According to the World Health Organization (WHO), more than 55 million people have dementia globally. Though the major risk factor is increased age, sex differences also contribute to dementia development, with women twice as likely to develop Alzheimer’s disease, dementia’s most common form.
This is likely to be because women have longer life expectancies; however, loss of the hormone oestrogen after menopause onset may also contribute. Later-life (50 years and older) cognitive decline is a risk factor for dementia and menopause is associated with worsened cognition, but it is unclear from studies whether this cognitive decline is caused by the end of the menstrual cycle or by menopausal symptoms. In research published in March 2025 in PLoS ONE, Jasper F E Crockford and colleagues measured the relationship between menopausal symptoms and later-life cognitive changes. The study found that every additional menopausal symptom was associated with a 5.37% higher everyday cognition scale (ECog-II) score, with higher scores associated with cognitive decline.
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Baseline data was collected from participants from the CAN-PROTECT study. This online observational cohort study recruited dementia-free participants 18 years and older living in Canada. Participants completed a demographic questionnaire and online assessments on multiple themes including cognition. Menopausal symptoms were measured using the menopausal symptom burden scale comprising 11 symptoms, with scores ranging from 0 to 11 based on symptom burden. ECog-II was used to assess cognition and consisted of questions assessing memory changes, language, visual-spatial and perceptual abilities, planning, organisation and executive function. These questions were rated from 0 to 3, with 0 representing no change in cognition and 3 representing much worse cognition relative to the participant’s baseline.
Each symptom was linked to a 5.37% increase in cognitive decline score
In total, 896 menopausal participants assigned female at birth were included in the study, 666 of whom experienced menopausal symptoms. Menopausal symptoms were associated with worse cognition, with every additional symptom being associated with 5.37% higher ECog-II scores. Age of menopausal onset, progestin or unnamed hormone therapy use and hormone therapy use did not affect this association.
The study by Crockford and colleagues provides evidence for the number of menopausal symptoms being a key risk factor of cognitive decline, which in turn is associated with increased dementia risk. Assessing menopausal symptom burden could therefore be a useful predictor for identifying at-risk groups for dementia. However, this study had a small sample size, and its results will need to be validated by studies with larger sample sizes. Additionally, it used an online self-completion questionnaire, which is subject to response bias, and its cross-sectional design makes it difficult to establish cause and effect.
GlobalData epidemiologists forecast that in the sixteen major markets (16MM: Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, Russia, South Africa, South Korea, Spain, the UK and the US), diagnosed prevalent cases of dementia in those aged 60 years and older will increase from 17.0 million cases in 2025 to 21.5 million cases in 2032 for women, and from 7.6 million cases in 2025 to 9.5 million cases in 2032 for men.
