Memory difficulties in perimenopause: neuropsychological distinction from early-onset dementia
L. G. NunesIntroduction
Memory complaints in middle-aged women are often misinterpreted as signs of mild cognitive impairment (MCI) or early-onset dementia. However, perimenopause represents a period of neurobiological vulnerability associated with estrogen decline and transient hypometabolism in the hippocampus and prefrontal cortex. This case highlights neuropsychological parameters useful for distinguishing functional cognitive changes from amnestic-type neurodegenerative syndromes.
Objectives
To highlight how neuropsychological assessment can distinguish functional memory impairment related to perimenopausal hormonal changes from early-onset dementia in women with high cognitive reserve.
Methods
A 49-year-old female judge, with a Master’s degree in Law, no psychiatric history, under hormonal replacement therapy and GLP-1 agonist use, reported progressive forgetfulness over six months. A comprehensive neuropsychological assessment was conducted, including WAIS-IV, RAVLT, FDT, and BPA.
Results
Full-Scale IQ = 120 (+1.3 SD). Verbal Comprehension ≈ +1 SD, Perceptual Organization ≈ +0.7 SD, Processing Speed ≈ +0.8 SD.
RAVLT revealed a progressive learning curve with marked loss after interference and limited recognition gains , indicating a weakness in consolidation (−1.3 SD delayed recall) rather than attentional control.
Immediate recall was average (0 SD), delayed recall low-average (−1.3 SD).
FDT showed reduced cognitive flexibility (−1.3 SD) with preserved inhibitory control.
BPA indicated attention performance ranging from average to low-average (alternating ≈ −0.3 SD, divided ≈ −0.6 SD, sustained ≈ −1.0 SD).
Conclusions
The pattern reveals high intellectual functioning with isolated reduction in long-term verbal memory and cognitive flexibility. The learning curve profile and post-interference decay indicate functional hippocampal hypofunction linked to hormonal and metabolic changes of perimenopause, rather than neurodegeneration.
Disclosure of Interest
None Declared