Critical menarche age for late-life dementia and the role of education and socioeconomic status

ABSTRACT

Estrogen exposure during menstrual years has been associated with late-life neuroprotection. We explored the presence of an age-sensitive menarche window for cognition in old age and the impact of socioeconomic status and education. We compared neuropsychological performance of 1082 older women [Mean^AGE = 72.69 (5.48)] with menarche in childhood, early-, mid-, and late-adolescence and dementia prevalence, severity, and type, including the effects of education and socioeconomic status. Adjusting for covariates, menarche at 11–14 years of age was associated with better memory, executive and global cognitive functioning in old age, and stronger positive effects of education and socioeconomic status on cognition than those with menarche at 15–17 years. We found a critical age window for the neuroprotective effects of estrogens during early adolescence, putting women with later menarche at higher risk for cognitive decline. Effects of socioeconomic status and education in adulthood should be a focus of future research.

KEYWORDS:

• Menstruation
• cognitive decline
• Alzheimer’s
• aging
• menopause

Acknowledgments

This paper is a collaborative work of the authors, each making unique contributions. Specifically, S.M. formulated the research hypotheses, conducted background research and statistical analyses. She played a central role in composing the article. N.S. contributed to the design of the study protocol, oversaw primary data collection, and provided a thorough revision of the Introduction, Methods, and Results sections offering valuable insights. M.Y. refined the Introduction, Methods, and Results sections, ensuring their alignment with the research design. E.D., G.M.H., and P.S. contributed to the design of the study protocol, oversaw data collection, and provided domain-specific expertise and insights. Finally, M.H.K. oversaw all aspects of the study, including contribution to the design of the study protocol, primary data collection, and secondary data analysis, as well as proofreading the manuscript ensuring accuracy and coherence. All authors have reviewed and approved the final manuscript. We would like to thank all the professionals and researchers who assisted in the data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, M.H.K. The data are not publicly available due to privacy restrictions governed by the General Data Protection Regulation.

Additional information

Funding

This study was supported by the following grants: IIRG-09-133014 from the Alzheimer’s Association; 189 10276/8/9/2011 from the ESPA-EU program Excellence Grant (ARISTEIA), which is co-funded by the European Social Fund and Greek National resources, and DY2b/oik.51657/14.4.2009 from the Ministry for Health and Social Solidarity (Greece).