Abstract
Background: Menopause is associated with physical and emotional symptoms, and subjective cognitive concerns that are 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 and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause.Methods: Twenty-seven menopausal women (M age = 53.74, SD = 4.14) completed a 5-week group-based intervention (with a post-group booster) consisting of 2-h weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS).Results: All but one MACCS subscale significantly decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d = −0.39 to −0.91) with gains maintained at 1-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 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 = 0.027, d = −0.45). 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 depression ratings.Conclusion: To our knowledge, this is the first feasibility study of its kind targeting perceptions of cognitive impairment during menopause. Although generally well-tolerated, recruitment and scheduling difficulties were flagged as challenges to engagement while a small sample size and lack of control group limit conclusions about efficacy. Providing current results could be replicated with enhanced methods, these results provide support that cognitive remediation is a feasible and credible treatment, and may improve quality of life for women in menopause.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03311880.
Highlights
Menopause, or the absence of a menstrual period for at least 12 consecutive months, is a natural biological transition that all women experience caused by a gradual decline in the reproductive hormones oestrogen and progesterone
In addition to physical and emotional symptoms, subjective perceptions of cognitive difficulty have been frequently reported during the menopausal transition
We hypothesised that the combination of psychoeducation, cognitive remediation strategies and development of lifestyle changes to promote brain health, presented in a group-based format would ameliorate subjective cognitive concerns and attenuate distress
Summary
The absence of a menstrual period for at least 12 consecutive months, is a natural biological transition that all women experience caused by a gradual decline in the reproductive hormones oestrogen and progesterone. In a study by Mitchell and Woods [9], women in early, middle, and late stages of the menopausal transition between the ages of 35 and 55 completed open-ended interviews covering topics such as health and well-being, psychosocial stressors, menstrual cycle changes, role strain, and attitudes toward menopause and ageing. They were asked about cognition with questions such as “Have you noticed any changes in your memory over the last few years?” Of the 230 women interviewed, 62% subjectively reported difficulties recalling names/numbers, forgetting events and actions, and concentrating. The current study assessed the feasibility and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause
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