Rate of grey matter brain atrophy accelerates after menopause

A study of MRI volumetric measures and cognitive performance in women with MS showed accelerated grey matter brain atrophy after their menopause, independent of chronological age. Atrophy may represent a structural correlate to worsening cognition, although in this study no significant acceleration in cognitive deterioration could be established.

In women with MS, objective disability accumulation accelerates after the final menstrual period. The relationship between menopause and longitudinal changes in brain volume in MS is not clear. Dr Alyssa Nylander (University of California, CA, USA) and colleagues, therefore, analysed changes in MRI volumetric measures and cognitive performance in a cohort of women with MS followed prospectively through their menopausal transition [1].

The study sample was derived from the UCSF Expression/genomics, Proteomics, Imaging, and Clinical (EPIC) study. This is a prospective observational cohort of MS patients evaluated annually since 2004. The researchers selected 184 post-menopausal women with MS, with data collected before and after menopause. Almost all (n=177) contributed brain MRI data, constituting 965 brain MRIs in total. Mean current age was 63 years, median age at natural menopause was 50 years. Median duration of MS was 24 years, and most recent EDSS score was 2.5. The study focused on brain structures that have been associated with cognitive deficits in MS patients, notably atrophy in total grey matter (cortical and deep grey structures), cortical grey matter, and corpus callosum.

After the final menstrual period, Dr Nylander noted modest, but statistically significant worsening in the slopes of cortical grey matter (P=0.0012), total grey matter (P=0.0019), and corpus callosum volume (P<0.0001) in 144 patients with the required data available. No similar change was observed for total brain volume or white matter volume. Dr Nylander added that this model will need further adjustment for potential confounding and contributing factors, such as T2 lesions, use of disease-modifying therapy, vitamin D levels, and BMI.

A trend was noted for worsening of cognitive measures: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), or World health Organisation Disability Assessment Schedule (WHODAS) performance. Since atrophy has been identified as a structural correlate to worsening cognition, Dr Nylander said that more comprehensive cognitive batteries, especially verbal learning and word finding, may be needed to evaluate cognitive changes. Dr Nylander also hopes to perform further in-depth analysis of additional brain regions and substructures relevant to cognition.

1. Nylander A, et al. Accelerated rate of grey matter brain atrophy after menopause in a longitudinal cohort of women with MS. O175, MSMilan 2023, 11–13 October, Milan, Italy.

 

Copyright ©2023 Medicom Medical Publishers



Posted on 4 December, 2023