Pauline M Maki1, Gayle Springer2, Kathryn Anastos3, Deborah R Gustafson4, Kathleen Weber5, David Vance6, Derek Dykxhoorn7, Joel Milam8, Adaora A Adimora9, Seble G Kassaye10, Drenna Waldrop11, Leah H Rubin2,12. 1. Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. 4. Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, NY. 5. Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, IL. 6. School of Nursing, University of Alabama at Birmingham, Birmingham, AL. 7. Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Coral Gables, FL. 8. Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA. 9. Department of Medicine, University of North Carolina, Chapel Hill, NC. 10. Department of Medicine/ Division of Infectious Diseases, Georgetown University, Washington, DC. 11. University of Miami Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. 12. Department of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.
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.
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.
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