Implications of Menopause Etiology and Hormonal Alterations in Healthy and Neurodegenerative Aging: Impacts on Learning, Memory, and Neurobiological Outcomes

Variations in menopause etiologies, from surgical manipulation to a natural transition, can impact cognition in both healthy and neurodegenerative aging. Although abundant research has demonstrated impacts from surgical versus transitional menopause, such as variations in timing of menopause, both variations in initiation of menopause and length of time since menopause, but not all avenues have been systematically evaluated. Further, assessments of variations in hormone therapies have demonstrated marked outcomes on the brain and cognition in different menopause etiologies, and results can differ depending on type of hormone, combination of hormones, dose, route of administration, among other factors, in regard to healthy aging. Further, the impact of the endocrine system on neurodegenerative disease is multifaceted. Research has highlighted that the endocrine system not only impacts neurodegeneration, such as in Alzheimer’s disease (AD), but that fluctuations in the endocrine system might be strong mediators in disease prevalence and progression. This dissertation seeks to understand how factors such as menopause etiology, biological sex, and hormone therapy impact normative and neurodegenerative aging. Assessments in a rat model of normal aging of progestogen-based hormone therapy given during the transition to menopause demonstrated attenuation of impairment seen with transitional menopause that was working memory specific. In evaluating a rat model of AD, there were distinct trends in neuropathology and associated cognitive changes in males and females with and without gonadal hormone deprivation. Further, assessment of transitional menopause in this AD model yielded an interaction between follicular depletion and genotype for neuropathology that was not present in cognitive assessments. Together, these dissertation chapters highlight that there are a multitude of factors to consider when evaluating effects of menopause and that these variations in experience underscore a need for personalized medicine when selecting therapeutic targets for healthy and neurodegenerative aging that includes consideration of overall hormone milieu and menopause history. Further, these data suggest that the inclusion of males and females in the study of AD-related factors is crucial for understanding disease progression.