Role of psychiatric comorbidity on cognitive function during and after the menopausal transition

Abstract

While cognitive complaints are common during the menopausal transition, measurable cognitive decline occurs infrequently, often due to underlying psychiatric or neurological disease. To clarify the nature, etiology and evidence for cognitive and memory complaints during midlife, at the time of the menopausal transition, we have critically reviewed the evidence for impairments in memory and cognition associated with common comorbid psychiatric conditions, focusing on mood and anxiety disorders, attention-deficit disorder, prolonged stress and decreased quantity or quality of sleep. Both the evidence for a primary effect of menopause on cognitive function and contrarily the effect of cognition on the menopausal transition are examined. Impairment in specific aspects of executive function is explored. Evaluation and treatment strategies for the symptomatic menopausal woman distressed by changes in her day-to-day cognitive function with or without psychiatric comorbidity are presented.

The intensity of menopausal symptoms is associated with episodic memory in postmenopausal women

“…Psychological symptomatology exhibited an inverse association with memory scores and general mental status. Anxiety and mood disorders are associated with deficits in processing speed, verbal memory and working memory, according to the Study of Women's Health Across the Nation and other studies 15,17,22,23,34 . Women with depressive disorders have almost twice the risk of developing incident mild cognitive impairment and dementia, independently of anthropometric and vascular risk factors 35 .…”

HIV and the menopause

“…[65][66][67] However, evidence for benefit with hormone replacement therapy has been equivocal. 68 Alexander et al 69 suggest that symptoms of the perimenopause such as sleep loss have the potential to affect cognition.…”

“…Attention to psychiatric co-morbidity during menopause, including depression, is also critical. 69 Research on cognition in HIV-infected women would be strengthened by adoption of more uniform, sensitive testing.…”