By Dr. Patricia Yarberry Allen

Dear Dr. Pat,

I am concerned about my worsening cognitive function. I am in excellent health.   I am 50 and have very infrequent periods.  I have a few hot flashes but nothing that I can’t deal with.  

I have a PhD in economics and work in a large and pressured financial institution.  I can’t afford not to be sharp and on my game at all times.  We have had lay-offs throughout our global offices in all departments, certainly in the analytical work that I do.  I worry about my job security for other reasons as well.  The women in my industry, at my level, seem to have the least job security.  I haven’t had a good night’s sleep for about 2 years now, since the pressure at work increased.  And, I know I am depressed about this situation, but this feels like depression that is due to something that I can’t control.  My periods became very irregular at the same time that the stress increased at work and I think that menopause is having a negative impact on my ability to solve problems and retrieve information quickly, always a strength of mine. I don’t have the time or energy to exercise and my diet isn’t that great because I eat on the run or forget to eat altogether.  I do not smoke or use drugs.  I do have 2 glasses of wine every night to take the edge off my difficult days.  There are no other issues in my life that have changed.   No one in my large extended family had any problems with dementia until they were in their late 80’s.  What should I do to find out what is causing this problem?  I can’t tell you how desperate I am to get some answers and to find a plan to think better quickly. 

Margaret

Dear Margaret,

These are very difficult times for most people in the worlds of finance and banking.   It is understandable that you are worried about keeping your job.  We know that some forgetfulness occurs with age but this process can be worsened by many of the things that have become a part of your life for the last few years.  While you do need an evaluation with your personal physician, let’s review the areas in your life that could be adding to the cognitive impairment and look for ways to help you get your game back.

Click below for Dr. Pat's recommendations;

There are a great many reasons for abnormal mental functioning that go beyond the impact of menopausal hormonal change on brain biochemistry. The first step in the management of your symptoms should not be hormone therapy! Find a doctor who specializes in cognitive dysfunction and undergo the appropriate testing so that you won’t be continually frightened by the unknown. Many studies describe the relationship between stress and depression as important risk factors for cognitive decline. Cortisol is a hormone produced in the adrenal glands in response to stress. Evaluations of people who have high levels of cortisol find that they often have cognitive complaints when compared to men and women who have normal cortisol levels . Experts point out that chronic stress can have long-term effects on memory as well. Depression affects learning, cognition and other types of memory. Parts of the brain do not function properly in people who are depressed. In addition, a history of severe depression is associated with the development of dementia in some people as they age. You report that you drink two glasses of wine every night. Observational studies indicate that women who drink one to 6 glasses of wine a week have a decrease in dementia but heavier alcohol consumption is associated not only with cognitive decline, but with depression and sleep disturbances that inhibit cognitive performance. Almost everyone knows that the feeling of a hangover impedes clear thinking. Alcohol also inhibits the absorption of the B vitamins that are important to cognition. You mentioned that you have been sleeping very poorly for the past two years. There is increasing evidence that indicates that continued inadequate sleep (7-8 hours a night is optimal) causes real problems in a number of areas in cognitive performance. Thyroid hormone deficiency is associated with inattentiveness, inability to concentrate, slowing of the thought processes and inability to calculate and to understand complex questions. An evaluation of thyroid function is essential in all patients who are concerned about a change in their cognitive functioning. Deficiencies in the B vitamins can impair cognitive functioning. You noted that you “eat on the run and often forget to eat” so it is possible that you may have low levels in these vitamins. A simple blood test will give you the information about the vitamin replacement that you may need. So let’s review the easy things that you can do that may improve your ability to think clearer, make better decisions, retrieve information better and faster and feel more confident that this loss of cognitive functioning is not beyond your control.

This cognitive make-over has to be your top priority. Change your schedule. Make time to eat in a healthy way. You know the drill: lots of vegetables, low fat dairy products, protein from fish (high in omega 3 fatty acids), lean meat and poultry, whole grains, nuts and fruits in moderation. Eat small meals every 2-3 hours. Studies suggest that being overweight and sedentary increase the risk for dementia. Drink no more than ½ glass of wine a day. Wine interferes with sleep, increases depression and mood disturbance in some people and can affect your cognitive function in the short term and in larger doses in the long term. Find time for daily meditation and exercise; meditation and exercise improve mood and sleep. And, regular exercise improves mental functioning by increasing blood supply to the brain. Check the blood levels of the important B vitamins and make sure that you have the right levels. Discuss other dietary supplements such as omega 3 fatty acids with your doctor. Develop an exit plan from this job that has certainly become toxic. 50 is a great age for reinvention; not just personally, but professionally as well. Find a life coach and review all the skills you have that could lead you to work that can give you joy and a return of confidence. Then address the issue of hormone therapy if this prescription for cognitive health fails.

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