I'm a dementia professor, but the solution to my brain fog surprised me

Telegraph

3 days ago

Aimee Spector, 50, is professor of clinical psychology of ageing and director of the Menopause Mind Lab at University College London (UCL). She has two children of 18 and 20 and lives with her husband, Nick, 52, in Hertfordshire.
I'd always prided myself on being a 'names person'. My job as a professor at University College London involves chairing meetings, introducing people, giving lectures and leading teams – I'd remember everyone. But in 2017, aged 42, that changed quite suddenly.
I'd recently taken a new consultancy role and was being shown around. Just as I went to introduce a very senior colleague, someone I'd worked with for 15 years and talked to daily, his name just… vanished. Gone. Awkwardly, feeling my face redden, I ended up helplessly pointing at the name on his door. I went home confused, shocked and frightened about what was happening.
More mortifying still was only last month, when I was working with the World Health Organisation updating dementia guidelines. During a high-level meeting about HRT and dementia risk, I forgot the word 'oestrogen'. I paused, tried to joke, 'it's my morning brain fog ' and people smiled sympathetically, but I felt paranoid they thought I was losing it.
A scary black fog had overtaken me
After that first time forgetting my colleague's name and dreading it happening again, I'd walk into meetings feeling panicked about forgetting names, which of course made it even more likely to happen.
It wasn't just at work. At home I'd ask my children – then both in their early teens – questions about a party for example. They'd eye-roll, 'Mum, you just asked that and we told you already.'
I'd watch a film with my husband, Nick, and have no recollection the next morning. I don't mean I couldn't recall the name of the movie, I couldn't remember the entire storyline, or even the genre. It was like a scary black fog had erased my memories. Another time I drove off with my handbag still on top of the car, scattering its contents over the road.
My fear of dementia was real – and informed
Until then, I'd been a successful psychologist specialising in dementia research, developing cognitive stimulation therapy, to help people with dementia improve their memory and thinking skills, which is now used across the NHS and in 42 countries worldwide.
As my career had been dedicated to studying dementia, my memory loss took on a sinister edge. In my early 40s, mine was now failing me and fearing I had early-onset dementia felt like my whole world unravelling.
I told my GP about these frightening memory blanks. She reassured me it probably wasn't dementia, because I was still able to work with numbers efficiently (essential as a scientist) and neither did I get lost in familiar places, or struggle recognising familiar objects. I had no problem dressing or feeding myself or parenting my teens. I never forgot faces. It was just that my ability to recall stories and my verbal skills seemed to be replaced with blackness.
The GP never suggested menopause as a possibility, and because I still had regular periods and no hot flushes, it never crossed my mind, either.
Back then, brain fog wasn't discussed as a menopause symptom. She and I agreed to keep an eye on it and over the next two years we spoke several times. Blessedly, my symptoms didn't worsen, which would not have been the case with a disease.
Talking myself out of a career
I spoke to my husband, parents and close friends about my fears. 'Don't worry,' they said. 'You're still functioning at a high level at work – no one else notices.' Classically, with early-stage dementia it's not just the person suffering symptoms who realises it, it's other people who notice it.
'You're fine,' everyone reassured. But inside, I seriously considered quietly leaving my job. I'd tell myself: 'You've had a good career, made a difference. Maybe it's time to slip away before everyone notices you're losing it.'
Brain fog destroyed my confidence, my sense of competence and my identity. I've since learnt that around one in 10 women in menopause quit work because they feel embarrassed about their abilities. Even more step back from important meetings (the kind necessary to further careers) or they reduce hours or pass up promotions. Careers women have grafted for, over decades, go up in smoke. It's frustrating to witness yet completely understandable – I was nearly one of them.
Finding the real cause
It wasn't until 2021, at the age of 47, nearly five years after my first symptoms, when a friend asked me 'could it be hormonal?'. So I paid to see a private menopause specialist. Hormonal blood tests are notoriously unreliable, yet mine indeed showed rock-bottom oestrogen levels, far lower than expected at any point in the menstrual cycle.
My progesterone and testosterone were also low and the specialist put me on HRT: oestrogen gel combined with progesterone tablets. Within six weeks, it was as if someone had flicked a light switch in my brain. My memory returned, as did my confidence. Finally I had confirmation my brain fog was hormonal, not degenerative like Alzheimer's.
When my health took a step back
But just nine months later I had to give it up when, in 2022, I was diagnosed with stage one breast cancer. I'd found a lump and it was caught early so I needed surgery but no chemotherapy. I didn't blame HRT, I hadn't been on it long enough, and had a strong family history of breast cancer.
However, because my cancer was hormone-receptive (meaning oestrogen was feeding the cancer cells) I had to immediately stop using it. That devastated me as much as the diagnosis itself, as I dreaded the return of brain fog.
But interestingly, it didn't come back as badly as before, and I believe that's because now I understood it wasn't dementia – that fear had gone and it was easier to manage.
Why perimenopause can cause brain fog
I wanted to investigate why perimenopause causes these cognitive changes – and what can be done. Especially for women who don't want, or can't take, HRT.
I found it helpful to acknowledge what was happening in my brain, understanding that my drop in oestrogen was likely to be affecting the neurotransmitters which affected memory and words. It's this fluctuation of hormones during perimenopause when things like brain fog, or hot flushes or poor sleep, are triggered. The good news is that once the hormones re-stabilise post-menopause, these symptoms go away.
Putting my experience to good use
After what happened to me I wanted to see what the research said, and discovered there was little out there. That had to change. I wanted other women to feel more supported. So in 2023, alongside my work in dementia, I established UCL's Menopause Mind Lab, a research hub focusing on the impact of menopause on cognition and mental health.
I'm proud of what we've achieved so far. But there is more to do. Campaign group Menopause Mandate's survey last year (of nearly 20,000 people) identified brain fog as the single most troubling and prevalent symptom for 76 per cent of women – not hot flushes, which surprised many.
That's why we're joining forces for this year's survey; we're determined to find better treatments. This is why this year we want more women – 30,000 – to take part, from as many different backgrounds and ethnicities as possible, including those with no symptoms at all: it's all helpful. These results will inform academic research on menopause and brain health and power lobbying efforts for better workplace policies. We will present our findings to MPs later this year.
Currently at UCL we're developing a non-drug-based treatment including attention training, cognitive strategies and CBT (cognitive behaviour therapy) to support women who cannot take HRT.
The strategies I use to help me
At 50 now, I still have regular periods, and I still forget words, but I no longer spiral into panic now I've developed strategies to cope (see below).
I want other women to know they're not losing their mind. Brain fog is a manageable symptom of menopause transition. With understanding, support and the right strategies, we can continue to thrive at work and at home. I almost gave up on myself – and I'm so glad I didn't. Please don't lose hope.