Do Menopausal Symptoms Account for the Declines in Cognitive Function During the Menopausal Transition?

Women both report and show significant changes in cognition as they transition through the menopause. Changes in sex steroid hormones contribute to these changes, as do menopause symptoms. As measured by questionnaire or diary, vasomotor symptoms (VMS) do not reliably associate with cognitive performance at midlife. In contrast, emerging findings indicate that physiological VMS, measured with ambulatory skin conductance monitors, do associate with cognition. The extent to which physiologic hot flashes contribute to cognitive changes across the menopause is unknown. Psychological symptoms of the menopause, including depressive symptoms and anxiety, are associated with worse cognitive performance, but not appear to explain the change in cognition observed across the transition. Lastly, sleep disturbance is associated with worse cognitive performance at midlife, though the extent to which sleep accounts for cognitive changes as women transition through the menopause is unknown. Prospective studies using objective measures of VMS and sleep are needed to characterize the factors associated with cognitive changes in women at midlife.