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Summary

A recent cross-sectional study was conducted by an Indian university on whether women’s cognitive abilities are sensitive to the severity of menopausal symptoms [1]. The study involved 404 rural women aged 40 to 65 years who completed the Green Climacteric Scale to assess the severity of menopausal symptoms and the Hindi Mini-Mental State Examination scale to assess certain cognitive performances. Possible associations of the menopausal symptoms were assessed to the overall cognitive performance and five cognitive domains (orientation, registration, attention, recall, and language/visuo-spatial skills). The results found that women experiencing severe menopausal symptoms (higher Total Greene climacteric score) presented significantly lower average values for orientation, registration, attention, recall, and language/visuo-spatial skills as compared to women with mild menopausal symptoms. Multivariate linear regression analysis found that severe depression and sexual dysfunction were significantly and negatively associated with overall cognitive scores. The authors conclude that the cognitive performance of women was sensitive to severe depression and sexual dysfunction.

Commentary

Cognition refers to the various functions of the human brain, including its ability to learn, recall any information, organize, plan, divert attention, recognize, and utilize language and perform computation [2]. Cognitive impairment is common among women in the menopausal transition [3]. The US Study of Women’s Health across the Nation (SWAN) [4] explored whether depression, anxiety, sleep disturbance, vasomotor symptoms negatively impact cognitive performance during the menopausal transition in a 6-year longitudinal cohort of 1,903 mid-aged US women. Higher levels of depressive and anxiety symptoms negatively impacted cognitive performance. Women with high levels of depressive symptoms had significant impairments of cognitive assessment scores during performing the ‘Processing Speed Test’, decreased cognitive performance in those with severe anxiety disorders, particularly deterioration in episodic memory. In contrast, sleep disturbance or vasomotor symptoms were not associated with current cognitive and/or learning performance. Another study in women with moderate to severe vasomotor symptoms [5] examined the extent to which subjective memory problems were associated with objective cognitive test performances, affective symptoms and menopausal symptoms. Sixty-eight mid-aged women (average age 53 years) with at least 35 hot flashes per week completed memory function questionnaires, objective cognitive tests, menopause symptom scales, and mood questionnaires. Women with memory impairment during the menopausal transition reported accurately about their memory problems, i.e. subjective assessments of their decreased memory function. Their cognitive impairment was related to emotion, with vasomotor symptoms leading to sleep disturbance, fatigue and depressive symptoms strongly associated with the memory problems.

A recent study [6] assessed the association between the severity of menopausal symptoms and daily cognitive decline in Chinese peri- and postmenopausal women. A total of 295 women were enrolled. The conclusion was that age, body mass index, monthly income, occupational status, education level, menopausal status, birth frequency, regular exercise, chronic history, anxiety, and physical/mental chief complaint fatigue were positively associated with daily cognitive decline. Menopausal anxiety and physical and mental fatigue were independent predictors of daily cognition. Therefore, severe menopausal symptoms in postmenopausal women should be actively treated to prevent or reduce the possible short or long-term adverse effects of menopausal symptoms on cognitive function [6].

Regarding the research on severe female sexual dysfunction (FSD) in most studies FSD was significantly negatively associated with overall and/or certain cognitive scores. After evaluating some major studies in this field, it has been concluded that the co-existence of anxiety, depression and sexual dysfunction in women may be one of the underlying causes of poor or impaired cognitive function [7]; as found by the authors of the present commented study of Kaur et al. [1]. Nevertheless, predictors of FSD are multifaceted. According to a systematic review and qualitative analysis of 135 studies from 41 countries [8] persistent considerable risk factors for FSD were: poor physical and mental health, stress, genitourinary problems, sexual dissatisfaction and religious beliefs. Nonetheless, the effects of many factors remain unclear, so a variety of physiological, psychological and social factors have a certain impact on the occurrence of sexual dysfunction [8].

Finally, we would to conclude on the commented research that although an association of women’s cognition with menopausal symptoms found, it is important to bear in mind that there are various cognitive tests that may render different results in different groups dependent on a variety of endogenous and exogenous (environmental) factors. Most of the knowledge is based on observational studies, most with small sample sizes, which may be biased by confounding factors such as race, education level, body mass index and especially also varying degrees of health of menopausal women. Hence, for the management in clinical practice in the future there is a need for large-scaled prospective studies to better understand the importance of treating menopausal symptoms in context with the possible risk of impaired cognitive performances.

Dr. Yunhe Zhang, MD and Prof. Dr. Alfred O. Mueck, PhD
Research Centre for Women’s Health and
University Women’s Hospital of Tuebingen,
University of Tuebingen, Tuebingen, Germany

References

  1. Kaur M, Kaur M. Is cognitive performance of women sensitive to the severity of menopausal symptoms? Menopause. 2022;29(2):170-177.
    https://pubmed.ncbi.nlm.nih.gov/35013054/
  2. Nationalmssociety.org [Internet]. New York (NY).
    https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes
  3. Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol. 2000;152(5):463-73.
    https://pubmed.ncbi.nlm.nih.gov/10981461/
  4. Greendale GA, Wight RG, Huang MH, et al. Menopause-associated symptoms and cognitive performance: results from the study of women’s health across the nation. Am J Epidemiol. 2010;171(11):1214-24.
    https://pubmed.ncbi.nlm.nih.gov/20442205/
  5. Drogos LL, Rubin LH, Geller SE, Banuvar S, Shulman LP, Maki PM. Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause. 2013;20(12):1236-42.
    https://pubmed.ncbi.nlm.nih.gov/23676633/
  6. Huang W, Jiang S, Geng L, Li C, Tao M. Correlation between menopausal symptoms and everyday cognition in Chinese (peri)menopausal women. Gynecol Endocrinol. 2021;37(7):655-659.
    https://pubmed.ncbi.nlm.nih.gov/33645380/
  7. Basson R, Gilks T. Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Womens Health (Lond). 2018;14:1745506518762664.
    https://pubmed.ncbi.nlm.nih.gov/29649948/
  8. McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018;18(1):108.
    https://pubmed.ncbi.nlm.nih.gov/29929499/

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If you would like to add a comment or contribute to a discussion based on this issue, please contact Menopause Live Editor, Peter Chedraui at peter.chedraui@cu.ucsg.edu.ec.

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