ANA Continuing Education | Menopause Health Educators Program: Monograph 3, page 7

Nursing Implications: Mood, Cognition, and Alzheimer's Disease

Because menopause is a time of transition, it represents an opportunity for women to evaluate and rethink their health and lifestyle. Only when they have information about the changes associated with menopause, the health risks that ensue, and the options available can they chart a healthy course for the future. In terms of central nervous system changes, nurses need to take a proactive approach to counseling. Patients need to know about the mood alterations and cognitive changes that may occur. That is not to say that these symptoms are inevitable, but that for some women, the possibility exists, and there are interventions that can ameliorate these symptoms. One way to elicit information, and in the process, begin a discussion about mood and cognition is to ask patients about the following:

energy levels
sleep patterns
weight and appetite changes
level of interest in activities and daily life
concentration
memory
sensation of a "short fuse"
frustration

Beyond the simple issues of mood and cognition, these questions can lead to a patient/nurse discussion of depression as well as the measures that may delay the onset of Alzheimer's disease.

It is also valuable for patients to know that depression is often one of the first signs of AD. Depression and symptoms of early dementia can occur simultaneously, but the relationship between the 2 disorders is not clear. It has been suggested that an onset of depression late in life, with no prior history, is a risk factor for the development of Alzheimer's disease.(38) Conversely, depression can also present as a clinical pseudodementia or depression with cognitive impairment that, unlike AD, resolves with treatment. When depression and dementia overlap, they contribute to lowered cognitive function and performance. Correction of the depression can improve the cognitive dysfunction to some extent.(39,40)

The fact that depression and dementia share similar neurovegetative symptoms such as psychomotor changes, loss of interest, or insomnia, can complicate diagnostic efforts. Clarification often results after taking a careful history of the problem and comparing several characteristics of these disorders listed in Table 5. Both the patient and caregiver should be interviewed during the assessment. Several studies have reported that patients with dementia are poor raters of their symptoms and underestimate the severity of their condition.(41) Depression is more common in the mild to moderate stages of Alzheimer's disease and is less problematic in the late stages.(42)

Table 5

Differentiating between dementia and depression is critical in older patients, and it can also provide valuable information for menopausal women who assume caregiving roles for older relatives.

Menopausal Women as Caregivers

When menopausal women are in caregiving roles for relatives with AD, nurses can play a significant role in helping these women preserve their own health and well-being. Nurses can provide information and can act as facilitators to help women cope with this burden. The stress inherent in caring for a cognitively impaired family member may exceed the capacity of an individual woman, or her family, to continue to provide care. But making the decision to arrange alternative care is a difficult journey. Menopausal women may be overwhelmed and depressed by their responsibility. Yet, their point of contact with healthcare providers often occurs sporadically, and they may not seek help for depression.

Caregiving has a dramatic influence on the physical, emotional, social, and financial resources of an individual. A number of studies have documented the tremendous hardship placed upon caregivers and the sequelae of physical and emotional disorders that caregivers develop.(43-48) These studies also emphasize that the personal resources of the caregiver, as well as the existing social support network, determine how the "burden" or responsibility of caregiving is perceived.

It is helpful for caregivers to know that the course of dementing disorders can be significantly improved by a number of pharmacological agents, such as estrogen replacement therapy. This knowledge provides caregiving women the means for greater control over an illness previously thought untreatable. A sense of mastery or control, along with the social support networks suggested by nurses, can contribute to the well-being of caregivers.(49-51)

previous: Alzheimer's Disease
next: Colon Cancer