Cognitive function in women with polycystic ovary syndrome (PCOS): impact of reproductive and metabolic factors

Abstract

ObjectivePolycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by abnormalities in both reproductive and metabolic health. Gonadal steroids are implicated in widely reported sex differences in cognitive abilities while emerging evidence supports an impact of metabolic factors on cognition. The condition of PCOS presents a unique opportunity to investigate the dual burden of reproductive and metabolic disturbance on cognitive function in women of reproductive age. To that end, we compared cognitive task performance in women with and without PCOS and explored associations among cognitive test scores and reproductive and metabolic features.DesignCase-control study.Materials and Methods79 women with PCOS, as defined by the Rotterdam criteria, and 40 healthy women with regular menstrual cycles and normal androgens were recruited. Participants completed tests of spatial ability (Vandenberg and Kuse Mental Rotation Task), manual dexterity (Purdue Pegboard Task) and perceptual speed (Identical Pictures Task). Cognitive tests were performed in the early follicular phase of the menstrual cycle or at a random time in those reporting amenorrhea. Differences in cognitive test scores among groups were evaluated by Mann-Whitney U Tests. Stepwise regression by backward selection was used to assess associations among cognitive test performance and reproductive and metabolic features.ResultsWomen with PCOS performed worse on tests of spatial ability and manual dexterity as judged by lower scores on the Mental Rotation Task (Median Scores: 6.0 vs. 8.5, p=0.020) and longer time to complete scores for the Purdue Pegboard Task (Median Times: Dominant Hand, 49 sec vs. 46 sec, p=0.010; Both Hands, 60 sec vs. 58 sec, p=0.025) compared to controls. Both reproductive and metabolic features emerged as independent predictors of spatial ability (Menstrual Cycle Length, Number of 2 - 5 mm Follicles per Ovary, Triglycerides; p<0.05) and manual dexterity (Free Androgen Index, Androstenedione, Hemoglobin A1C; p<0.05) in women with PCOS.ConclusionsWomen with PCOS showed reduced spatial ability and manual dexterity. Poorer spatial ability was inconsistent with testosterone’s role in mediating enhanced visuospatial cognition. Both reproductive and metabolic factors predicted cognitive function in PCOS. However, associations pointed to competing influences on cognitive function. Further research is needed to ascertain any meaningful impact of reduced cognitive task performance in women with PCOS. ObjectivePolycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by abnormalities in both reproductive and metabolic health. Gonadal steroids are implicated in widely reported sex differences in cognitive abilities while emerging evidence supports an impact of metabolic factors on cognition. The condition of PCOS presents a unique opportunity to investigate the dual burden of reproductive and metabolic disturbance on cognitive function in women of reproductive age. To that end, we compared cognitive task performance in women with and without PCOS and explored associations among cognitive test scores and reproductive and metabolic features. Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by abnormalities in both reproductive and metabolic health. Gonadal steroids are implicated in widely reported sex differences in cognitive abilities while emerging evidence supports an impact of metabolic factors on cognition. The condition of PCOS presents a unique opportunity to investigate the dual burden of reproductive and metabolic disturbance on cognitive function in women of reproductive age. To that end, we compared cognitive task performance in women with and without PCOS and explored associations among cognitive test scores and reproductive and metabolic features. DesignCase-control study. Case-control study. Materials and Methods79 women with PCOS, as defined by the Rotterdam criteria, and 40 healthy women with regular menstrual cycles and normal androgens were recruited. Participants completed tests of spatial ability (Vandenberg and Kuse Mental Rotation Task), manual dexterity (Purdue Pegboard Task) and perceptual speed (Identical Pictures Task). Cognitive tests were performed in the early follicular phase of the menstrual cycle or at a random time in those reporting amenorrhea. Differences in cognitive test scores among groups were evaluated by Mann-Whitney U Tests. Stepwise regression by backward selection was used to assess associations among cognitive test performance and reproductive and metabolic features. 79 women with PCOS, as defined by the Rotterdam criteria, and 40 healthy women with regular menstrual cycles and normal androgens were recruited. Participants completed tests of spatial ability (Vandenberg and Kuse Mental Rotation Task), manual dexterity (Purdue Pegboard Task) and perceptual speed (Identical Pictures Task). Cognitive tests were performed in the early follicular phase of the menstrual cycle or at a random time in those reporting amenorrhea. Differences in cognitive test scores among groups were evaluated by Mann-Whitney U Tests. Stepwise regression by backward selection was used to assess associations among cognitive test performance and reproductive and metabolic features. ResultsWomen with PCOS performed worse on tests of spatial ability and manual dexterity as judged by lower scores on the Mental Rotation Task (Median Scores: 6.0 vs. 8.5, p=0.020) and longer time to complete scores for the Purdue Pegboard Task (Median Times: Dominant Hand, 49 sec vs. 46 sec, p=0.010; Both Hands, 60 sec vs. 58 sec, p=0.025) compared to controls. Both reproductive and metabolic features emerged as independent predictors of spatial ability (Menstrual Cycle Length, Number of 2 - 5 mm Follicles per Ovary, Triglycerides; p<0.05) and manual dexterity (Free Androgen Index, Androstenedione, Hemoglobin A1C; p<0.05) in women with PCOS. Women with PCOS performed worse on tests of spatial ability and manual dexterity as judged by lower scores on the Mental Rotation Task (Median Scores: 6.0 vs. 8.5, p=0.020) and longer time to complete scores for the Purdue Pegboard Task (Median Times: Dominant Hand, 49 sec vs. 46 sec, p=0.010; Both Hands, 60 sec vs. 58 sec, p=0.025) compared to controls. Both reproductive and metabolic features emerged as independent predictors of spatial ability (Menstrual Cycle Length, Number of 2 - 5 mm Follicles per Ovary, Triglycerides; p<0.05) and manual dexterity (Free Androgen Index, Androstenedione, Hemoglobin A1C; p<0.05) in women with PCOS. ConclusionsWomen with PCOS showed reduced spatial ability and manual dexterity. Poorer spatial ability was inconsistent with testosterone’s role in mediating enhanced visuospatial cognition. Both reproductive and metabolic factors predicted cognitive function in PCOS. However, associations pointed to competing influences on cognitive function. Further research is needed to ascertain any meaningful impact of reduced cognitive task performance in women with PCOS. Women with PCOS showed reduced spatial ability and manual dexterity. Poorer spatial ability was inconsistent with testosterone’s role in mediating enhanced visuospatial cognition. Both reproductive and metabolic factors predicted cognitive function in PCOS. However, associations pointed to competing influences on cognitive function. Further research is needed to ascertain any meaningful impact of reduced cognitive task performance in women with PCOS.