As testosterone declines with age, so does cognitive function. Older men and women may experience deterioration in their memory, attention, language and visuospatial ability. The prevalence of cognitive dysfunction in the aging population is high. According to statistics, moderate to severe memory impairment has been estimated to occur in about 13% of adults aged 65 years and above, and in 32% of adults aged 85 years and above. 
Researchers have suggested that the age-related declines in cognitive function and testosterone are closely related.  Numerous studies suggest that cognitive impairment is a component of late-onset hypogonadism, for which some men may undergo testosterone replacement therapy. [319-321]Other studies also concluded that low levels of testosterone may be related to reduced cognitive ability, and testosterone replacement therapy may improve some aspects of cognitive ability. [322-327]
Treating older men with testosterone may help improve spatial intelligence (deals with judgment and the ability to visualize) and verbal memory, according to a small study conducted by researchers at the University of Washington in Seattle.  The results of this study clearly suggest that restoring testosterone to healthy levels may improve cognition.
In another study, Cherrier et al. investigated the effects of 6-week testosterone supplementation via injection among 19 men aged 63 to 85 years with Alzheimer disease (AD) or mild cognitive impairment (MCI).  Improvements in spatial memory, constructional abilities and verbal memory were evident as their levels of testosterone increased by an average of 295%.
In a related study by Ackermann et al., healthy subjects encoded pictures taken from the International Affective Picture System (IAPS) and they underwent a free recall test 10 minutes after memory encoding.  The study revealed that higher levels of testosterone were related to increased brain activation and that testosterone has a male-specific role in enhancing memory by increasing the biological salience of incoming information.
Higher testosterone levels also offer great benefits on the brain. One study referenced in the Harvard Men’s Health Watch found that higher levels of testosterone in middle-aged men were associated with preservation of brain tissue in different regions later in life.  In this way, brain aging as well as cognitive decline can be slowed.
In a study by Anawalt et al., testosterone was found to activate a network in the brain which helps improve cognition as well as verbal and visual memory.  Researchers believe that this mechanism helps boost cognitive health in elder men and women.
Not only does testosterone supplementation helps support cognitive health. A study by Wahjoepramono et al. found that testosterone supplementation can also significantly reduce the risk of dementia, a condition characterized by a decline in memory or other thinking skills.  This may be due to the fact that testosterone supplementation in the study participants resulted in improved performance on various measures of cognitive functioning.
In line with the above findings, there is also an overwhelming body of clinical research that supports the safety and efficacy of testosterone replacement therapy in improving various parameters of cognitive health, including memory, attention, language, visuospatial ability, and thinking skills, in patients with testosterone deficiency and age-related decline in cognitive function. [334-341]
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