Many women report cognitive difficulties — forgetfulness, distractibility, feeling foggy —during the transition to menopause.  While much attention has been devoted to the treatment of vasomotor symptoms, such as hot flashes or night sweats, less attention has focused on the memory difficulties and other cognitive problems many menopausal women may suffer.

A recent study published in JAMA Neurology suggests that metabolic syndrome (MetS; see below for more information) may increase risk for mild cognitive impairment (MCI) and its progression to dementia.  This finding is especially concerning as metabolic syndrome is becoming more common due to a rise in obesity rates among adults. The prevalence of MetS is higher in postmenopausal women than in premenopausal women, increasing as a factor of age and body mass index (BMI).  It is now estimated that between 30% and 60% of postmenopausal women have metabolic syndrome.

In this prospective study carried out in Singapore, the following characteristics were associated with an increased risk of MCI: metabolic syndrome (hazard ratio [HR], 1.46), central obesity (HR, 1.41), diabetes mellitus (HR, 2.84), dyslipidemia (HR, 1.48), and 3 or more component cardiovascular risk factors (HR, 1.58). Progression of MCI to dementia was more common in women with metabolic syndrome (HR, 4.25), diabetes mellitus (HR, 2.47), and 3 or more component cardiovascular risk factors (HR, 4.92).

Given the prevalence of metabolic syndrome, this finding is quite concerning.  The good news is that metabolic syndrome is potentially a modifiable risk factor.  Increasing physical activity,  healthy diet, and weight loss are lifestyle modifications which reduce the risk of metabolic syndrome.  In addition, medications that lower lipid levels and stabilize blood pressure may also be indicated.

What is Metabolic Syndrome?

Metabolic syndrome is a cluster of metabolic risk factors which increase risk for cardiovascular disease, diabetes, and stroke.

According to the American Heart Association, metabolic syndrome occurs when a person has three or more of the following:

  • Abdominal obesity (waist circumference of 40 inches or above in men, and 35 inches or above in women)
  • Triglyceride level of 150 mg/dL or greater
  • HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
  • Systolic blood pressure of 130 mm Hg or greater, or diastolic blood pressure of 85 mm Hg or greater
  • Fasting glucose of 100 mg/dL or greater


Ruta Nonacs, MD PhD

Cooper C, Sommerlad A, Lyketsos CG, Livingston G.  Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis.  Am J Psychiatry. 2015 Apr;172(4):323-34.

Ng T, Feng L, Nyunt M, et al. Metabolic Syndrome and the Risk of Mild Cognitive Impairment and Progression to Dementia: Follow-up of the Singapore Longitudinal Ageing Study Cohort. JAMA Neurol. Published online February 29, 2016. 

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