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Tennilä J, Muukkonen L, Utriainen P, Voutilainen R, Jääskeläinen J, Liimatta J. Cognitive performance in young adult women with a history of premature adrenarche. Pediatr Res 2024:10.1038/s41390-024-03380-4. [PMID: 38969813 DOI: 10.1038/s41390-024-03380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/23/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Girls with premature adrenarche (PA) mature earlier than peers and have been found to have greater symptom accounts reflecting anxiety compared to peers. It is not known, however, whether PA effects cognitive development. This longitudinal case-control cohort study aimed: (1) To investigate whether a history of PA leads to measurable changes in adulthood cognitive performance, and (2) to assess whether findings characteristic of PA girls predict adulthood cognitive performance. METHODS Twenty-seven girls with PA and 27 age-matched control girls were examined and followed from mid-childhood (mean age 7.2 years) until early adult age (18.5 years). Wechsler Adult Intelligence Scale, Fourth Edition scores were used as main outcome measure. RESULTS Allostatic load (AL) scores, which compile multisystem variables to reflect the overall wear and tear of the body from increased and prolonged stress, were higher in the PA group in both prepuberty and adulthood, but there were no differences in WAIS-IV results between the groups (full-scale IQ 92.7 vs. 97.5, p 0.376; no differences in separate indexes). Childhood androgen levels, glucose metabolism biomarkers, and AL scores failed to predict adulthood cognitive performance outcomes. CONCLUSION The study suggests that PA does not predispose to adverse adulthood outcomes of cognitive development. IMPACT The study suggests that a history of premature adrenarche (PA) does not affect cognitive performance in adult age. Childhood androgen levels and biomarkers of glucose metabolism failed to predict adulthood cognitive outcomes in this study. Allostatic load scores were elevated in the PA group both in childhood and adulthood but did not predict adulthood cognitive outcomes.
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Affiliation(s)
- Jussi Tennilä
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland.
| | | | - Pauliina Utriainen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, 00029, Helsinki, Finland
| | - Raimo Voutilainen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
| | - Jani Liimatta
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
- Department of BioMedical Research, University of Bern, 3012, Bern, Switzerland
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Huddleston HG, Jaswa EG, Casaletto KB, Neuhaus J, Kim C, Wellons M, Launer LJ, Yaffe K. Associations of Polycystic Ovary Syndrome With Indicators of Brain Health at Midlife in the CARDIA Cohort. Neurology 2024; 102:e208104. [PMID: 38295344 DOI: 10.1212/wnl.0000000000208104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Polycystic ovary syndrome (PCOS) is a common reproductive disorder associated with an adverse cardiometabolic profile early in life. Increasing evidence links cardiovascular risk factors, such as diabetes and hypertension, to accelerated cognitive aging. However, less is known about PCOS and its relationship to brain health, particularly at midlife. Our goal was to investigate possible associations between PCOS and midlife cognitive function and brain MRI findings in an ongoing prospective study. METHODS We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a geographically diverse prospective cohort study of individuals who were 18-30 years at baseline (1985-1986) and followed for 30 years. We identified women with PCOS from an ancillary study (CARDIA Women's study (CWS); n = 1,163) as those with elevated androgen levels and/or hirsutism in conjunction with symptoms of oligomenorrhea. At year 30, participants completed cognitive testing, including the Montreal Cognitive Assessment, Rey Auditory Verbal Learning Test (RAVLT) (verbal learning and memory), Digit Symbol Substitution Test (processing speed and executive function), Stroop test (attention and cognitive control), and category and letter fluency tests (semantics and attention). A subset completed brain MRI to assess brain structure and white matter integrity. Multivariable linear regression models estimated the association between PCOS and outcomes, adjusting for age, race, education, and study center. RESULTS Of the 1163 women in CWS, 907 completed cognitive testing, and of these, 66 (7.1%) met criteria for PCOS (age 54.7 years). Women with and without PCOS were similar for age, BMI, smoking/drinking status, and income. At year 30, participants with PCOS performed lower (mean z score; 95% CI) on Stroop (-0.323 (-0.69 to -7.37); p = 0.008), RAVLT (-0.254 (-0.473 to -0.034); p = 0.002), and category fluency (-0.267 (-0.480 to -0.040); p = 0.02) tests. Of the 291 participants with MRI, 25 (8.5%) met PCOS criteria and demonstrated lower total white matter fractional anisotropy, a measure of white matter integrity (coefficient (95% CI) -0.013 (-0.021 to -0.005); p = 0.002), though not abnormal white matter. DISCUSSION Our results suggest that women with PCOS have lower cognitive performance and lower white matter integrity at midlife. Additional research is needed to confirm these findings and to determine potential mechanistic pathways including potential modifiable factors.
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Affiliation(s)
- Heather G Huddleston
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Eleni G Jaswa
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Kaitlin B Casaletto
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - John Neuhaus
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Catherine Kim
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Melissa Wellons
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Lenore J Launer
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
| | - Kristine Yaffe
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (H.G.H., E.G.J.), Memory and Aging Center (K.B.C.), and Departments of Epidemiology and Biostatistics (J.N.) and Psychiatry (K.Y.), University of California, San Francisco; Department of Medicine (C.K.), University of Michigan, Ann Arbor; Department of Medicine (M.W.), Vanderbilt University, Nashville, TN; and Laboratory of Epidemiology and Population Sciences (L.J.L.), Intramural Research Program, National Institute on Aging, Gaithersburg, MD
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