Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV

• Authors: Pauline M Maki, University of Illinois at Chicago; Gayle Springer, Johns Hopkins Bloomberg School of Public Health; Kathryn Anastos, Albert Einstein College of Medicine; Deborah R Gustafson, SUNY-Downstate Medical Center; Kathleen Weber, Cook County Health & Hospitals System & Hektoen Institute of Medicine; David Vance, University of Alabama Birmingham; Derek Dykxhoorn, University of Miami; Joel Milam, University of Southern California; Adaora A Adimora, University of North Carolina; Seble G Kassaye, Georgetown University; Drenna Waldrop, Emory University; Leah H Rubin, Johns Hopkins Bloomberg Sch Publ Hlth
• Journal Title: MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY
• Volume: Volume 28, Number 4
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2021-04-01, Pages 360-368
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/GME.0000000000001725
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Cognition; HIV; Memory; Menopausal transition; Menopause; DEPRESSIVE SYMPTOMS; MEMORY PERFORMANCE; INTERAGENCY HIV; COMPLAINTS; PERIMENOPAUSE; THERAPY; STAGE

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 menopause stages 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.