Cognitive Performance During Menopause Transition Examined

News Release

WEDNESDAY, Jan. 13, 2021 — Measures of cognitive performance show decline from premenopause to later menopause stages among low-income women of color, according to a study published online Jan. 11 in Menopause.

Pauline M. Maki, Ph.D., from the University of Illinois at Chicago, and colleagues examined longitudinal changes in cognitive performance across menopause stages in a sample of 443 low-income women of color (69 percent African American and 18 percent Hispanic), including women with HIV (WWH). Tests of verbal learning and memory, attention/working memory, processing speed, verbal fluency, motor skills, and executive function were completed at an index premenopausal visit and every two years thereafter for up to six visits (mean follow-up, 5.7 years).

The researchers found that the overall sample and WWH showed longitudinal declines in continuous measures of learning, memory, and attention/working memory domains from premenopause to early perimenopause and from premenopause to postmenopause after adjustment for age and relevant covariates. In categorical scores of cognitive impairment, effects on those same domains were evident, with increased odds of impairment varying from 41 to 215 percent. The increase ranged from 4 to 13 percent in predicted probability of impairment by menopausal stage.

“It will be important in future studies to identify which factors account for individual differences in cognitive declines associated with the menopause,” the authors write.

Two authors disclosed ties to the biopharmaceutical industry.

Abstract

Objective:

To assess longitudinal changes in cognitive performance across menopause stages in a sample comprised primarily of low-income women of color, including women with HIV (WWH).

Methods:

A total of 443 women (291 WWH; 69% African American; 18% Hispanic; median age = 42 y) from the Women’s Interagency HIV Study completed tests of verbal learning and memory, attention/working memory, processing speed, verbal fluency, motor skills, and executive function first at an index premenopausal visit and thereafter once every 2 years for up to six visits (mean follow-up = 5.7 y). General linear-mixed effects regression models were run to estimate associations between menopausestages and cognition, in the overall sample and in WWH. We examined both continuous scores and categorical scores of cognitive impairment (yes/no >1 standard deviation below the mean).

Results:

Adjusting for age and relevant covariates, the overall sample and WWH showed longitudinal declines in continuous measures of learning, memory, and attention/working memory domains from the premenopause to the early perimenopause and from the premenopause to the postmenopause, Ps < 0.05 to < 0.001. Effects on those same domains were also evident in categorical scores of cognitive impairment, with the increased odds of impairment ranging from 41% to 215%, Ps < 0.05 to < 0.001. The increase in predicted probability of impairment by menopausal stage (% affected) ranged from 4% to 13%.

Conclusions:

Menopause stage was a key determinant of cognition in a sample of low-income women of color, including WWH. Many of these changes reached a clinically significant level of cognitive impairment.