Severity of menopausal symptoms impacts cognitive performance
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The cognitive performance of women was sensitive to the severity of their menopausal symptoms, particularly depression and sexual dysfunction, according to a cross-sectional study published in Menopause.
The study included 404 women aged 40 to 65 years (mean age, 50.78 years) living in the rural areas of district Rupnagar, Punjab, India, according to Mankamal Kaur, MSc, a research scholar, and Maninder Kaur, PhD, chair and assistant professor, both of the department of anthropology at Panjab University in Chandigarh, India.
With a mean age at menarche of 14.89 ± 0.08 years and at menopause of 47.24 ± 0.32 years, 107 of the participants were premenopausal, 90 were perimenopausal, 92 were early menopausal and 115 were late menopausal according to WHO criteria.
Also, 83.4% were married, and 93.8% did not have any kind of private or government job. In terms of education, 22.5% were illiterate, 37.6% had primary to middle school education, 32.2% had a high school degree and 7.7% were graduates or postgraduates.
The women were evaluated according to the Greene Climacteric Scale, which evaluates 21 menopausal symptoms across psychological, somatic, vasomotor and sexual interest classifications.
Depression (67%), somatic (63.5%) and sexual dysfunction (67.8%) were highest among late postmenopausal women. Anxiety (58.7%) and vasomotor symptoms (59.8%) were highest among early postmenopausal women.
Also, the women completed a 30-point Hindi version of the Mini-Mental State Examination (MMSE) to gauge their global cognitive performance across its orientation to time and place, registration, attention and calculation, recall, and language and visuo-spatial ability subdomains.
Women with severe menopausal symptoms had significantly lower mean values for orientation (8.11 vs. 8.9; P < .001), registration (2.77 vs. 2.91; P < .001), attention (4.31 vs. 4.48; P < .01), recall (2.26 vs. 2.53, P < .05) and language/visio-spatial skills (7.13 vs. 7.91, P < .001) than women with mild symptoms.
In a univariate linear regression analysis, the severity of each menopausal symptom was negatively and significantly associated with global cognitive scores, the researchers said.
In the multivariate linear regression analysis, though, only severe depression and greater intensity of sexual dysfunction had a negative and significant association with MMSE scores.
After adjusting for age and marital and educational status, the researchers found that severe depression and sexual dysfunction were the only symptoms with a significant association with overall cognitive performance.
Severe vasomotor symptoms were not predictors of cognitive performance in all the cognitive domains on the MMSE scale except for attention, and once the researchers adjusted for covariates in the model, its significance was lost as well. No significant association was observed between somatic symptoms and cognitive performance either.
Although more longitudinal and cross-sectional studies of large population-based samples could clarify these associations, the researchers said, they believe their results can help rural services address these issues and help many women.
References:
- Kaur M, et al. Menopause. 2022;doi:10.1097/GME.0000000000001910.
- Greendale GA, et al. Am J Epidemiol. 2021;doi:10.1093/aje/kwq067.
- Maki PM, et al. Menopause. 2021;doi:10.1097/GME.0000000000001725.
Perspective
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The study showed a link between cognitive performance and the severity of menopause symptoms in a cohort of midlife women in rural India. The finding of cognitive changes in women during the menopause transition is not new.
Many women describe “brain fog” during the menopause transition, and this may relate to a number of factors, including sleep disruption related to menopause (insomnia, night sweats), mood disorders and life stressors.
Sleep disorders unrelated to menopause are also more prevalent in midlife and include restless leg syndrome and obstructive sleep apnea, which can contribute to daytime fatigue and cognitive changes.
Life stressors potentially resulting in sleep disruption and contributing to poorer cognitive performance include caretaking, relationship discord, financial stressors and other factors.
We also know that the menopause transition is a period of vulnerability in terms of mood, and mood disorders can certainly result in poorer cognitive performance.
Whether cognitive changes that occur in midlife are transient remains unclear. In contrast to findings of the Study of Women’s Health Across the Nation (SWAN), a recent study by Maki et al showed that cognitive declines in menopause may be persistent in women with multiple risk factors for cognitive dysfunction, including those with low income, low education, mental health disorders and high trauma exposure — factors that may be more prevalent in rural populations in India.
The study by Kaur and Kaur, however, highlights the importance of screening for potentially modifiable factors in individual women, such as sleep issues, mood disorders and bothersome menopause symptoms. But it also underscores the importance of addressing the more difficult societal level issues of the effects of poverty and trauma on health and quality of life.
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