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"ABSTRAKPada perempuan pascamenopause diperlukan marka biokimiawi dan klinis pada masa jendela terapeutik yang diharapkan dapat digunakan untuk menapis HKND yang berperan sangat penting dalam menghindari dampak demensia tipe alzheimer setelah terapi hormon. Penapisan HKND dapat dimanfaatkan juga untuk upaya terapeutik HKND pada perempuan pascamenopause dan mencegah perburukan ke dalam kondisi demensia tipe alzheimer. Dilakukan studi potong lintang pada 282 perempuan pascamenopause di Jakarta yang dibagi menjadi 2 kelompok, yaitu kelompok positif dengan HKND dan kelompok tanpa HKND. Pemeriksaan dilakukan pada sejumlah variabel seperti usia, lama menopause, keluhan vasomotor, IMT, kadar FSH, kadar LH, kadar leptin, kadar estradiol, dan status kognitif, kemudian dianalisis secara statistik. Diperoleh nilai FSH yang berhubungan bermakna dengan kejadian HKND p = 0,018 , serta variabel lain seperti nisbah FSH/estradiol p = 0,029 dan nisbah FSH/sOB-R p = 0,011 , sementara variabel lain tidak bermakna. Analisis multivariat menunjukkan nisbah FSH/estradiol adalah variabel yang paling berperan terhadap kejadian HKND, dengan nilai OR 1,15. Berdasarkan kurva ROC didapat nilai titik potong nisbah FSH/estradiol dalam memprediksi HKND adalah 1,94 dengan sensitivitas 66,5 dan spesifisitas 46,8 . Nisbah FSH/estradiol pada perempuan pascamenopause yang menderita HKND yang lebih tinggi secara bermakna dibandingkan dengan kelompok tanpa HKND dikaitkan dengan peran neuron KNDy terhadap peningkatan sekresi GnRH dan rendahnya neurosteroid estradiol di otak perempuan pascamenopause yang berisiko menderita HKND. Nilai nisbah FSH/estradiol > 1,94 dapat digunakan untuk penapis diagnostik HKND pada perempuan pascamenopause.

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ABSTRACTBiochemical and clinically important markers are needed in the window therapeutic period for postmenopausal women which are expected to be used as a screening methods for CIND as it is very important in avoiding the effect of dementia associated Alzheimer disease after hormone therapy. CIND screening was also useful for CIND treatment strategies in postmenopausal women and preventing postmenopausal women from impaired cognitive function due to dementia. A cross sectional study included 282 postmenopausal women in Jakarta was done, and subjects were further classified into two groups, with CIND and without CIND. Several related variables such as age, duration of menopause, vasomotor symptoms, BMI, FSH level, LH level, leptin level, estradiol level, and cognitive status, were assessed and analyzed statistically. The prevalence of CIND was significantly correlated with FSH level p 0.018 , along with ratio of FSH levels estradiol p 0.029 and ratio of FSH sOB R p 0.011 , while other variables were not. By multivariate analysis, FSH estradiol ratio of 1.15 was found as the most significant factor with probability of having CIND in postmenopausal women. Using the ROC curve, the ratio threshold of FSH estradiol to predict CIND was 1.94, with sensitivity 66.5 and specificity 46.8 . Level of FSH estradiol ratio in postmenopausal women with CIND was significantly higher than women without CIND, and is related to the role of KNDy neurons that induce the secretion of GnRH, and low level of neurosteroid estradiol in postmenopausal women rsquo s brain with risk of CIND. Ratio of FSH estradiol levels 1.94 could be used for screening methods of CIND in postmenopausal women."

"Pendahuluan Menopause merupakan tahapan penuaan reproduksi yang akan dialami setiap wanita, Hendaya Kognitif Nir Demensia atau HKND memiliki prevalensi cukup tinggi pada wanita menopause, rentangnya hingga mencapai 27-40%, awalnya kadar estradiol ditenggarai menjadi salah satu faktor yang dapat mempengaruhi kejadian HKND, namun dalam penelitian terkini ditemukan tidak ada hubungan bermakna antara kadar estradiol dengan kejadian HKND, dalam berapa hipotesa dikatakan justru faktor-faktor lain seperti metabolik, aktivitas sosial, dan aktivitas fisik dapat mempengaruhi kejadian tersebut. Sehingga peneliti ingin mencari faktor – faktor yang dapat berpengaruh terhadap kejadian HKND pada wanita menopauseBahan dan Metode Penelitian dilakukan di Rumah Sakit Rumah Sakit Dr. Cipto Mangunkusumo (RSCM), Indonesian Medical Education and Research Institute Fakultas Kedokteran Univeristas Indonesia (IMERI FKUI), Majelis Taklim Nurul Huda dan Majelis Taklim As Syifa, Jakarta Pusat sejak Januari 2022 hingga Mei 2024. Penelitian ini menggunakan instrumen kuosioner tervalidasi HKND model 2 yang diciptakan Martina Wiwie dkk,(2007), dengan menambahkan kuesioner faktor – faktor aktivitas, kognitif, fisik dan riwayat penyakit metabolikHasil Pada penelitian ini terdapat 165 subjek pasien perempuan pasca menopause dengan rentang usia 54 (47—65 rahun) dengan di antaranya sebanyak 78 subjek mengalami HKND. Lama menopause (<5 tahun / >5 tahun) didapatkan tidak bermakna secara statistik, demikian juga dengan tingkat pendidikan, IMT, aktivitas fisik, riwayat hipertensi dan DM. Aktivitas sosial, aktivitas kognitif, status pekerjaan dan riwayat merokok, memiliki hubungan bermakna secara statistik dengan p-value (0.024, 0.011, 0.032, dan 0.020)Kesimpulan Semua wanita akan mengalami menopause pada waktunya, pencegahan kejadian HKND pada wanita menopause akan meningkatkan kualitas hidup pada wanita menopause, faktor – faktor protektif yang diteliti pada penelitian ini dapat menjadi dasar untuk wanita menopause tetap produktif dengan meningkatkan aktivitas sosial, kognitif dan bekerja. Dan menghidari rokok yang didapatkan sebagai faktor risiko kejadian HKND pada wanita menopause

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Background Menopause is a stage of reproductive aging that every woman will experience. Cognitive Impairment Without Dementia (CIND) has a relatively high prevalence among menopausal women, ranging from 27% to 40%. Initially, estradiol levels were suspected to be one of the factors influencing the occurrence of CIND. However, recent studies have found no significant relationship between estradiol levels and the occurrence of CIND. Several hypotheses suggest that other factors, such as metabolic conditions, social activities, and physical activities, may influence its occurrence. Therefore, the researchers aim to identify the factors that can affect the incidence of CIND in menopausal women.

Methods Study was conducted at the Dr. Cipto Mangunkusumo Hospital (RSCM), Indonesian Medical Education and Research Institute of the Faculty of Medicine, University of Indonesia (IMERI FKUI), Majelis Taklim Nurul Huda, and Majelis Taklim As Syifa, Central Jakarta, from January 2022 to May 2024. This study used the validated CIND model 2 questionnaire instrument created by Martina Wiwie et al. (2007), with additional questions on factors such as activity, cognition, physical condition, and history of metabolic diseases

Results There were 165 postmenopausal female patients aged between 54 years (47–65 years), of which 78 subjects experienced CIND. The duration of menopause (<5 years / >5 years) was found to be statistically insignificant, as were education level, BMI, physical activity, history of hypertension, and diabetes mellitus. However, social activity, cognitive activity, employment status, and smoking history showed a statistically significant relationship with p-values of 0.024, 0.011, 0.032, and 0.020, respectively.

Conclusion All women will experience menopause in due time; preventing the occurrence of HKND in menopausal women will improve their quality of life. The protective factors examined in this study can serve as a foundation for menopausal women to remain productive by increasing social and cognitive activities as well as working, while avoiding smoking, which has been identified as a risk factor for HKND in menopausal women."