As a society, our concerns about ageing and its effect on our brain have never been greater. With the ‘greying’ of the population, there is a new focus on the need for a better understanding of dementia and its consequences. This has a particular resonance for women.

• Women live on average about 4 years longer than men.

• Women represent a greater proportion of all the people who develop dementia over the age of 75.

• Compared with men, women more often act as caregivers for those who develop dementia.

Not all ageing leads to disease. Some changes in our cognitive abilities and mental health are part of normal, healthy ageing. As we age we expect not to be able to run as fast, and we should also expect to remember things less easily or accurately than we used to. We should learn to adapt to such inevitable changes.

But it's not all bad news! The ageing brain may bring benefits that are often absent in younger women. In this chapter, we will outline the expected changes in how the brain works with ageing, looking at the impact of the menopause and the possible mental impairment that may affect women in their later years. We will end on a positive note about the benefits of the ‘ageing brain’.

Normal age-related changes in cognition in women

As the body ages, so does the brain, and its ability to function reduces. For women about to experience or experiencing the menopause (usually in their 40s or 50s), the ability to remember names, recall recent events and think quickly often becomes more difficult. During this period in their lives, women often complain that their brains are ‘fuzzy’ or that they are ‘losing their minds’ as they struggle with their memories. Often described as ‘brain fog’, this phenomenon has some scientific validity. Research has found that perimenopausal women might have impaired verbal memory and speed of thinking. Luckily, such changes can improve and by the time the women are fully postmenopausal, their cognitive profile may be no different from that of men of a similar age.