Original Studies

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

Maki, Pauline M. PhD1; Springer, Gayle MLA2; Anastos, Kathryn MD3; Gustafson, Deborah R. PhD4; Weber, Kathleen MS5; Vance, David PhD6; Dykxhoorn, Derek PhD7; Milam, Joel PhD8; Adimora, Adaora A. MD9; Kassaye, Seble G. MD10; Waldrop, Drenna PhD11; Rubin, Leah. H. PhD2,12

Author Information

1Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL

2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

3Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY

4Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, NY

5Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, IL

6School of Nursing, University of Alabama at Birmingham, Birmingham, AL

7Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Coral Gables, FL

8Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA

9Department of Medicine, University of North Carolina, Chapel Hill, NC

10Department of Medicine/ Division of Infectious Diseases, Georgetown University, Washington, DC

11University of Miami Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA

12Department of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence to: Pauline M. Maki, PhD, Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood St., MC 913, Chicago, IL 60612. E-mail: [email protected]

Received 9 September, 2020

Revised 27 October, 2020

Accepted 27 October, 2020

Funding/support: L.H.R.'s efforts were funded by U01 HL146201 and P30MH075673. Data in this manuscript were collected by the MACS/WIHS Combined Cohort Study (MWCCS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241-01; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201-01; Bronx CRS (K.A. and Anjali Sharma), U01-HL146204-01; Brooklyn CRS (D.R.G. and Tracey Wilson), U01-HL146202-01; Data Analysis and Coordination Center (Gypsyamber D'Souza, Stephen Gange, and Elizabeth Golub), U01-HL146193-01; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245-01; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240-01; Connie Wofsy Women's HIV Study, Northern California CRS (Bradley Aouizerat and Phyllis Tien), U01-HL146242-01; Los Angeles CRS (Roger Detels and Otoniel Martinez-Maza), U01-HL146333-01; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205-01; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203-01; UAB-MS CRS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-HL146192-01; UNC CRS (Adaora Adimora), U01-HL146194-01. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Human Genome Research Institute (NHGRI), National Institute on Aging (NIA), National Institute of Dental & Craniofacial Research (NIDCR), National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), National Institute of Nursing Research (NINR), National Cancer Institute (NCI). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).

Financial disclosures/conflicts of interest: P.M.M. has received consulting honoraria from Abbvie, Pfizer, and Balchem. A.A.A. has received funding from Merch, Viiv, and Gilead. The other authors report no disclosures/conflicts.

Menopause 28(4):p 360-368, April 2021. | DOI: 10.1097/GME.0000000000001725

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.

© 2021 by The North American Menopause Society

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