年龄、月经史与大脑。

Age, menstruation history, and the brain.

机构信息

Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Florey, Canberra, ACT, Australia.

Norwich Medical School, University of East Anglia, Norwich, United Kingdom.

出版信息

Menopause. 2020 Oct 26;28(2):167-174. doi: 10.1097/GME.0000000000001688.

DOI:10.1097/GME.0000000000001688

PMID:33109997

Abstract

OBJECTIVES

To investigate the cross-sectional association between measures of menstruation history (including menopausal status, age of menopause, age of menarche, and duration of reproductive stage) and brain volume.

METHODS

Women (aged 45 to 79 years) from the UK Biobank were included (n = 5,072) after excluding those who had (1) hysterectomy or bilateral oophorectomy, (2) ever used menopausal hormone therapy, (3) ever had a stroke, or (4) were perimenopausal. Multiple linear hierarchical regression models were computed to quantify the cross-sectional association between measures of menstruation history and brain volume. Sensitivity analysis based on propensity matching for age (and other demographic/health covariates) were applied to estimate differences in brain volumes between matched premenopausal and postmenopausal women.

RESULTS

Postmenopausal women had 1.06% (95% confidence interval [CI]; 1.05-1.06) and 2.17% (95% CI, 2.12-2.22) larger total brain volume (TBV) and hippocampal volumes (HV), respectively, than premenopausal women. Sensitivity analysis with age matched samples produced consistent results (TBV: 0.82%, 95% CI, 0.25-1.38; HV: 1.33%, 95% CI, 0.01-2.63). For every year increase in age above 45 years, postmenopausal women experienced 0.23% greater reduction in TBV than premenopausal women (95% CI, -0.60 to -0.14), which was not observed for HV. Moreover, every 1 year delayed onset of menopause after 45 was associated with 0.32% (95% CI, -0.35 to -0.28) and 0.31% (95% CI, -0.40 to -0.22) smaller TBV and HV, respectively. Every additional year in age of menarche was associated with 0.10% (95% CI, 0.04-0.16) larger TBV, which was not detected for HV. Similarly, every 1 year increase in duration of reproductive stage was associated with 0.09% smaller TBV (95% CI, -0.15 to -0.03), which was not detected for HV.

CONCLUSIONS

Menopause may contribute to brain volume beyond typical aging effects. Furthermore, early age of menarche, delayed age of menopause and increasing duration of reproductive stage were negatively associated with brain volume. Further research is required to determine whether the negative association between age of menopause and HV is potentially an indicator of future vulnerability for dementia.

摘要

目的

探讨绝经史（包括绝经状态、绝经年龄、初潮年龄和生殖期持续时间）与脑容量的横断面关联。

方法

在排除（1）子宫切除术或双侧卵巢切除术、（2）曾使用绝经激素治疗、（3）曾中风或（4）围绝经期的情况下，纳入英国生物库的女性（45 至 79 岁）（n=5072）。采用多元线性分层回归模型来量化绝经史测量指标与脑容量之间的横断面关联。基于年龄（和其他人口统计学/健康协变量）的倾向匹配进行敏感性分析，以估计匹配的绝经前和绝经后女性之间脑容量的差异。

结果

与绝经前女性相比，绝经后女性的总脑容量（TBV）和海马体积（HV）分别大 1.06%（95%置信区间[CI]：1.05-1.06）和 2.17%（95% CI，2.12-2.22）。使用年龄匹配样本进行的敏感性分析得出了一致的结果（TBV：0.82%，95% CI，0.25-1.38；HV：1.33%，95% CI，0.01-2.63）。与 45 岁以上的绝经前女性相比，每增加 1 岁，绝经后女性的 TBV 减少 0.23%（95% CI，-0.60 至 -0.14），而 HV 则没有观察到这种情况。此外，45 岁以后绝经年龄每延迟 1 年，TBV 和 HV 分别减少 0.32%（95% CI，-0.35 至 -0.28）和 0.31%（95% CI，-0.40 至 -0.22）。初潮年龄每增加 1 岁，TBV 增加 0.10%（95% CI，0.04-0.16），而 HV 则没有检测到这种情况。同样，生殖期持续时间每增加 1 年，TBV 减少 0.09%（95% CI，-0.15 至 -0.03），而 HV 则没有检测到这种情况。