Simple Question a UCLA Neurologist Wants Every Woman to Ask Herself About Memory Loss

The Fear Behind Every Forgotten Word

Losing a train of thought, struggling to recall once-familiar words, or forgetting the reason for walking into a room can leave older adults wondering if they are experiencing early signs of Alzheimer's disease or dementia. It's one of the most quietly terrifying experiences of midlife — and it turns out, it may be far more common and far less alarming than many women fear.

These brain blips can often be tied to hormone shifts later in life, medical experts note — and women who experience a loss of estrogen during perimenopause and menopause are particularly affected. The challenge has always been knowing when to worry — and when not to. Now, a leading neurologist says the answer may come down to a single, powerful question.

The 10-Year Rule

According to Dr. Rhonda Voskuhl, a professor of neurology at UCLA and co-founder of Cleopatra RX in Los Angeles, women experiencing memory struggles in midlife should compare their cognitive function to their own past performance before assuming something is seriously wrong. Her approach is disarmingly simple: stop comparing yourself to everyone else, and start comparing yourself to who you used to be.

The first question she asks is whether a woman is worse than she was 10 years ago, referencing the Voskuhl Brain Fog Menopause Assessment used at UCLA's Comprehensive Menopausal Program. This comparison can help reveal whether a woman's cognitive changes may be linked to menopause, while giving patients and physicians a baseline for tracking symptoms over time. She wants women to think back concretely — recalling whether they once struggled to find words, whether multitasking felt effortless, whether their processing speed felt sharp. With the loss of estrogen during menopause, processing speed can slow down because the synaptic connections between brain cells are decreased, and multitasking that once came easily now takes more time.

Why Standard Tests Often Miss the Problem

Standard memory tests don't always catch subtle shifts in everyday cognitive function. In the medical community, this is known as subjective cognitive decline — when patients notice changes even though neurological testing remains normal. Voskuhl has a vivid analogy for why this gap exists. To illustrate why routine tests can miss early menopausal brain fog, she compared it to a high-performing athlete: "If somebody is an NFL football player and he says, 'I'm weaker than I used to be,' and I go and do my neurological test, I say, 'Oh no, you're still strong.'" What the player is feeling still matters, even if a standard test shows no obvious decline.

The CDC reports that roughly one in nine adults report subjective cognitive decline, yet less than half discuss these memory concerns with a healthcare professional. That silence is part of the problem. Women may dismiss real symptoms as normal aging — or, conversely, spiral into unnecessary fear about dementia when hormones are the actual culprit.

Fog vs. Dementia: There Is a Difference

Menopausal brain fog typically involves temporary, inconsistent lapses like misplacing items or experiencing slower processing speed, but overall reasoning skills and independence remain intact. Dementia looks different. It is more persistent, more progressive, and more likely to disrupt basic tasks such as handling money, driving familiar routes, or making sound decisions that used to come easily.

Existing cognitive assessments used in Alzheimer's disease aren't sensitive enough for use in cases of menopausal brain fog — because brain fog is not global dementia: not all cognitive areas are affected, and there isn't a decrease in IQ. Voskuhl's message is ultimately one of empowerment. She says women should trust what they notice in themselves: "I think they should listen to themselves." If something feels off compared to a decade ago, that instinct deserves a real conversation with a doctor — not a dismissal, and not a spiral into worst-case thinking. The 10-year rule won't replace a clinical evaluation, but it gives women a concrete, personal starting point at a time when clarity can feel very hard to come by.