Women's cognitive and affective health and neuropsychiatry

Recent interest in women's health has focused on the cognitive consequences of aging and hormonal changes. Based on hypotheses about estrogenic effects in the central nervous system (CNS), large-scale clinical trials were designed to address the efficacy of hormone replacement on protection against dementia and cognitive decline. Surprisingly, an absence of risk reduction for dementia and cognitive loss was found and much reanalysis of these findings has focused on timing of hormone replacement. Here we take a broad perspective to address a fuller range of psychological health. Gender differences in other psychiatric conditions including depression and anxiety have been attributed to hormones, and the neurotransmitter systems that are implicated in affective disorders may have an impact on cognitive impairment as well. Hormonal influences on neurotrophic mechanisms, as well as neurotransmitter effects, may be responsible for a breadth of neuropsychiatric conditions, particularly in aging. This review will focus on cognition, mood and anxiety issues among women with an emphasis on changes associated with aging. We will review data on the epidemiology of these entities and examine the biological mechanisms, which may be involved, with an emphasis on those mechanisms that may contribute to the multiple aspects of neuropsychiatry and women's health.