From the Department of Psychiatry (R.C.T., M.W., H.J.A.), Epidemiology (R.C.T., E.A.B.-M.), Psychology (R.C.T.), and Neurosurgery (Y.-F.C.), University of Pittsburgh, PA; Department of Neurology and Epidemiology and Population Health (C.A.D.), Albert Einstein College of Medicine, Bronx, NY; and Department of Psychiatry (P.M.), University of Illinois at Chicago, IL.
Neurology. 2023 Jan 10;100(2):e133-e141. doi: 10.1212/WNL.0000000000201401. Epub 2022 Oct 12.
The menopause transition is increasingly recognized as a time of importance for women's brain health. A growing body of work indicates that the classic menopausal symptom, vasomotor symptom (VMS), may be associated with poorer cardiovascular health. Other work links VMS to poorer cognition. We investigate whether VMS, when rigorously assessed using physiologic measures, are associated with greater white matter hyperintensity volume (WMHV) among midlife women. We consider a range of potential explanatory factors in these associations and explore whether VMS are associated with the spatial distribution of WMHV.
Women aged 45-67 years and free of hormone therapy underwent 24 hours of physiologic VMS monitoring (sternal skin conductance), actigraphy assessment of sleep, physical measures, phlebotomy, and 3 Tesla neuroimaging. Associations between VMS (24-hour, wake, and sleep VMS, with wake and sleep intervals defined by actigraphy) and whole brain WMHV were considered in linear regression models adjusted for age, race, education, smoking, body mass index, blood pressure, insulin resistance, and lipids. Secondary models considered WMHV in specific brain regions (deep, periventricular, frontal, temporal, parietal, and occipital) and additional covariates including sleep.
The study sample included 226 women. Physiologically assessed VMS were associated with greater whole brain WMHV in multivariable models, with the strongest associations observed for sleep VMS (24-hour VMS, B[SE] = 0.095 [0.045], = 0.032; Wake VMS, B[SE] = 0.078 [0.046], = 0.089, Sleep VMS, B[SE] = 0.173 [0.060], = 0.004). Associations were not accounted for by additional covariates including actigraphy-assessed sleep (wake after sleep onset). When considering the spatial distribution of WMHV, sleep VMS were associated with both deep WMHV, periventricular WMHV, and frontal lobe WMHV.
VMS, particularly VMS occurring during sleep, were associated with greater WMHV. Identification of female-specific midlife markers of poor brain health later in life is critical to identify women who warrant early intervention and prevention. VMS have the potential to serve as female-specific midlife markers of brain health in women.
更年期过渡阶段日益被视为女性大脑健康的重要时期。越来越多的研究表明，经典的更年期症状——血管舒缩症状（VMS）可能与心血管健康状况较差有关。其他研究将 VMS 与认知能力下降联系起来。我们调查了使用生理测量方法严格评估的 VMS 是否与中年女性的大脑白质高信号体积（WMHV）增加有关。我们考虑了这些关联中的一系列潜在解释因素，并探讨了 VMS 是否与 WMHV 的空间分布有关。
年龄在 45-67 岁且未接受激素治疗的女性接受了 24 小时生理 VMS 监测（胸骨皮肤电导率）、睡眠活动记录仪评估的睡眠、身体测量、采血和 3T 神经影像学检查。在调整年龄、种族、教育程度、吸烟、体重指数、血压、胰岛素抵抗和血脂后，在线性回归模型中考虑了 24 小时、觉醒和睡眠 VMS（通过活动记录仪定义觉醒和睡眠间隔）与全脑 WMHV 之间的关联。次要模型考虑了特定脑区（深部、脑室周围、额叶、颞叶、顶叶和枕叶）的 WMHV 以及包括睡眠在内的其他协变量。
研究样本包括 226 名女性。在多变量模型中，经生理评估的 VMS 与全脑 WMHV 增加相关，其中睡眠 VMS 的相关性最强（24 小时 VMS，B[SE] = 0.095[0.045]， = 0.032；觉醒 VMS，B[SE] = 0.078[0.046]， = 0.089，睡眠 VMS，B[SE] = 0.173[0.060]， = 0.004）。其他协变量（包括活动记录仪评估的睡眠）无法解释这些关联（睡眠后觉醒时间）。当考虑 WMHV 的空间分布时，睡眠 VMS 与深部 WMHV、脑室周围 WMHV 和额叶 WMHV 均有关联。
VMS，特别是睡眠期间发生的 VMS，与更大的 WMHV 相关。确定女性一生中大脑健康状况不佳的特定中年标志物对于确定需要早期干预和预防的女性至关重要。VMS 有可能成为女性特定的中年大脑健康标志物。
