A-01: When `Normal Aging' Isn't: Neurocognitive Disorders Misattributed to Midlife Hormonal Change

Abstract

Objective: To describe three women reporting subjective cognitive concerns initially attributed to expected midlife hormonal or menopausal changes, later diagnosed with neurocognitive disorders following comprehensive neuropsychological evaluation. This case series emphasizes centering patient-reported symptoms, recognizing non-amnestic presentations, and addressing diagnostic biases through increased education to reduce delayed identification of emerging neurodegenerative processes in midlife women. Method/Data Selection: Clinical interviews and neuropsychological testing were reviewed across three cases. Shared features included midlife onset of gradually progressive cognitive symptoms, increased reliance compensatory strategies, word-finding difficulties, distractibility, and difficulty tracking conversations. Sleep disruption and mood symptoms were present with variable severity and were commonly framed as hormonally mediated by patients and community providers initially. Results/Data Synthesis: Premorbid abilities ranged from low average to high average. All profiles were non-amnestic yet demonstrated consistent objective weaknesses, including visuospatial/visuoconstructional deficits or language impairments exceeding expectations from contextual factors alone. Suspected etiologies included frontotemporal degeneration or primary progressive aphasia, severe microvascular disease later observed on imaging, and posterior cortical atrophy. Conclusions: All patients met criteria for mild neurocognitive disorder with additional mood-related diagnoses. Common recommendations included additional medical follow-up, biomarker or imaging evaluation, sleep optimization, compensatory strategies, and modifiable protective factors. These cases underscore neuropsychology’s role in capturing women’s cognitive symptoms, refining diagnosis, and advocating timely, equitable evaluation through interdisciplinary education efforts.