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Polycystic ovary syndrome, known as PCOS, has long been known for symptoms such as missed periods or excess body hair. Now, new research has revealed another potential effect: cognitive dysfunction later in life.
The scientific report “is one of the few studies to investigate cognitive functioning and brain outcomes in those women at midlife,” said Dr. Pauline Maki, a professor and director of the Women’s Mental Health Research Program at the University of Illinois Chicago, via email. Maki wasn’t involved in the study, published Wednesday in the journal Neurology.
Polycystic ovary syndrome refers to symptoms related to a hormonal imbalance in people assigned female at birth. Telltale signs can include “menstrual cycle changes, skin changes such as increased facial and body hair and acne, abnormal growths in the ovaries, and infertility,” according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The chronic condition affects around 8% to 13% of women and girls of reproductive age worldwide, according to the World Health Organization, but as many as 70% could be experiencing PCOS while undiagnosed.
The new study involved 907 female participants, between the ages of 18 and 30 at the beginning of the study, who were followed for 30 years. The study participants completed tests on memory, verbal abilities, attention and processing speed. On the attention test, the 66 people with PCOS scored about 11% lower on average compared with participants without the condition. Those with the condition also scored lower on measurements of memory and verbal abilities.
“While (PCOS) has been linked to metabolic diseases like obesity and diabetes that can lead to heart problems, less is known about how this condition affects brain health,” said Dr. Heather G. Huddleston, director of the University of California San Francisco’s PCOS clinic and research program, in a news release. Huddleston is the study’s first author.
“Our results suggest that people with this condition have lower memory and thinking skills and subtle brain changes at midlife. This could impact a person on many levels, including quality of life, career success and financial security.”
The authors also found, via brain scans, that compared with those without PCOS, 25 people with the condition had white matter in poorer condition, which can be an indicator of brain aging. White matter is made of bundled nerve fibers and helps coordinate communication between different regions of the brain.
The findings highlight “potential cognitive vulnerabilities in women with PCOS, though it’s important to know that these are cognitive weaknesses, not impairments,” Maki said. “In other words, they are performing worse than other women on these tests, but they are not performing in the impaired range.”
Early yet concerning research
Several limitations of the study mean its findings should be interpreted carefully, experts said.
For one, the study showed an association between PCOS and cognitive decline, but didn’t prove that the condition causes cognitive decline, the authors said. Secondly, what constituted a PCOS diagnosis wasn’t a doctor’s opinion, but androgen levels and participants’ recollections of their symptoms. High androgen levels are one of the characteristic features of PCOS doctors look for during the diagnostic process.
“Essentially, what we could be seeing here is what happens when PCOS is left untreated,” said Mateja Perović, a doctoral student in the department of psychology at the University of Toronto, via email. “This is important for any concerned readers to keep in mind. If they are managing their PCOS symptoms, they are already doing a lot to protect their brain health down the line.”
Endocrinologist Dr. Wiebke Arlt, who wasn’t involved in the study, had concerns about the authors’ diagnostic criteria.
Polycystic ovary syndrome “was diagnosed to unusual criteria, e.g. androgens above the 75th centile of the reference range,” said Arlt, head of Imperial College London’s Institute of Clinical Sciences, via email. “Usually this would be above the 95th centile of the reference range.”
Given these limitations, additional research is needed to confirm the findings and determine how these changes occur, Huddleston said, “including looking at changes that people can make to reduce their chances of thinking and memory problems.”
But for now, some experts have at least preliminary ideas about the potential processes behind the link between PCOS and cognitive decline.
However, “the mechanism behind accelerated cognitive aging is that metabolic abnormalities — insulin resistance, inflammation, impaired glucose tolerance — affect not only the blood vessels and heart, but every organ including the brain,” said Dr. Katherine Sherif, a professor of medicine at Thomas Jefferson University in Philadelphia, who wasn’t involved in the study, via email.
Genetics may also play a role in the links between PCOS and cognitive decline, said Dr. Ricardo Azziz, professor of obstetrics and gynecology at the University of Alabama at Birmingham, who wasn’t involved in the research.
Managing PCOS and brain health
There currently isn’t a cure for PCOS, but there are treatments and lifestyle changes that can help manage symptoms.
“We all want to bring a healthy brain into late life so that it is resistant to diseases of aging like Alzheimer’s disease,” Maki said. “So, for women with PCOS, they (should) maintain their brain health by controlling their diabetes, getting good exercise, controlling blood pressure, keeping their cholesterol levels in the healthy range and, perhaps (if) future research confirms these findings, maintaining androgen levels in the normal range as they age.”
Sherif echoed these sentiments.
“Most girls and women are prescribed the birth control pill and told to ‘lose weight,’” she said, but aggressively treating the metabolic disturbances is the best way to manage PCOS and prevent cognitive decline.
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