Cognitive remediation for women during the menopausal transition: a pilot study

Abstract

The menopausal transition is associated with physical and emotional symptoms as well as subjective perceptions of cognitive difficulty that is generally not borne out on objective cognitive measures. This discrepancy suggests that a psychological rather than biological mechanism likely mediates the cognitive concerns of women in menopause. The current study assessed the feasibility of a cognitive remediation intervention (consisting of psychoeducation, cognitive compensatory strategies, and lifestyle modification) with the goal of reducing subjective perceptions of cognitive difficulty during the menopause. Participants (N=27, M age=53.74, SD=4.14) completed a five-week group-based intervention (with a one-month post-group booster) consisting of 2-hour weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and a comprehensive battery of objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS). All but one MACCS subscale decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d=-.39 to -.91) with gains maintained at one-month follow-up. Interestingly, no change in objective cognitive test performance was observed, indicating increases in subjective cognitive confidence in the absence of objective cognitive improvement. There was also no change in mood, anxiety, or stress scores. Two-level HLM analyses revealed that those with higher baseline neuroticism, as measured by the NEO Personality Inventory, had smaller decreases in post-group MACCS High Standards subscale relative to those with lower baseline neuroticism (p=.027, d=-.45). Further, those with higher baseline depression scores on the Depression Anxiety Stress Scale (DASS-21) had a smaller decrease in post-intervention MACCS Total Score relative to those with lower ratings of depression. To our knowledge, this is the first study of its kind in targeting perceptions of cognitive impairment and associated functional difficulties during menopause. This intervention holds the promise of improving quality of life for women in menopause that might also translate to reduced healthcare burden, as many women worry that perceived cognitive changes may signal the onset of dementia rather than reflect normal hormonal changes.