Research published in Neurology found an association between symptoms of cognitive decline and polycystic ovary syndrome (PCOS).
The study included 907 female participants (66 with PCOS) over the course of 30 years. Participants were tested on memory, verbal abilities, processing speed, and attention. Those with PCOS scored lower on tests and showed reduced white matter integrity in brain scans than those without PCOS.
Experts say that more research is needed but that hormones and metabolic health can undoubtedly impact the brain. Clinicians should also be aware that the study had several limitations and that confounders like PCOS patient stress levels could also impact cognitive function.
New research published today in Neurology shows an association between symptoms of cognitive decline during middle age and polycystic ovary syndrome (PCOS).
PCOS is the most common hormonal disorder in women of reproductive age. Patients with PCOS may experience irregular menstruation, hyperandrogenism, and polycystic ovaries. PCOS affects 6% to 12% of women of reproductive age in the US, with the prevalence of adverse metabolic outcomes associated with PCOS ranging among different ethnic groups. Diagnostic delays are common and underdiagnosis is an issue. PCOS has a genetic component, although the environment can trigger gene expression in patients.
PCOS is linked to several comorbidities, explains G. Thomas Ruiz, MD, lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. “PCOS is a major medical disorder, and it can lead to long-term health consequences. Adult onset diabetes disease as well as hyperplasia and endometrial cancer if [the patient] is not menstruating are the two big risks,” Dr. Ruiz says.
However, how PCOS impacts cognition is less understood. “There has been minimal research into cognition in PCOS, with just a handful of studies with small numbers of participants,” says study author Heather G. Huddleston, MD, a specialist in reproductive endocrinology and infertility and Director of the University of California San Francisco PCOS Clinic. This study was the first to look at PCOS and cognition in the middle-aged population.
The study looked at 907 female participants between the ages of 18 and 30. They were studied for 30 years, at which point they were tested for memory, verbal abilities, processing speed, and attention. At the time of testing, 66 participants had PCOS.
The attention test, for example, required participants to look at a list of words written in different colors. They were then tasked with naming the color of the word rather than the actual word. The participants with PCOS scored approximately 11% lower than those without PCOS on this test. In general, participants with PCOS scored lower than those without PCOS in areas of memory, attention, and verbal abilities.
291 participants also underwent brain scans at years 25 and 30. Of those, 25 had PCOS. The scans looked at the integrity of the brain’s white matter pathways. Researchers found that people with PCOS had lower white matter integrity than the other participants.
White matter, according to the Archives of Pharmacal Research, plays “highly significant and pivotal functions in the brain based on the fact that its abnormalities are associated with numerous neurological diseases.” Researchers say that white matter deficits can lead to executive dysfunction, memory retrieval dysfunction, sustained attention deficit, visuospatial impairment, and various psychiatric disorders.
Dr. Huddleston says that patients with PCOS frequently report brain fog, a term that she says is vague and difficult to measure. However, she goes on to explain, “One of the reasons to have suspicions about cognition in PCOS is that PCOS is defined by both hormonal and metabolic features, and we know that both hormones and metabolic health can impact the brain.”
The study’s limitations and possible confounders Dr. Ruiz notes the study’s limitations: The participants’ PCOS diagnoses were based on androgen levels and self-reported symptoms, rather than being diagnosed by a doctor. More so, he says, more research needs to be done in order to show a definitive connection between memory and hormone levels. “The study’s results demonstrated a trend, which is not the same as a correlation,” he says.
He adds that he “would look at confounders, or other things that are not covered in the study which could lead to the same result.” For example, he says, high stress levels could also lead to memory issues.
His patients with PCOS face many stressors: “The stress of not getting a period, the stress of going into an episode of prolonged menstruation, or the stress around [the] inability to get pregnant. High stress levels can lead to depression, which leads to inability to focus and a decreased sense of well-being. This may lead to memory issues,” he says.
Future research, Dr. Ruiz says, “is going to have to be more granular and more detailed and see if there's more cause and effect. They’ll need to do the study in a much more controlled fashion.”
How can clinicians support patients with PCOS?
“There is a lot to learn about PCOS in particular,” Dr. Huddleston says, “but more broadly, there is good research that suggests that exercise in particular is critical in supporting healthy brain aging. This would be an important recommendation. In addition, comorbidities such as type 2 diabetes are known to adversely impact brain health, so working with your provider to optimize metabolic health is important as well.”
When it comes to helping patients with PCOS manage stressors that could affect cognition, Dr. Ruiz says that he first treats the condition—by addressing diet, infertility, or menstrual disorder—and recommends that his patients seek mental healthcare.