Women who notice memory lapses in midlife should measure their thinking against their own past performance before assuming they are developing Alzheimer's disease or another form of dementia, according to a neurologist who studies the effects of menopause on the brain.
Dr. Rhonda Voskuhl, a professor of neurology at UCLA and co-founder of Cleopatra RX in Los Angeles, recommends a simple benchmark she calls the 10-year rule. Women should ask themselves whether they are worse than they were a decade ago, recalling what they were doing then and whether they struggled to find words, multitask or process information quickly.
«The first question is, are you worse than you were 10 years ago?» Voskuhl said, describing the Voskuhl Brain Fog Menopause Assessment used at UCLA's Comprehensive Menopausal Program. «Ten years is a pretty good spot. And they think, 'What was I doing 10 years ago? What was I like? Was I having problems finding the words? Was I at the point where I couldn't multitask anymore? Was I slow in my processing?' And they'll remember.»
The comparison gives patients and physicians a personal baseline for tracking symptoms over time, something standard memory tests do not always provide. Voskuhl said women should trust their own observations about how their thinking has changed.
«I think they should listen to themselves,» she said. «They know. Just ask yourself.»
Her remarks point to a gap in how cognitive decline is typically evaluated. Neurological testing can remain normal even when patients notice real changes in everyday function, a condition known as subjective cognitive decline. The Centers for Disease Control and Prevention reports that roughly one in nine adults report such decline, yet fewer than half discuss the concerns with a healthcare professional.
Voskuhl compared the situation to a professional athlete whose strength has declined. If an NFL player says he is weaker than he used to be, a standard neurological exam might still show normal strength, she said, but what the player feels remains meaningful. Women, she added, can likewise recognize when their cognitive abilities have shifted from their own baseline.
The distinction between hormonal brain fog and neurodegenerative disease comes down to how memory loss affects daily life. Menopausal brain fog typically involves temporary, inconsistent lapses such as misplacing items or slower processing speed, while overall reasoning and independence remain intact, according to Mayo Clinic. Symptoms often fluctuate and can worsen with stress or poor sleep.
Early dementia, by contrast, causes persistent and progressive memory loss that interferes with basic tasks such as managing finances, following familiar driving routes or exercising sound judgment. Those differences matter because women who experience a loss of estrogen during perimenopause and menopause are particularly affected by cognitive changes, and the symptoms can be mistaken for something more serious.
Experts advise anyone with cognitive concerns to seek a full medical evaluation, including brain MRIs or vascular screenings, to rule out underlying problems such as blood vessel disease or thyroid imbalances. For women who feel their concerns are being dismissed, Voskuhl offered direct advice: «When they have doctors who don't listen to them, they need to find another doctor.»
The guidance places a premium on self-awareness and persistence. Rather than waiting for a test to confirm what they already sense, women are encouraged to document changes, compare them with their own history and press for answers that account for hormonal shifts as well as neurological disease.