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Alzheimer's Association International Conference 2026
July 12-15, 2026 | London, United Kingdom, and Online
13299
Menopause As A Critical Window For Understanding Alzheimer’s Risk: Testing Feasibility & Acceptability Of Digital Cognitive Assessment
Part of Topic
Clinical Manifestations -> Neuropsychology -> Measurements of Cognition and Function
Menopause as a Critical Window for Understanding Alzheimer’s Risk: Testing Feasibility & Acceptability of Digital Cognitive Assessment
Key takeaway: Remote cognitive testing sensitive to early AD-related changes was feasible, acceptable, and sensitive to cognitive variability in midlife women.
Introduction
- Women account for approximately two-thirds of those living with Alzheimer’s Disease (AD).
- Midlife hormone changes, including menopause and Menopause Hormone Therapy (MHT), may impact cognitive health and AD risk.
- Scalable methods that sufficiently capture reproductive health and cognitive tasks sensitive to early AD may overcome previous methodological limitations.
- Remote, independently completed online methods can facilitate this research, but suitability must first be established in midlife women.
Study aim: To assess the feasibility and acceptability of an online, remote questionnaire and cognitive task battery among midlife MHT users ahead of larger studies testing menopause and MHT effects on cognition.
Methods
Who participated? Women who started MHT in the last 18 months.
What did they do? All completed an onlinequestionnaire, cognitive task battery and feedback. n = 6 completed semi-structured interviews.
Questionnaire (~15 mins), capturing:
- Menopause experience & staging
- Reproductive health
- Subjective cognition
- General health & lifestyle
- Inhibition-switch task (executive attention)
- Semantic and phonological verbal fluency tasks
- n-back task (working memory)
- Object Mnemonic Similarity Task (object MST) (mnemonic discrimination)
- The Virtual Supermarket Task (spatial navigation)
- Greebles ‘Odd-one-out’ Task (perceptual discrimination)
- Immediate & Delayed Verbal Memory Task
Participant characteristics: n = 31; mean age = 47.58 years (SD = 4.01, range 37-57); recruited from 11 English counties.
Participant flow and retention: n = 39 consented, n = 37 completed the questionnaire & associated feedback, n = 33 started the tasks, n = 29 completed tasks & associated feedback (2 withdrew, 2 incomplete)
Feasibility & acceptability
- Minimal missing data and reported technical difficulties.
- 93% agreed tasks were possible to complete.
- Question acceptability: 9.0/10.
- Question comfort: 9.16/10.
Qualitative feedback highlights
- High acceptability of remote completion.
- Recommendations for improving questionnaire relevance, task burden and usability.
Cognitive task performance: Tasks showed meaningful performance variability. Analysis examples below:
- Object MST Lure Discrimination Index (LDI; mean = 0.517, SD = 0.165).
-
Greebles’ accuracy by ambiguity condition: Low: M = 95.2%, SD = 6.1%; high: M = 85.4%, SD = 11.5%.
Feedback and refinement:
- Exogenous hormone users difficult to stage → separate pathways for natural cyclers & exogenous hormone users.
- Cognitive & mental health symptoms not fully captured → validated measures added.
- Task battery too long → task battery reduced for future longitudinal study
Conclusion
- The online methods were feasible and acceptable in midlife MHT users.
- Tasks captured meaningful variability.
- Refined methods are now used in larger studies of menopause, APOEε4 and cognition, including longitudinal MHT studies.
Why does this matter? Menopause is a potential window for identifying early cognitive changes associated with AD risk. Scalable, remote tools can enable larger and more inclusive studies of women's brain health.
Contact: Emily Budden, PhD Researcher, Brighton & Sussex Medical School, e.budden@bsms.ac.uk
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