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From the Division of Geriatrics, David Geffen School of Medicine (G.A.G., M.-H.H., T.S., A.S.K.), and Department of Community Health Sciences, School of Public Health (R.G.W.), University of California, Los Angeles; Irvine School of Medicine (C.L.), University of California, Irvine; Division of Public Health Sciences (N.E.A.), Wake Forest University School of Medicine, Winston-Salem, NC; and Alaska Native Epidemiology Center (J.J.), Alaska Native Tribal Health Consortium, Anchorage.
Address correspondence and reprint requests to Dr. Gail A. Greendale, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095-1687 ggreenda{at}mednet.ucla.edu
Background: There is almost no longitudinal information about measured cognitive performance during the menopause transition (MT).
Methods: We studied 2,362 participants from the Study of Women's Health Across the Nation for 4 years. Major exposures were time spent in MT stages, hormone use prior to the final menstrual period, and postmenopausal current hormone use. Outcomes were longitudinal performance in three domains: processing speed (Symbol Digit Modalities Test [SDMT]), verbal memory (East Boston Memory Test [EBMT]), and working memory (Digit Span Backward).
Results: Premenopausal, early perimenopausal, and postmenopausal women scored higher with repeated SDMT administration (p 
0.0008), but scores of late perimenopausal women did not improve over time (p = 0.2). EBMT delayed recall scores climbed during premenopause and postmenopause (p 0.01), but did not increase during early or late perimenopause (p 
0.14). Initial SDMT, EBMT-immediate, and EBMT-delayed tests were 4%–6% higher among prior hormone users (p 0.001). On the SDMT and EBMT, compared to the premenopausal referent, postmenopausal current hormone users demonstrated poorer cognitive performance (p 0.05) but performance of postmenopausal nonhormone users was indistinguishable from that of premenopausal women.
Conclusions: Consistent with transitioning women's perceived memory difficulties, perimenopause was associated with a decrement in cognitive performance, characterized by women not being able to learn as well as they had during premenopause. Improvement rebounded to premenopausal levels in postmenopause, suggesting that menopause transition–related cognitive difficulties may be time-limited. Hormone initiation prior to the final menstrual period had a beneficial effect whereas initiation after the final menstrual period had a detrimental effect on cognitive performance.
Abbreviations: CVD = cardiovascular disease; DSB = Digit Span Backward; EBMT = East Boston Memory Test; FMP = final menstrual period; MT = menopause transition; SDMT = Symbol Digit Modalities Test; SWAN = Study of Women's Health Across the Nation.
Supplemental data at www.neurology.org
The Study of Women's Health Across the Nation (SWAN) has grant support from the NIH, DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495).
Disclosure: The authors report no disclosures.
Disclaimer: The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.
Received October 6, 2008. Accepted in final form February 25, 2009.
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 Perimenopause and Cognitive Function Journal Watch Women's Health, June 18, 2009; 2009(618): 2 - 2. [Full Text]
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