Menopause effects on verbal memory: findings from a longitudinal community cohort

Abstract

Context: Although cognitive complaints are common among menopausal women, it is debatable whether there is an objective decline in cognition with menopause that exceeds what is expected with normal aging.

Objective: The objective of the study was to determine whether reproductive senescence is associated with an age-independent decline in verbal memory.

Design and setting: The study was a 14-year, longitudinal, population-based cohort study of women who underwent yearly endocrine, behavioral, and cognitive assessments from pre- to postmenopause.

Participants: Caucasian and African American premenopausal women (n = 403), who were enrolled in the Penn Ovarian Aging Study, participated in the study.

Main outcome measures: Buschke Selective Reminding Test (immediate and delayed verbal recall), the digit symbol substitution task, and the symbol copy task were used to measure outcomes.

Results: A total of 3958 assessments were conducted in this sample of 403 women. In models that were adjusted for age and important cofactors, immediate (P = .03) and delayed (P = .03) recall on the Buschke Selective Reminding Test declined from the pre- to postmenopausal stages. Further evaluation identified a significant decline (P < .002) in delayed recall early in the transition and immediate recall (P = .04) late in the transition. Race was a significant factor in performance on all tasks (all P < .0001) except the delayed verbal recall task (P = .06) in adjusted models. Endocrine measures were significantly associated with cognitive performance in unadjusted models.

Conclusions: Certain cognitive domains are sensitive to the physiological changes of reproductive senescence independent of age. The differences in cognitive performance between African American and Caucasian women were not explained by factors examined in this study but are of important public health concern that warrants further investigation.

Figure 1.

A, Decrement in immediate verbal memory across the menopause transition. The figure depicts the estimated change in immediate verbal recall in women at various stages of the menopause transition with performance during the premenopause as the reference. A significant decline in immediate verbal memory was observed when comparing performance on the Buschke Selective Reminding Task post- vs premenopause. B, Decrement in delayed verbal memory across the menopause transition. The estimated change in delayed verbal recall in women at various stages of the menopause transition with performance during the premenopause as the reference is depicted. A significant decline in delayed verbal memory was observed when comparing the performance on the Buschke Selective Reminding Task in the early transition and late transition vs premenopause. There was a trend for poorer performance as early as the late premenopause and as late as the postmenopause vs the premenopause. Whether the lack of significance in performance in the post- vs premenopause stages signals a leveling off of a decline in the delayed verbal recall or is a result of the relatively fewer women/assessments in the postmenopause stage is not known.