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Mental health

Poor mental health, poverty and pollution significantly raise women’s heart failure risk – study

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Poor mental health, poverty and pollution can raise women’s heart failure risk, with up to one in four cases potentially preventable, a study has found.

UK Biobank data from more than 230,000 women suggest that depression, socioeconomic hardship and exposure to polluted environments are linked to a significantly higher risk of heart failure in women.

Heart failure happens when the heart becomes too weak or too stiff to pump blood effectively around the body.

High blood pressure, high cholesterol, smoking and diabetes are among the better-known risk factors often targeted in public health campaigns.

Peige Song from China’s Zhejiang University and her team found that living in polluted areas, having poor mental wellbeing, facing socioeconomic deprivation and experiencing chronic inflammatory conditions such as lupus, in which the immune system attacks the body’s own tissues, make women more prone to heart failure.

These risks, however, are often overlooked.

The researchers found that mental wellbeing, environmental exposures, socioeconomic circumstances and reproductive history together contributed almost as much risk for heart failure as all well-known risk factors combined.

The study also found that risk rises with socioeconomic hardship and chronic inflammatory conditions such as lupus or rheumatoid arthritis, approaching the impact of conventional risk factors.

Song said: “[The study] is a call to redefine prevention in women’s cardiovascular health, integrating biological, psychosocial and structural determinants into a unified, equitable approach.

“One in four heart-failure cases in women could be prevented if all under-recognised risk factors were eliminated, assuming causal relationships.”

While completely eliminating all risks is not realistic, Song said “even partial reductions through better mental health services, social equity policies and environmental regulations could yield significant public health benefits”.

Catherine Pirkle, a women’s health specialist at the University of Hawaiʻi at Mānoa in the US, who was not involved in the study, said: “These calculations show convincingly that under-recognised and female-specific risk factors contribute significantly to heart failure in women, independently of the well-established ones.”

Song said: “It’s important to understand that heart health is influenced by more than just blood pressure or cholesterol.

“Factors like mental wellbeing, reproductive milestones and socioeconomic conditions all matter. Awareness and advocacy for comprehensive, gender-sensitive care are key.”

Mental health

Lifting weights shows mental health and cognitive benefits in older women, study finds

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Weightlifting can improve memory and mental health in older women, whether they lift heavier or lighter weights, a clinical trial has found.

The study suggests structured exercise could offer a non-drug way to help protect the ageing mind.

As people age, physical abilities often decline and the risk of cognitive impairment rises.

Women can also face a higher risk of depression and anxiety later in life because of menopause, hormonal changes and shifting social factors.

Over time, poor mental health can speed up physical and cognitive decline.

Medical professionals often recommend cardiovascular and resistance training to help preserve physical independence.

Beyond building muscle and strength, lifting weights may also help protect the brain.

The research team recruited 120 women with an average age of 68 who were not taking part in any structured exercise programmes.

Before the intervention, independent cardiologists screened the volunteers using diagnostic stress tests to make sure they could take part safely.

The researchers then divided the women into three equal groups based on their baseline physical strength to ensure a balanced comparison.

The first group followed a resistance training programme using heavier weights for eight to 12 repetitions.

The second performed the same exercises using slightly lighter weights for 10 to 15 repetitions. The third acted as a control group and remained sedentary throughout the trial.

For three months, the active groups visited the university fitness facility three mornings a week.

Under the direct supervision of qualified fitness experts, participants completed three sets of eight different full-body exercises. These included weight machines and free weights, with movements such as chest presses, leg extensions, seated rows and bicep curls.

As the women grew stronger over the 12 weeks, supervisors progressively increased the weight they lifted.

This ensured participants stayed within their assigned repetition range while maintaining proper breathing and movement technique. Researchers also told all participants not to start any new exercise outside the laboratory setting.

The scientists carried out a broad set of cognitive and psychological tests before the programme began and again shortly after it ended.

They used the Montreal Cognitive Assessment to measure spatial skills, short-term memory and language processing.

The team also used several standardised surveys to track symptoms of geriatric depression and general anxiety.

Other tests assessed executive function, the mental processes involved in planning, focusing attention and multitasking.

In the Trail Making Test, the women had to connect a scattered sequence of numbers and letters as quickly as possible to assess cognitive flexibility.

In another verbal test, they had to name as many words beginning with the letter F, or as many animals as possible, within 60 seconds.

The researchers also used a computerised Stroop test to assess inhibitory control. In this visual test, the women saw words such as “red” or “black” displayed in conflicting ink colours, such as green.

They had to suppress the automatic urge to read the word and instead press a button matching the ink colour.

After the three-month intervention, both groups of weightlifters showed clear improvements in their test scores.

Their performance on the overall cognitive assessment rose, and their reaction times in executive function tests fell substantially.

The control group showed no such improvements, and in some categories their mental performance worsened slightly.

The structured exercise also reduced the severity of mood disorders among the active participants.

Scores for depressive symptoms fell by roughly 34 per cent in the lower repetition group and 24 per cent in the higher repetition group. Anxiety scores fell by more than 40 per cent in both groups.

The researchers said these improvements met the threshold for a clinically meaningful difference.

In practical terms, that means the psychological benefits were large enough for the women to notice in their daily emotional state.

The trial found no major differences in outcomes between the two repetition strategies, suggesting both intensities worked equally well against cognitive decline.

The study has several caveats that may shape future research into the neurological benefits of structured exercise.

The testing relied heavily on self-reported psychological surveys, which can be affected by subjective bias or temporary changes in mood.

The team also did not closely track differences in the women’s light daily physical activity outside the gym.

The researchers also said the social structure of the fitness programme may have contributed to the emotional benefits.

For 12 weeks, the active participants exercised in a shared, supportive environment, with regular contact with peers and supervisors.

This kind of consistent social interaction can help reduce loneliness and provide psychological relief.

Future trials will need to isolate whether different exercise durations or extra social interaction change these positive neural effects.

Even so, the results suggest resistance training could offer an accessible way to help treat mild cognitive and mood problems.

Regular weightlifting may benefit the mind as well as the muscles in older adults.

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Menopause

More research needed to understand link between brain fog and menopause, expert says

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Brain fog in menopause is common but still poorly understood, with researchers calling for more work to explain the link and how best to support women.

For a new perspective article published in The Lancet Obstetrics, Gynaecology, & Women’s Health, researchers based in the UK and Australia reviewed the evidence on menopause-related cognitive symptoms. They found that symptoms such as forgetfulness, reduced concentration and brain fog are common during the menopause transition, but are still poorly recognised and under-researched.

More than two-thirds of women report difficulties with memory or concentration over the menopause transition. Multiple factors may contribute to these cognitive symptoms, including hormonal changes, sleep disturbances and psychological and psychosocial stress. Yet, because cognitive symptoms are not widely discussed, they can cause considerable worry, with some fearing they are signs of dementia or undiagnosed neurodevelopmental conditions.

The review paper emphasises that overall cognitive performance for women experiencing menopause-related brain fog typically remains within expected ranges and, importantly, that cognitive symptoms are not linked to an increased risk of dementia.

Professor Aimee Spector of UCL Division of Psychology and Language Sciences, co-author on the paper, said: “Cognitive symptoms such as forgetfulness and ‘brain fog’ are incredibly common during menopause, yet they are often overlooked. Our findings highlight just how complex menopause-related cognitive symptoms are, and how much we still don’t know about what drives them. More targeted research is essential if we are to identify which biological, psychological or lifestyle factors contribute most, and what types of support or treatment are likely to be effective.”

The authors argue that clinicians can play a key role in understanding and validating women’s experiences by asking about the duration of cognitive symptoms, impacts on day-to-day functioning and any other medical or psychosocial factors that could be contributing to cognitive symptoms.

The review also discusses a range of approaches that may ease cognitive symptoms, such as improving sleep quality, engaging in regular aerobic exercise and eating a balanced diet. There is also little but promising research into the impact of psychological therapies targeting cognitive symptoms, with a recent meta-analysis of three cognitive behavioural therapy-based studies showing significant improvements in memory and concentration. The evidence is more mixed for the benefits of hormone therapy on cognitive symptoms during menopause.

The authors identify cognitive symptoms as a major area of unmet need in menopause research. They call for a unified definition of menopause-related cognitive changes and for prospective, longitudinal studies that can track women from pre- to post-menopause. Better understanding of the biological, psychological and social factors that contribute to cognitive symptoms will be crucial for developing effective treatments.

Lead researcher Dr Caroline Gurvich of Monash University said: “There’s a lot of pressure to use objective measures of cognitive decline, like a memory test, for example, in a clinical trial, but the key symptom of brain fog is a subjective experience. So having a definition that acknowledges the key cognitive symptom is critical.”

This is not without precedent – we already use subjective or self-report measures for depression, anxiety and other mental health conditions with great success.

Dr Gurvich said the proposed definition would also validate women’s individual experiences while empowering them through the reassurance that any objective decline in their cognitive ability is subtle.

She added: “This is a decrease in cognitive or learning efficiency, not functionality or capacity. For many women, the perception they are losing capacity is what drives them to stop work or lose the confidence to live fulfilling lives during and after menopause. I hear all the time from women who have gone through menopause that validation would have made a significant difference to their resilience and the approach they took to living with menopause.”

Co-author Professor Martha Hickey of the University of Melbourne and Royal Women’s Hospital said: “Our analysis of the best available research shows that many women experience some degree of cognitive symptoms, such as brain fog, during the menopause transition.”

“But there’s a lack of long-term data, which means that there’s a gap in our knowledge about how the brain fog symptom develops and changes from peri-menopause to after menopause ends. It’s a real gap in our understanding.”

Professor Spector added: “We increasingly see women, typically at the peak of their careers, losing confidence in the workplace, often translating to leaving work or reducing work hours. Having simple strategies to support and retain them at work is also a broader economic issue.”

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Mental health

Inflammation linked to depression in women with diabetes, study finds

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Inflammation may help flag depression in women with type 2 diabetes, new research reveals, but the link appears to vary by symptoms and by how depression is measured.

The findings suggest both the promise and the challenge of identifying biomarkers, measurable indicators in blood or other tests, for depression.

Women with type 2 diabetes are at higher risk of depression, which can accelerate diabetes complications, impair functioning and increase the risk of death. Research suggests inflammation may be a key link between the two conditions, as certain inflammatory biomarkers are frequently found in both.

Scientists have yet to identify an objective diagnostic biomarker for depression, such as something measured through blood work, a genetic test or a brain scan.

To diagnose and measure depression, mental health providers usually use questionnaires. Some add up the number of symptoms as a checklist, while others measure the severity of different symptoms.

Depression can also look very different from one person to the next, with symptoms spanning physical effects such as sleeping too much or too little, mood-related issues such as persistent sadness, and cognitive difficulties such as trouble concentrating.

Nicole Beaulieu Perez, assistant professor at NYU Rory Meyers College of Nursing and study author, said: “Depression is the most measured construct in all of science, but part of our problem is that we’re not defining depression the same, there may be different types, but we’re lumping them all together.

“The variability in depression symptoms complicates how we diagnose and treat it, particularly in the absence of validated biological markers.”

To better understand the connection between inflammation and different symptoms and measures of depression, researchers at NYU Rory Meyers College of Nursing studied 38 women with type 2 diabetes, many of whom were also living with HIV.

They analysed blood samples for 10 different inflammatory biomarkers, including CRP, IL-6, IL-4 and IL-8.

They also assessed participants for depression using PROMIS, an NIH-developed series of short questionnaires that includes measures of depression, anxiety, sleep and fatigue, as well as the CES-D, an older measure that adds up depression symptoms.

The researchers found that certain inflammatory biomarkers were linked to depression, but the associations varied depending on the measures and symptoms used.

Higher levels of depression and anxiety measured using PROMIS were associated with lower levels of IL-4.

They also found contradictory associations for CRP and IL-6. Both were positively correlated with depression when it was measured using CES-D and negatively correlated when it was measured using PROMIS.

Sleep disturbances measured using PROMIS were associated with IL-8.

Perez said: “It was interesting to see that, in some cases, the direction of these associations flipped entirely based on which measure of depression we were using.”

The findings, while preliminary because of the small number of people studied, suggest that the link between inflammatory biomarkers and depression may not be consistent across all measures or symptoms.

More research is needed to tease out the role of inflammation and whether subtypes of depression can be identified based on symptoms and objective biological markers.

Perez said: “We think there’s something going on with inflammation and depression, but if we look closely, we may find that’s true for some forms of depression but not others.”

She said she hoped that in future, pairing depression measures with biomarkers such as blood tests could provide more objectivity in diagnosing depression, which could help further destigmatise mental illness, as well as help clinicians catch it earlier and guide treatment.

Perez said: “Precision mental health has great potential.

“If we can identify a specific type of depression, for instance, one that appears to be driven by inflammation, this may inform which medications to try to target an underlying biological pathology, hopefully reducing the trial and error often needed to find an effective treatment for depression.

“By identifying specific inflammatory biomarkers linked to different dimensions of mental health, our findings suggest a path toward precision mental health that moves beyond one-size-fits-all approaches.”

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