Menopausal Symptoms, Menopausal Stage and Cognitive Functioning in - - PowerPoint PPT Presentation

Menopausal Symptoms, Menopausal Stage and Cognitive Functioning in Black Urban African Women

NICOLE G JAFF, PHD, NCMP

DEPARTMENT OF CHEMICAL PATHOLOGY, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, SOUTH AFRICA

LEAH H RUBIN, PHD

DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF ILLINOIS AT CHICAGO, CHICAGO, IL, DEPARTMENTS OF NEUROLOGY, PSYCHIATRY, AND EPIDEMIOLOGY, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD

NIGEL J CROWTHER, PHD

DEPARTMENT OF CHEMICAL PATHOLOGY, NHLS AND UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, SOUTH AFRICA

SHANE A NORRIS, PHD

SAMRC/DEVELOPMENTAL PATHWAYS FOR HEALTH RESEARCH UNIT, UNIVERSITY OF THE WITWATERSRAND, CHRIS HANI BARAGWANATH HOSPITAL, JOHANNESBURG, SOUTH AFRICA

PAULINE M MAKI, PHD

DEPARTMENTS OF PSYCHIATRY, PSYCHOLOGY AND OB/GYN, UNIVERSITY OF ILLINOIS AT CHICAGO, CHICAGO, IL.

Disclosures

None: I disclose that I have no relevant financial relationships with any commercial interests .

Background

• North American and European studies show

cognitive function is influenced by menopausal symptoms and menopausal stage1

• These associations are understudied in sub-

Saharan African women

• Defining a uniform experience of menopause in

women of different cultures is challenging2

• Standardized tools accounting for cultural and

ethnic specifics of menopausal symptoms should be used

• 1. Greendale GA, et al. Am J Epidemiol 2010;171:1214–24 2; 2. Parsons MA, & Obermeyer CM

Menopause 2007;14:760–8

Aims and Hypotheses

AIM:

• Evaluate the association of cognitive function with

menopausal symptoms and stage HYPOTHESES:

• Premenopausal women will show better cognitive

performance than those women later in the transition

• Menopausal symptoms will be inversely related to

cognition

Methods

• Enrolled in the Study of Women Entering and in Endocrine

Transition (SWEET)1

– Mothers and caregivers of children participating in the longitudinal Birth to Twenty cohort (BT20)2 – After 21 years, 2200 of these women were in contact with the researcher teams – During the SWEET 3-year recruitment period , 902 of these 2200 women were randomly selected for SWEET

• Entry criteria:

– Black urban South African women between 40 to 60 years – Within 10 years of menopause

• Sample size: n=702

Participants

• 1. Jaff NG, et al. Menopause 2014;21:1225–33 2. Richter L, et al. Int J Epidemiol 2007;36:504–11

Methods

• Design - Cross sectional
• Menopause Stage - STRAW+10 criteria1
• Menopause Symptoms - Menopause Rating Scale (MRS)2
• Cognitive Function - Symbol Digit Modalities Test (SDMT), a

measure processing speed and incidental recall3

Methods

• 1. Harlow SD, et al. Menopause; 2012;19(4):387-95. 230. 2. Heinemann LA, et al. Health Qual Life
• Outcomes. 2003;1:1–4 3. Smith A, Symbol Digit Modalities Test. Los Angeles, CA: Western

Psychological Service; 1982

FILL IN

• Questionnaires - menstrual history, general and

reproductive health, educational level, smoking and snuff use

• Body anthropometry - Blood pressure, height, weight,

waist, hip circumference

• HIV serostatus - voluntary HIV antibody test
• Hormone assays - Follicle-stimulating hormone (FSH) and

estradiol (E2) levels as supportive criteria for staging1

• Statistical methods: ANOVA, chi-squared tests,

multivariable linear regression analyses

Methods cont.

• 1. Randolph JF Jr & Zheng H. JCEM. 2011;96:746-541

Variables Menopausal stages (from STRAW+10) Late reprodutíve

• 3b & -3a

(n=192) Menopausal transition

• 2 & -1

(n=121) Early postmenopause

+1a to +1c

(n=147) Late postmenopause

+2

(n=130) p-value Age (years) 45.2 ± 3.30 48.2 ± 3.73 51.6 ± 3.85 55.2 ± 3.50 <0.001 No HS education 118 (62) 65 (54) 85 (58) 81 (62) 0.45 Employed 125 (65) 61 (50) 79 (54) 70 (54) 0.04 BMI (kg/m2) 33.6 ± 7.61 34.3 ± 7.96 33.3 ± 7.28 32.1 ± 6.26 0.12 HIV-serostatus: Unknown Negative Positive, no ARV Positive, ARV 84 (44) 77 (40) 13 (7) 18 (9) 56 (46) 49 (40) 8 (7) 8 (7) 69 (47) 65 (44) 5 (3) 8 (6) 42 (32) 75 (58) 4 (3) 9 (7) 0.07 Estradiol 5.69 ± 0.98 4.90 ± 1.31 4.06 ± 1.11 3.64 ± 0.73 <0.001 FSH 0.88 ± 0.40 1.35 ± 0.50 1.68 ± 0.36 1.79 ± 0.19 <0.001

Table 1. Characteristics of the study sample by menopausal stage.

Data given as mean ± SD or n (%); HS=high school

Table 2. Severe menopausal symptoms and cognitive performance on the Symbol Digit Modalities Test (SDMT) by menopausal stage.

Variables

Menopausal stages (from STRAW+10)

Late reproductive (n=192) Menopausal transition (n=121) Early postmenopause (n=147) Late postmenopause (n=130) p-value Severe symptoms: Exhaustion 36 (19) 20 (17) 30 (20) 42 (32) 0.008 Anxiety 19 (10) 20 (17) 22 (17) 23 (18) 0.19 Irritability 47 (25) 34 (28) 30 (20) 39 (30) 0.29 Mood 36 (19) 27 (22) 32 (22) 32 (25) 0.65 Sleep disturbance 39 (20) 24 (20) 37 (25) 31 (24) 0.64 Hot flushes 32 (17) 32 (26) 40 (27) 33 (25) 0.08 Cognition (SDMT): Processing speed 31.0 ± 10.8 30.0 ± 11.5 26.4 ± 11.1 23.7 ± 9.84 <0.001 Incidental recall 5.05 ± 3.86 4.97 ± 3.65 4.14 ± 3.31 4.27 ± 3.37 0.05 Data given as mean ±SD and n (%); SDMT = Symbol digit modalities test.

Table 3. Association between menopausal symptoms and cognitive performance on the Symbol Digit Modalities Test (SDMT).

Symptoms SDMT scores Processing Speed p-value Incidental Recall p-value Exhaustion: Severe (n=128) Not severe (n=460) 25.7 ± 11.8 28.6 ± 10.9 0.008 4.07 ± 3.63 4.79 ± 3.63 0.04 Anxiety: Severe (n=84) Not severe (n=499) 25.1 ± 12.3 28.5 ± 11.0 0.009 4.13 ± 3.33 4.72 ± 3.65 0.17 Irritability: Severe (n=150) Not severe (n=438) 26.8 ± 10.9 28.4 ± 11.3 0.14 4.26 ± 3.45 4.75 ± 3.64 0.15 Mood: Severe (n=127) Not severe (n=463) 27.2 ± 11.3 28.3 ± 11.1 0.34 3.87 ± 3.24 4.84 ± 3.66 0.007 Sleep disturbance: Severe (n=131) Not severe (n=458) 27.1 ± 12.2 28.3 ± 10.9 0.28 4.33 ± 3.78 4.73 ± 3.54 0.26 Hot flushes: Severe (n=137) Not severe (n=452) 25.1 ± 11.6 29.0 ± 10.9 <0.001 4.31 ± 3.62 4.73 ± 3.59 0.23 Data given as mean ± SD

Table 4. Multivariable model predicting cognitive performance on the Symbol Digit Modalities Test (SDMT).

***p<0.001; **p<0.01; *p<0.05; †p>0.05 and p<0.09. Variables SDMT Processing speed (n=578) β-coefficient Incidental recall (n=586) β-coefficient Age

• 0.24***
• 0.12†

Snuff user (vs. not)

• 0.08†
• 0.04

No high school (vs. high school)

• 0.12**
• 0.06

Unemployed (vs. employed)

• 0.21***
• 0.08†

BMI 0.02 0.02 HIV status (vs. HIV-uninfected): HIV-infected no ARV HIV-infected ARV Unknown Status

• 0.05
• 0.04
• 0.06
• 0.02

0.00 0.03 Menopausal Stage (vs. late reproductive): Menopausal transition Early postmenopausal Late postmenopausal 0.05

• 0.01
• 0.04

0.02

• 0.03

0.02 Severe hot flushes (vs. not)

• 0.11**
• Severe mood symptoms (vs. not)
• 0.11**

Severe fearfulness (vs. not)

• 0.07†

Limitations:

• Cross-sectional study limited sensitivity - possible effects of menopausal stages
• Unable to assess verbal memory performance due to language – 11 different

languages in South Africa

• No formal tool to measure anxiety
• Assessment of HIV serostatus voluntary so status of all participants not determined
• may explain the lack of association between HIV serostatus and processing speed

Strengths:

• Open and close-ended questions asked by a single interviewer in a well-suited

approach to self reported VMS in cultural diverse groups1,2

• The MRS symptom list is cross-culturally applicable - internationally validated, and

translated into nine different languages3

• 1. Parsons MA & Obermeyer CM. Menopause 2007;14:760–8; 2. Crawford SL. Menopause 2007;14:725–33
• 3. Heinemann LA, et al Health Qual Life Outcomes 2003;1:1–4

Limitations/Strengths

Conclusions

• No association between menopause stage and SDMT

performance

• Menopausal symptoms are associated with processing speed
• Anxiety and hot flashes are significantly associated with

decreased psychomotor speed

• Severe mood symptoms are a significant predictor of incidental

recall

• A common underlying neurological substrate is reflected in the

associations between menopausal symptoms and cognitive performance and is not related to cultural understanding and expectations of the menopause

Acknowledgements

• The mothers and caregivers of the BT20 study
• SWEET team members – Thozile Lephato, Thabile

Sibya, S’mangele Sigasa

• Grants - Medical Research Council of South Africa

(MRC), National Health laboratory Service (NHLS) and the Iris Ellen Hodges Cardio-vascular Research Trust