Abstract Polycystic ovary syndrome (PCOS) is characterized by excess androgens, ovulatory disorders, and a higher prevalence of obesity and metabolic disturbances including type 2 diabetes, hyperlipidemia, and hypertension, some of which are risk factors for neurodegenerative disorders such as Alzheimer’s disease and brain atrophy. However, it is unclear whether brain aging occurs more rapidly in women with PCOS compared to those without PCOS. Except for the hypothalamic-pituitary-gonadal axis involved in the conventional ovulatory process, little is known regarding the role of the gray matter in the pathogenesis of PCOS, and limited existing studies examining brain structures in PCOS have shown inconsistent results. This case-control study aimed to investigate the age-related differences in total and regional brain gray matter volume and average cortical thickness in young women with and without PCOS by using brain magnetic resonance imaging (MRI) to understand whether women with PCOS exhibit distinctive patterns of brain aging, and their association with factors including obesity, hyperandrogenism, and metabolic disturbances. Seventy-six women diagnosed with PCOS and 68 age-matched women without PCOS (aged 20-35 years) underwent brain MRI to measure gray matter volume and cortical thickness. Anthropometric, hormonal, and metabolic measurements were conducted to assess their associations with the investigated brain structures. In women without PCOS, increasing age was significantly correlated with a decrease in global gray matter volume (r = -0.5598, P < 0.0001), while this association was not significant in women with PCOS (r = -0.1475, P = 0.204). The decline in gray matter volume with age differed significantly between the two groups regardless of obesity (body mass index exceeding 25 Kg/m2), especially in the frontal, parietal, occipital, and temporal regions. After adjusting for dehydroepiandrosterone sulfate (DHEAS) levels, the negative association between age and global gray matter volume became statistically significant in women with PCOS. Increasing age was also significantly associated with a decrease in global cortical thickness in women without PCOS, but not in women with PCOS. Such negative association between global cortical thickness and age was particularly stronger in women with obesity compared to those without. The negative association between age and global cortical thickness in women with PCOS became pronounced after adjusting for DHEAS levels. Women with PCOS experience a milder gray matter loss with age compared to women without PCOS. The neuroprotective effect of high DHEAS levels in women with PCOS may be implicated in this relationship.
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