and progesterone during menopause can cause mood changes at other stages of life, so it is not entirely surprising that these can feature during the menopause transition too. Menopausal symptoms may have a lasting effect on the mental health of older women and their Quality of Life(QoL).

Symtoms asociated with menopausal transition may be mild in some women, whereas in others the severity may vary, to the extent of being unbearable, and even with a tendency to have suicidal thoughts that may last for more than a few weeks. The doctors identify this condition as a major depressive episode which tends to develop in women who experienced major depression before menopause. The brain responds to unstable oestrogen levels by becoming more susceptible to depression and anxiety in specific women who experience no mental health issues throughout the menopausal transition.

Hot flushes and night sweats alongside sleep disruptions and sexual problems as well as weight fluctuations and forgetfulness associate with menopause often interfere with mental health symptoms.

Various sources of stress from daily life events act as additional challenges for middle-aged women. Midlife brings widespread stress to people as their personal situation and the external world go through updates. Strong mood changes emerge as a result of these effects for certain women. The following circumstances from people's lives affect their mental health status:

• Caring for children
• Empty nest syndrome
• Caring for elderly parents
• Career changes
• Relationship dynamics undergoing shifts
• Ageing
• Body changes
• Illnesses

The main types of Cognitive problems that can arise in this age category are

Epigenetics of Cognitive decline

Epigenetic dysregulation is proposed as one of the underlying mechanisms for cognitive ageing.

Epigenetic dysregulation occurs with cognitive ageing, with, various other mechanisms that may be implicated:

• Chromatin-modifying enzymes regulate transcription essential for memory.
• Changes in histone post-translational modifications
• Changes in DNA methylation and non-coding RNA.
• Disruption in multivariate epigenetic coordination in the hippocampus.
• Changes in synaptic plasticity

Studies within the past few years create hypotheses that epigenetic functions of DNA methylation alongside histone post-translational modifications control gene expression leading to cognitive deficits from aging processes. DNA methylation together with histone acetylation remains essential to regulate gene transcription related to memory function. Whether these epigenetic changes are epiphenomenal or causal is yet to be elucidated.

Pharmacological and lifestyle factors have the potential to change aberrant epigenetic profiles, but more studies and research is needed in this area.

Untangling Physical and Mental health issues

For some women, mental health issues and other physical changes can affect the way they lead their lives and a holistic approach by the family physician or the Gynaecologist to these problems can be very useful in untangling this web. The approach to understanding this complex set of issues can be in the form of:

• Identifying the stage of menopause and its physical and cognitive symptoms.
• Discussing past history of mental health problems, including any premenstrual dysphoria or post partum depression
• Discussing the current set of mental health issues
• Understand the current lifestyle practices that can affect mood, for eg lack of sleep, exercise, change in appetite and eating habits etc.
• Understanding other stressful life circumstances.

Treatment options or Recovery Avenues

Lifestyle changes towards improvement in mental health are quite similar to those recommended for physical well-being in the perimenopause and menopausal stages of life, such as

• Ensuring adequate levels of physical activity
• Adequate sleep
• A wholesome diet rich particularly in Calcium and Vitamin D
• Trying to reduce stress levels surrounding life circumstances
• Seeking additional help in the form of Counselling or Psychothearpy where symptoms are severe or very distressing. Some of these are CBT and Mindfulness.

To address the associated cognitive decline, multiple approaches can be adopted such as

• Herbal remedies
• Hormone replacement therapy in carefully selected patients. The “window of opportunity” hypothesis proposes that following long-term ovarian hormone deprivation, such as in those with premature ovarian failure of surgical menopause at an early age, the brain and The brain gains resistance to externally given estrogens after age-related cognitive changes occur but provides beneficial results when exposed to the hormones at critical peri-menopausal stages. It has therefore been suggested that Menopausal Hormone therapy use in the early postmenopausal years was associated with a lower risk of dementia
• Stem cell based regenerative medicine
• Capitalising on the nootropic potential of Ashwagandha and Brahmi extracts

Conclusion

Cognitive decline, mainly dementia and Alzheimers disease is a pandemic, non-communicable disease. About 1 in 10 women will be diagnosed over the age of 65, with these.

A holistic and tailor-made approach, is essential towards this transition on the lives of older women to ensure proper interventions are implemented for successful aging.

Cognitive decline with conditions like dementia and Alzheimer’s disease, is an increasing global concern, specifically amongst older women. In fact, about one in ten women over 65 is diagnosed with these conditions. Supporting cognitive health during menopause calls for a comprehensive, personalized approach that incorporates lifestyle changes, medical treatments, and psychological support.

Specialized programs, such as a Fellowship in Reproductive Medicine in India, can play a substantial role in enhancing research and treatment strategies for cognitive decline related to menopause. By deepening expertise in reproductive endocrinology and menopause care, these curricula help healthcare professionals develop effective ways to support women through this crucial life stage. This ensures a smoother transition into aging, promoting better cognitive well-being.