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New research links PCOS to cognitive decline in midlife. Westend61/Getty Images
  • Polycystic ovarian syndrome (PCOS) is a chronic hormonal endocrine disorder that can affect multiple aspects of health.
  • Previous research shows people with PCOS are at an increased risk for several diseases such as type 2 diabetes, endometrial cancer, and high blood pressure.
  • Researchers from the University of California, San Francisco have now found that people with PCOS may be at a higher risk of developing memory and thinking problems in middle age.

About 116 million women around the world have polycystic ovarian syndrome (PCOS) — a chronic hormonal endocrine disorder that affects the reproductive system of people assigned female at birth.

Common symptoms of PCOS include irregular or missed periods, acne, enlarged ovaries, excessive body hair, and infertility.

Previous research shows that people with PCOS are at an increased risk for other diseases, including type 2 diabetes, heart disease, obstructive sleep apnea, liver disease, depression, and endometrial cancer.

Now, researchers from the University of California, San Francisco are adding to this list with evidence suggesting people with PCOS may be at a higher risk of developing memory and thinking problems in middle age.

The study was recently published in Neurology, the medical journal of the American Academy of Neurology.

According to Dr. Heather G. Huddleston, professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, and lead author of this study, they decided to study the impact of PCOS on brain health because medical professionals already know that PCOS is a disorder defined by differences in reproductive hormones and metabolic health, in particular insulin resistance.

“We also know that hormones and metabolic health can impact brain health, particularly with aging,” Dr. Huddleston told Medical News Today. “Thus, we thought it was important to investigate brain health in older women with PCOS — particularly since no studies had previously been done regarding this question.”

People with PCOS normally have high levels of androgen hormones — such as testosterone — and low levels of progesterone.

Previous research shows androgens can sometimes have neurotoxic effects and progesterone has neuroprotective effects, which may be diminished when levels are too low.

For this study, Dr. Huddleston and her team recruited 907 female participants who were between the ages of 18 and 30 at the beginning of the study, who were then followed by researchers for 30 years.

At the end of 30 years, all participants were asked to complete tests to measure their memory, verbal learning, cognitive control, processing speed, and attention. At the time of testing, 66 study participants had a PCOS diagnosis.

Researchers found participants with PCOS had lower scores on three of the five tests given, specifically in the areas of memory, attention, and verbal abilities, when compared to those without PCOS.

Specifically for the test measuring attention, scientists reported participants with PCOS had an average score about 11% lower than those without the condition.

“We had a hypothesis that we might find evidence of lower cognitive scores with aging, based on what we already know about various health conditions that can impact the brain,” Dr. Huddleston said. “However, these study participants were relatively young (mid-life), so in some ways, I was still surprised to see the differences that we did.”

To further validate their findings, the research team conducted a smaller study of 291 participants who received MRI brain scans at years 25 and 30 of the larger study. Of this smaller cohort, 25 had PCOS.

Through the MRI scans, scientists were able to examine the integrity of white matter pathways in the brain. White matter helps the brain process information and connects the areas of the brain responsible for learning, balance, focusing, and problem-solving.

Dr. Huddleston and her team found participants with PCOS had lower white matter integrity compared to those who did not.

“White matter integrity on MRI can be an early sign of changes in the brain that can happen with aging,” Dr. Huddleston explained. “We did not find any of the more significant changes, such as abnormal white matter so it is reassuring that only early signs were found.”

“I think it is key that we verify these findings in other populations and/or datasets,” she continued. “I am also very interested in developing a longitudinal study of women with PCOS to determine if and when differences in cognition start to arise. Finally, it would be fascinating to develop a study to look at ways to protect brain health in this population.”

As more information linking PCOS and brain health comes to the forefront, it may become increasingly important for doctors to talk with people with PCOS about how it could potentially affect their cognition.

Dr. Huddleston said there are health practices that can protect brain health.

“For example, we know that exercise has important effects on the brain and can protect the brain from accelerated decline with aging,” she detailed. “So, for starters, encouraging physical activity would be an important recommendation.”

“Along these lines, managing cardiovascular risk factors, such as dyslipidemia, hypertension, and diabetes is critical,” Dr. Huddleston added. “These conditions are increased in PCOS but also have a range of very effective treatments. “For these reasons, making sure women with PCOS have access to comprehensive and informed care is critical.

MNT also spoke with Dr. Michael Krychman, a board certified OB/GYN and medical director of Women’s Health Services at MemorialCare Saddleback Medical Center in Laguna Hills, CA, about this study.

Dr. Krychman said he was not shocked by this study’s findings.

PCOS is really associated with a variety of metabolic health conditions like obesity, diabetes, hypertension, (and) heart health issues,” he explained. “There are changes in hormones, including androgens. So the association between PCOS and cognitive decline or memory issues is not very surprising at all.”

When it comes to talking to people with PCOS about its potential impact on their brain health, Dr. Krychman said the whole focus for PCOS really should be on a bio-psycho-social comprehensive treatment paradigm.

“So it’s not only about hormonal balance and hair and acne, but also, I think we will now incorporate primary prevention of cognitive decline into treatment paradigms,” he continued. “And what that may look like is keeping active, limiting alcohol, healthy diet, monitoring cardiometabolic issues, sugar control, (and) cholesterol control.”

“Also, the concept of cognitive enrichment, like playing games, reading a book, memory training — all those things will help enrich your life and may help preserve mental function,” Dr. Krychman added. “The concept of focusing on brain health in a multi-dimensional factor will be really important.”