Women with polycystic ovarian syndrome (PCOS) were found to have lower cognitive performance at midlife than women without PCOS, according to a recent cross-sectional study published in the journal Neurology.
“Our findings may indicate the potential for an accelerated cognitive decline trajectory in PCOS. Given that up to 10% of women may be affected by PCOS, these results have important implications for public health at large,” noted lead author Heather G. Huddleston, MD, University of California, San Francisco, and co-authors. “Current recommendations for PCOS include management of cardiovascular risk and screening for depression, and our work suggests that appropriate management of these aspects may serve to also improve brain aging for this population.”
Researchers examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study of individuals who were 18–30 years at baseline (1985–1986) and followed for 30 years. Women with PCOS were identified via the ancillary CARDIA Women’s Study by determining elevated androgen levels and/or hirsutism with symptoms of oligomenorrhea. At year 30 of follow-up, participants completed a series of tests to examine their cognitive function, including the Montreal Cognitive Assessment, Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test, Stroop test, and category and letter fluency tests. A smaller set of participants underwent magnetic resonance imaging (MRI) testing to assess their brain structure and white matter integrity.
In total, 907 women completed the cognitive testing, 66 of whom met criteria for PCOS. Both groups were similar in age, body mass index (BMI), smoking/drinking status, and income. When tested at follow-up year 30, participants with PCOS performed lower (mean z score; 95% CI) on Stroop (−0.323 (−0.69 to −7.37); p = 0.008), RAVLT (−0.254 (−0.473 to −0.034); p = 0.002), and category fluency (−0.267 (−0.480 to −0.040); p = 0.02) tests. Of the 291 participants that completed MRI testing, 25 met PCOS criteria and demonstrated lower total white matter fractional anisotropy (coefficient (95% CI) −0.013 (−0.021 to −0.005); p = 0.002), though not abnormal white matter.
Authors noted that since PCOS diagnoses were not made by a physician and were instead gleaned based on serum androgen levels and self-reports of oligomenorrhea and hirsutism, misclassification could be a potential limitation for this study.
“Whether midlife brain health in PCOS could be improved through early interventions targeting cardiometabolic health should be a focus on future research,” authors concluded. “Larger studies with longitudinal designs are needed to both validate our findings and to identify potential differences in cognitive trajectories.”
Reference
Huddleston HG, Jaswa EG, Casaletto KB, et al. Associations of polycystic ovary syndrome with indicators of brain health at midlife in the CARDIA cohort. Neurology. 2024;102(4). doi.org/10.1212/WNL.0000000000208104
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