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Pinto J, Cera N, Pignatelli D. Psychological symptoms and brain activity alterations in women with PCOS and their relation to the reduced quality of life: a narrative review. J Endocrinol Invest 2024; 47:1-22. [PMID: 38485896 PMCID: PMC11196322 DOI: 10.1007/s40618-024-02329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common feminine endocrine disorder, characterized by androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. The negative impact of symptoms on the quality of life (QoL) of patients is still not clear. PURPOSE The present review aimed at studying the impact of the symptoms, the psychological symptoms, and brain alterations in women with PCOS. METHODS A systematic search was undertaken for studies that assessed the impact of PCOS symptoms on QoL, psychological symptoms, and brain alterations in PCOS patients. RESULTS Most of the information about QoL came from psychometric studies, which used culture-based questionnaires. Alterations of sleep quality, body image, and mood disorders can negatively affect the QoL of the patients. Sexual satisfaction and desire were affected by PCOS. Brain imaging studies showed functional alterations that are associated with impairments of visuospatial working memory, episodic and verbal memory, attention, and executive function. CONCLUSIONS Several factors can negatively influence the quality of life of the patients, and they are directly related to hyperandrogenism and the risk of infertility. In particular, obesity, hirsutism, acne, and the fear of infertility can have a direct impact on self-esteem and sexual function. Metabolic and psychiatric comorbidities, such as mood, anxiety, and eating disorders, can affect the well-being of the patients. Moreover, specific cognitive alterations, such as impairments in attention and memory, can limit PCOS patients in a series of aspects of daily life.
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Affiliation(s)
- J Pinto
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135, Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - N Cera
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135, Porto, Portugal
- Research Unit in Medical Imaging and Radiotherapy, Cross I&D Lisbon Research Center, Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - D Pignatelli
- Department of Endocrinology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.
- Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
- Department of Biomedicine, Faculty of Medicine at University of Porto, Porto, Portugal.
- IPATIMUP Research Institute, Porto, Portugal.
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2
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Naz MSG, Rahnemaei FA, Tehrani FR, Sayehmiri F, Ghasemi V, Banaei M, Ozgoli G. Possible cognition changes in women with polycystic ovary syndrome: a narrative review. Obstet Gynecol Sci 2023; 66:347-363. [PMID: 37376796 PMCID: PMC10514592 DOI: 10.5468/ogs.22165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/15/2022] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Nowadays, polycystic ovary syndrome (PCOS) and cognitive dysfunction are major health problems among female. This narrative review aimed to investigate cognitive dysfunction in female with PCOS. English and Persian articles published in PubMed, Scopus, Web of Science, Google Scholar, PsycINFO, Scientific Information Database, and Cochrane Database of Systematic Reviews until May 2022 were searched. Sixteen studies involving 850 female with PCOS and 974 controls were assessed. In these studies, the association between biochemical factors and symptoms of PCOS and memory, attention, executive functioning, information processing speed, and visuospatial skills was evaluated. The literature review revealed the possible cognitive changes in female with PCOS. This study summarized the different aspects of cognitive function in female with PCOS due to medication, psychological problems (mood disorders caused by disease symptoms and complications), and biochemical markers, such as metabolic and sex hormone abnormalities. Considering the existing scientific gap regarding the possibility of cognitive complications in female with PCOS, further biological studies should be conducted to evaluate the potential mechanisms involved.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Fatemeh Alsadat Rahnemaei
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht,
Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Fatemeh Sayehmiri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Vida Ghasemi
- Department of Nursing, Asadabad School of Medical Sciences, Asadabad,
Iran
| | - Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas,
Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
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3
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Griksiene R, Monciunskaite R, Ruksenas O. What is there to know about the effects of progestins on the human brain and cognition? Front Neuroendocrinol 2022; 67:101032. [PMID: 36029852 DOI: 10.1016/j.yfrne.2022.101032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/24/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022]
Abstract
Progestins are an important component of hormonal contraceptives (HCs) and hormone replacement therapies (HRTs). Despite an increasing number of studies elucidating the effects of HCs and HRTs, little is known about the effects of different types of progestins included in these medications on the brain. Animal studies suggest that various progestins interact differently with sex steroid, mineralocorticoid and glucocorticoid receptors and have specific modulatory effects on neurotransmitter systems and on the expression of neuropeptides, suggesting differential impacts on cognition and behavior. This review focuses on the currently available knowledge from human behavioral and neuroimaging studies pooled with evidence from animal research regarding the effects of progestins on the brain. The reviewed information is highly relevant for improving women's mental health and making informed choices regarding specific types of contraception or treatment.
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Affiliation(s)
- Ramune Griksiene
- Department of Neurobiology and Biophysics, Life Sciences Center, Vilnius University, Lithuania
| | - Rasa Monciunskaite
- Department of Neurobiology and Biophysics, Life Sciences Center, Vilnius University, Lithuania
| | - Osvaldas Ruksenas
- Department of Neurobiology and Biophysics, Life Sciences Center, Vilnius University, Lithuania
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4
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Review of the effects of polycystic ovary syndrome on Cognition: Looking beyond the androgen hypothesis. Front Neuroendocrinol 2022; 67:101038. [PMID: 36154816 DOI: 10.1016/j.yfrne.2022.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022]
Abstract
Polycystic-ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age, and many features associated with PCOS - such as elevated androgens, insulin resistance and inflammation - are known to affect cognition. However, effects of PCOS on cognition are not well-understood. Here we review the current literature on PCOS and cognition, note the extent of PCOS symptomatology studied in relation to cognitive outcomes, and identify key research gaps and common methodological concerns. Findings indicate a pattern of worse performance across cognitive domains and brain measures in women with PCOS relative to non-PCOS controls, as well as a lack of evidence for the common assumption that women with PCOS will have higher performance on tasks with a demonstrated male-advantage due to high testosterone levels. We suggest strategies for moving beyond the focus on elevated androgens, in favor of research practices that account for the nuances and heterogeneity of PCOS symptoms.
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5
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Showkath N, Sinha M, Ghate JR, Agrawal S, Mandal S, Sinha R. EEG-ERP Correlates of Cognitive Dysfunction in Polycystic Ovarian Syndrome. Ann Neurosci 2022; 29:225-232. [PMID: 37064285 PMCID: PMC10101155 DOI: 10.1177/09727531221115318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Polycystic ovarian syndrome (PCOS) has been shown to affect the psychological and cognitive status of a woman. However, amidst various conflicting reports in this regard, very few studies attempted to assess these aspects objectively using electroencephalography (EEG) and event-related potential (ERP). Purpose To assess changes in neurocognitive and psychological parameters of PCOS women without any other comorbidities. Methods PCOS women aged 18 years to 35 years, diagnosed from obstetrics and gynecology OPD who are otherwise free of any other comorbidities, were assessed for psychological status (anxiety and depression using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively). Thereafter, a cognitive assessment was done subjectively by the Montreal Cognitive Assessment (MoCA) questionnaire and objectively by using EEG [absolute and relative power of alpha, beta, and theta waves along with theta/beta ratios (TBR) and theta/alpha ratio (TAR)] and P300 amplitude and latency of ERP during a visual oddball paradigm task in control ( n = 30) and PCOS ( n = 37) subjects. Results PCOS women showed significantly higher anxiety and depression scores along with low MoCA scores. Significantly reduced absolute alpha, increased frontal beta, and markedly increased theta (relative) power with increased TAR in the PCOS group were seen. Also, a significant reduction in P300 amplitude with prolonged latency during the visual oddball paradigm task was evident in them. Conclusion Reduced alpha and higher theta activity with increased TAR are indicative of poor neural processing ability. Reduced P300 amplitude with more latency also suggests a cognitive decline, which is corroborated by reduced MoCA scores. Our study objectively indicates the presence of subclinical cognitive impairment in PCOS patients even without any comorbidities.
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Affiliation(s)
- Neethu Showkath
- Department of Physiology, Travancore Medical College, Kollam, Kerala, India
| | - Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Jayshri R. Ghate
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sucharita Mandal
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Sukhapure M, Eggleston K, Fenton A, Frampton C, Porter RJ, Douglas KM. Changes in Mood, Anxiety, and Cognition with Polycystic Ovary Syndrome Treatment: A Longitudinal, Naturalistic Study. Neuropsychiatr Dis Treat 2022; 18:2703-2712. [PMID: 36411778 PMCID: PMC9675344 DOI: 10.2147/ndt.s385014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Individuals with polycystic ovary syndrome (PCOS) are at increased risk of depression and anxiety symptoms and impairment in aspects of cognitive function. However, there is little evidence regarding effects of standard treatment for PCOS on these features of the syndrome. The aim of this study was to examine the effect of 12 weeks of naturalistic treatment of PCOS, with usual medications, on depression symptoms, anxiety symptoms and cognitive function. PATIENTS AND METHODS Thirty-three participants with PCOS received 12 weeks of individualised treatment based on clinical presentation. Changes in depression and anxiety symptoms were assessed with the self-report Hospital Anxiety and Depression Scale at baseline and 12 weeks, and cognitive function was assessed at the same time-points with a battery of tests spanning cognitive domains of verbal learning and memory, visuospatial learning and memory, psychomotor speed, attention and executive function. Outcomes were compared with a control group of 40 healthy participants. RESULTS Participants with PCOS (mean age = 29.2 years; mean Body Mass Index = 27.4) were treated with a variety of medications, predominantly spironolactone (n = 22) and oral contraceptives (n = 16). Depression and anxiety symptoms improved significantly over the course of treatment, with moderate effect sizes (Cohen's d 0.43-0.55, p < 0.05). Effect sizes of the difference in change from that of the control group were moderate but did not reach statistical significance. Women undergoing PCOS treatment demonstrated significant improvements in aspects of cognitive function, but improvement did not differ significantly from controls and effect size changes were similar, suggesting practise effects in both groups. CONCLUSION Our study provides preliminary evidence that treatment of PCOS may be associated with improvement in psychiatric aspects of the syndrome, particularly depressive symptoms.
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Affiliation(s)
- Mayouri Sukhapure
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
| | - Anna Fenton
- Department of Endocrinology, Canterbury District Health Board, Christchurch, Canterbury, New Zealand.,Oxford Women's Health, Christchurch, Canterbury, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand
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7
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Gurvich C, Le J, Thomas N, Thomas EHX, Kulkarni J. Sex hormones and cognition in aging. VITAMINS AND HORMONES 2021; 115:511-533. [PMID: 33706960 DOI: 10.1016/bs.vh.2020.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hormones of the hypothalamic-pituitary-gonadal axis that regulate reproductive function are also potent neurosteriods that have multiple effects on the development, maintenance and function of the brain. There is a growing body of evidence linking sex hormones to cognitive functioning across the lifespan. Both subjective and objective cognitive changes can occur with aging. For women, cognitive complains are commonly associated with the menopause transition-a time of significant hormone flux. Sex differences in neurodegenerative conditions associated with cognitive dysfunction, such as Alzheimer's disease and Parkinson's disease, suggest a potential link between sex hormones and cognitive decline. Evidence for the effects of hormone therapy on cognition is growing, but remains inconclusive. This chapter provides an overview of sex hormones and cognition in association with healthy aging, including a focus on the menopause transition, as well as reviewing findings linking sex hormones to cognitive decline associated with Alzheimer's disease and Parkinson's disease. An overview of hormone therapy and cognition is also provided.
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Affiliation(s)
- Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Jessica Le
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Natalie Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Elizabeth H X Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
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8
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Mehrabadi S, Sadatmahalleh SJ, Kazemnejad A, Moini A. Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: A cross-sectional study. Int J Reprod Biomed 2021; 18:1049-1058. [PMID: 33426415 PMCID: PMC7778752 DOI: 10.18502/ijrm.v18i12.8026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background While polycystic ovary syndrome (PCOS) is often associated with psychological distress, its most frequent clinical characteristics include acne, hirsutism and increased level of androgen hormones. Objective To evaluate the level of depression and anxiety, hirsutism, acne, and level of androgen hormones in PCOS and control group and its association with cognitive function. Materials and Methods This cross-sectional study was conducted on 53 women with PCOS and 50 healthy women as a control group. Data were collected using a questionnaire including the samples' demographic information, clinical features, clinical findings of hyperandrogenism, and the Beck Depression and Anxiety questionnaire. In addition, the acne and hirsutism levels of the subjects were evaluated using the global acne grading system and the Ferriman-Gallwey scoring system, respectively. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that covers major cognitive domains. Results A significant difference was found between the two groups in the mean levels of acne, hirsutism, total testosterone, free androgen index, depression, and anxiety. However, some mean values of the MoCA were lower in the women of case group compared to the control group. Additionally, a significant difference was observed between the two groups in the domains of visual-spatial ability (p = 0.009), executive function (p = 0.05), attention (p = 0.03), and total MoCA scores (p = 0.002). Conclusion The PCOS women demonstrated significantly lower performance on the tests of executive function, attention, and visual-spatial function than the healthy control women.
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Affiliation(s)
- Saeideh Mehrabadi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ashraf Moini
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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9
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Saad MA, Eltarzy MA, Abdel Salam RM, Ahmed MAE. Liraglutide mends cognitive impairment by averting Notch signaling pathway overexpression in a rat model of polycystic ovary syndrome. Life Sci 2020; 265:118731. [PMID: 33160995 DOI: 10.1016/j.lfs.2020.118731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023]
Abstract
AIMS Polycystic ovary syndrome (PCOS), the rifest endocrine disorder in women, is involved in disrupting many metabolic processes. However, the impact of PCOS on cognitive deficits is still uncertain. Recently, Notch signaling pathway was identified as a key modifier in regulating the pathological process in the ovary and various neurodegenerative disorders. Liraglutide has favourable neuroprotective effects that may protect against the possible cognitive dysfunction in PCOS. MAIN METHODS PCOS was induced in rats by administrating Letrozole orally for 21 successive days. Then, Liraglutide (LIR) was administered intraperitoneally for 30 days. Memory was examined using Y-maze, novel object recognition (NOR), and Morris water maze (MWM) tests. Western blotting, enzyme immunoassay, and quantitative real-time PCR were used to examine Notch signaling downstream targets, as well as assessing the expression of the components of various pathways cross talked with Notch signaling in memory impairment. Furthermore, histopathological examination was performed to examine neuronal changes. KEY FINDINGS Notch signaling was overexpressed in PCOS rats, which increased Aβ aggregation, apoptosis, and neuroinflammation. Additionally, histopathological examination showed neuronal degeneration, which was marked by diminished acetylcholine levels in the PCOS rats' hippocampi. Finally, serum levels of insulin and testosterone were elevated while estradiol was reduced. Treatment with LIR repaired Notch signaling-attributed changes and improved the PCOS-induced memory impairment in rats. SIGNIFICANCE The obtained findings confirm that Notch signaling activation in the hippocampus of rats impairs cognitive functions in PCOS, which is mitigated by LIR. Therefore, LIR may offer a novel therapeutic intervention to impede PCOS-induced dementia.
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Affiliation(s)
- Muhammed A Saad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; School of Pharmacy, NewGiza University, Giza, Egypt
| | - Muhammad A Eltarzy
- Department of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology (MUST), 6th of October City, Giza, Egypt
| | - Rania M Abdel Salam
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; School of Pharmacy, NewGiza University, Giza, Egypt
| | - Maha A E Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology (MUST), 6th of October City, Giza, Egypt.
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10
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Boivin MJ, Fatehi F, Phillips-Chan AE, Richardson JR, Summers AN, Foley SA. Exploratory study of a screening measure for polycystic ovarian syndrome, quality of life assessment, and neuropsychological evaluation. BMC WOMENS HEALTH 2020; 20:132. [PMID: 32576264 PMCID: PMC7313190 DOI: 10.1186/s12905-020-00994-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/18/2020] [Indexed: 02/06/2023]
Abstract
Background The universally adopted 2018 PCOS medical diagnostic and treatment guidelines for Polycystic Ovarian Syndrome (PCOS) cites the need for a brief screening measure that can be easily administered in the clinical care setting. We evaluate a 12-item questionnaire emphasizing the medical symptoms of PCOS with a group of women with PCOS as well as comparison samples of college women not diagnosed with PCOS. Method Of 120 undergraduate psychology women 18 to 41 years of age, 86 screened negative on a 12-item PCOS symptoms inventory. They were compared to a group of PCOS patients diagnosed medically in a manner consistent with the Teede et al. (2018) evidence-based diagnostic guidelines. The screen-positive, screen-negative, and PCOS-confirmed groups were compared on the PCOS Quality-of-Life (QoL) questionnaire, Zung Self-Rating Depression Scale (ZDS), Spielberg State-Trait Anxiety Inventory (STAI), Fatigue Symptom Inventory (FSI), Spiritual well-being and Spiritual Beliefs Inventories, the computerized Automated Neuropsychological Assessment Metric (ANAM) battery, and an experimental tachistoscopic Bilateral Perceptual Asymmetries Letter and Dots Matching Bilateral Field Advantage (BFA) test (to evaluate the effects of early brain androgenization possible from PCOS). For each questionnaire and neuropsychological performance principal outcome, the Linear Mixed Effects (LME) model was employed to evaluate the predictive significance of demographic characteristics and group membership (confirmed cases, screen negative and screen positive cases) for these outcomes. Results The PCOS-confirmed women scored more poorly than the screen-negative (reference) and screen-positive groups on all the measures of physical, emotional, social, and spiritual well-being measures. On the ANAM neuropsychological battery, PCOS-confirmed women did more poorly on Sternberg Memory and Stimulus Response throughput measures. They also had slower correct response speed for both the unilateral and bilateral dot- and letter-matching tachistoscopic stimulus presentations. However, the bilateral field advantage throughput performance ratio did not differ among groups, which is a global measure of bilateral versus unilateral brain/behavior asymmetries. Conclusion PCOS screening can be a feasible and important part of women’s healthcare. PCOS-confirmed women should receive not only the medical standard of care from the 2018 guidelines, but also comprehensive psychosocial and neurocognitive support to enhance their quality of life.
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Affiliation(s)
- Michael J Boivin
- Department of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, 909 Wilson Road, Rm 327, West Fee Road, East Lansing, MI, 48824, USA.
| | - Farnaz Fatehi
- Department of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, 909 Wilson Road, Rm 327, West Fee Road, East Lansing, MI, 48824, USA
| | | | - Julia R Richardson
- Department of Psychology, Indiana Wesleyan University, Marion, Indiana, USA
| | - Amanda N Summers
- Department of Psychology, Indiana Wesleyan University, Marion, Indiana, USA
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11
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Franik G, Krysta K, Witkowska A, Dudek A, Krzystanek M, Madej P. The impact of sex hormones and metabolic markers on depressive symptoms and cognitive functioning in PCOS patients. Gynecol Endocrinol 2019; 35:965-969. [PMID: 31106608 DOI: 10.1080/09513590.2019.1613359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The aim of the study was to analyze associations between cognitive deficits and such factors like hormone levels and metabolic risk factors in PCOS women. Fifty-five PCOS patients aged 17-30 underwent analyses for FSH, LH, 17-beta-estradiol, DHEAS, androstenedione, SHBG, lipid profile during the follicular phase. Fasting glucose and insulin concentrations were also measured, as well as their levels after oral-glucose administration. All participants underwent an assessment with: Trail Making Test A and B, Stroop Test, Verbal and Categorical Fluency Test. The intensity of depressive symptoms was measured by the Beck Depression Inventory (BDI). We observed a positive correlation of the depression scores with the OGTT 120' and triglycerides, and a negative correlation of the depression scores with serum HDL. The higher were the insulin levels at 120 min; the more pronounced were the deficits of the verbal psychomotor speed. Higher free testosterone correlated with better verbal psychomotor speed. Androstenedione level was associated with worse scores in executive functions assessment. 17-OH-P levels positively correlated with phonology verbal fluency scores and higher plasma cortisol level at 10 p.m. correlated with worse verbal processing speed. Endocrine and metabolic parameters seem to be important factors mediating cognitive deficits in PCOS.
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Affiliation(s)
- Grzegorz Franik
- Department of Endocrinological Gynecology, Medical University of Silesia , Katowice , Poland
| | - Krzysztof Krysta
- Department of Rehabilitation Psychiatry, Medical University of Silesia , Katowice , Poland
| | - Agnieszka Witkowska
- Department of Endocrinological Gynecology, Students' Scientific Society, Medical University of Silesia , Katowice , Poland
| | - Arkadiusz Dudek
- Department of Rehabilitation Psychiatry, Students' Scientific Society, Medical University of Silesia , Katowice , Poland
| | - Marek Krzystanek
- Department of Rehabilitation Psychiatry, Medical University of Silesia , Katowice , Poland
| | - Paweł Madej
- Department of Endocrinological Gynecology, Medical University of Silesia , Katowice , Poland
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12
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Jarrett BY, Vantman N, Mergler RJ, Brooks ED, Pierson RA, Chizen DR, Lujan ME. Dysglycemia, Not Altered Sex Steroid Hormones, Affects Cognitive Function in Polycystic Ovary Syndrome. J Endocr Soc 2019; 3:1858-1868. [PMID: 31583367 PMCID: PMC6767628 DOI: 10.1210/js.2019-00112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
Context Polycystic ovary syndrome (PCOS) is a complex endocrine condition characterized by multiple reproductive and metabolic abnormalities. Because individual reproductive and metabolic abnormalities modulate working memory in the general population, there is growing interest in whether cognitive function is dually and negatively affected in PCOS. Objective To examine the association of reproductive and metabolic features with cognitive function in women with and without PCOS. Design An observational, cross-sectional study was conducted at an academic clinical research center in North America between 2006 and 2009. Common tests of working memory (i.e., manual dexterity, perceptual speed, and visuospatial ability) were performed by women with PCOS (n = 40) and control subjects (n = 40). Markers of sex steroid hormones, ovulatory function, and cardiometabolic health were also assessed. Results Reduced visuospatial ability was observed in women with PCOS compared with control subjects (P < 0.01). Reduced visuospatial ability was linked to higher levels of hemoglobin A1c in the entire study cohort, independent of body mass index or PCOS status. No associations were observed between visuospatial ability and reproductive features, after controlling for confounding variables. Conclusion Our findings support a role for glycemic control, and not PCOS per se, in cognitive dysfunction in women of reproductive age. Additional studies are needed to understand the short- and long-term effects of dysglycemia on brain health in women with PCOS, given their increased propensity for metabolic comorbidities, compared with control subjects.
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Affiliation(s)
| | - Natalie Vantman
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Reid J Mergler
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Eric D Brooks
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Roger A Pierson
- Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donna R Chizen
- Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Archer J. The reality and evolutionary significance of human psychological sex differences. Biol Rev Camb Philos Soc 2019; 94:1381-1415. [DOI: 10.1111/brv.12507] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 01/03/2023]
Affiliation(s)
- John Archer
- Department of PsychologyUniversity of Central Lancashire Preston Lancashire PR1 2HE U.K
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Forte R, Pesce C, De Vito G, Boreham CAG. The Body Fat-Cognition Relationship in Healthy Older Individuals: Does Gynoid vs Android Distribution Matter? J Nutr Health Aging 2017; 21:284-291. [PMID: 28244568 DOI: 10.1007/s12603-016-0783-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the relationship between regional and whole body fat accumulation and core cognitive executive functions. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS 78 healthy men and women aged between 65 and 75 years recruited through consumer's database. MEASUREMENTS DXA measured percentage total body fat, android, gynoid distribution and android/gynoid ratio; inhibition and working memory updating through Random Number Generation test and cognitive flexibility by Trail Making test. First-order partial correlations between regional body fat and cognitive executive function were computed partialling out the effects of whole body fat. Moderation analysis was performed to verify the effect of gender on the body fat-cognition relationship. RESULTS Results showed a differentiated pattern of fat-cognition relationship depending on fat localization and type of cognitive function. Statistically significant relationships were observed between working memory updating and: android fat (r = -0.232; p = 0.042), gynoid fat (r = 0.333; p = 0.003) and android/gynoid ratio (r = -0.272; p = 0.017). Separating genders, the only significant relationship was observed in females between working memory updating and gynoid fat (r = 0.280; p = 0.045). In spite of gender differences in both working memory updating and gynoid body fat levels, moderation analysis did not show an effect of gender on the relationship between gynoid fat and working memory updating. CONCLUSIONS Results suggest a protective effect of gynoid body fat and a deleterious effect of android body fat. Although excessive body fat increases the risk of developing CDV, metabolic and cognitive problems, maintaining a certain proportion of gynoid fat may help prevent cognitive decline, particularly in older women. Guidelines for optimal body composition maintenance for the elderly should not target indiscriminate weight loss, but weight maintenance through body fat/lean mass control based on non-pharmacological tools such as physical exercise, known to have protective effects against CVD risk factors and age-related cognitive deterioration.
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Affiliation(s)
- R Forte
- Roberta Forte Department of Human Health and Movement Sciences, University of Rome «Foro Italico», Roma 00135, Italy telephone +39 6 36733367 fax +39 6 36733362 e-mail:
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Marsh CA. Working memory in women with polycystic ovary syndrome. Fertil Steril 2016; 105:1157. [DOI: 10.1016/j.fertnstert.2016.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Soleman RS, Kreukels BP, Veltman DJ, Cohen-Kettenis PT, Hompes PG, Drent ML, Lambalk CB. Does polycystic ovary syndrome affect cognition? A functional magnetic resonance imaging study exploring working memory. Fertil Steril 2016; 105:1314-1321.e1. [DOI: 10.1016/j.fertnstert.2016.01.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/08/2016] [Accepted: 01/25/2016] [Indexed: 01/19/2023]
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Rees DA, Udiawar M, Berlot R, Jones DK, O'Sullivan MJ. White Matter Microstructure and Cognitive Function in Young Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2016; 101:314-23. [PMID: 26574952 PMCID: PMC4701841 DOI: 10.1210/jc.2015-2318] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/06/2015] [Indexed: 12/02/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a disorder characterized by insulin resistance and hyperandrogenism, which leads to an increased risk of type 2 diabetes in later life. Androgens and insulin signaling affect brain function but little is known about brain structure and function in younger adults with PCOS. OBJECTIVE To establish whether young women with PCOS display altered white matter microstructure and cognitive function. PATIENTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Eighteen individuals with PCOS (age, 31 ± 6 y; body mass index [BMI] 30 ± 6 kg/m(2)) and 18 control subjects (age, 31 ± 7 y; BMI, 29 ± 6 kg/m(2)), matched for age, IQ, and BMI, underwent anthropometric and metabolic evaluation, diffusion tensor MRI, a technique especially sensitive to brain white matter structure, and cognitive assessment. Cognitive scores and white matter diffusion metrics were compared between groups. White matter microstructure was evaluated across the whole white matter skeleton using tract-based spatial statistics. Associations with metabolic indices were also evaluated. RESULTS PCOS was associated with a widespread reduction in axial diffusivity (diffusion along the main axis of white matter fibers) and increased tissue volume fraction (the proportion of volume filled by white or grey matter rather than cerebrospinal fluid) in the corpus callosum. Cognitive performance was reduced compared with controls (first principal component, t = 2.9, P = .007), reflecting subtle decrements across a broad range of cognitive tests, despite similar education and premorbid intelligence. In PCOS, there was a reversal of the relationship seen in controls between brain microstructure and both androgens and insulin resistance. CONCLUSIONS White matter microstructure is altered, and cognitive performance is compromised, in young adults with PCOS. These alterations in brain structure and function are independent of age, education and BMI. If reversible, these changes represent a potential target for treatment.
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Affiliation(s)
- D Aled Rees
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Maneesh Udiawar
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Rok Berlot
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Derek K Jones
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Michael J O'Sullivan
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
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Gillies G, Virdee K, McArthur S, Dalley J. Sex-dependent diversity in ventral tegmental dopaminergic neurons and developmental programing: A molecular, cellular and behavioral analysis. Neuroscience 2014; 282:69-85. [PMID: 24943715 PMCID: PMC4245713 DOI: 10.1016/j.neuroscience.2014.05.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/12/2014] [Accepted: 05/18/2014] [Indexed: 02/02/2023]
Abstract
The knowledge that diverse populations of dopaminergic neurons within the ventral tegmental area (VTA) can be distinguished in terms of their molecular, electrophysiological and functional properties, as well as their differential projections to cortical and subcortical regions has significance for key brain functions, such as the regulation of motivation, working memory and sensorimotor control. Almost without exception, this understanding has evolved from landmark studies performed in the male sex. However, converging evidence from both clinical and pre-clinical studies illustrates that the structure and functioning of the VTA dopaminergic systems are intrinsically different in males and females. This may be driven by sex differences in the hormonal environment during adulthood ('activational' effects) and development (perinatal and/or pubertal 'organizational' effects), as well as genetic factors, especially the SRY gene on the Y chromosome in males, which is expressed in a sub-population of adult midbrain dopaminergic neurons. Stress and stress hormones, especially glucocorticoids, are important factors which interact with the VTA dopaminergic systems in order to achieve behavioral adaptation and enable the individual to cope with environmental change. Here, also, there is male/female diversity not only during adulthood, but also in early life when neurobiological programing by stress or glucocorticoid exposure differentially impacts dopaminergic developmental trajectories in male and female brains. This may have enduring consequences for individual resilience or susceptibility to pathophysiological change induced by stressors in later life, with potential translational significance for sex bias commonly found in disorders involving dysfunction of the mesocorticolimbic dopaminergic systems. These findings highlight the urgent need for a better understanding of the sexual dimorphism in the VTA if we are to improve strategies for the prevention and treatment of debilitating conditions which differentially affect men and women in their prevalence and nature, including schizophrenia, attention/deficit hyperactivity disorder, autism spectrum disorders, anxiety, depression and addiction.
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Affiliation(s)
- G.E. Gillies
- Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK,Corresponding author. Address: Division of Brain Sciences, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. Tel: +44-(0)-20-7594-7050.
| | - K. Virdee
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK,Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK
| | - S. McArthur
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1 6BQ, UK
| | - J.W. Dalley
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK,Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK,Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Hill’s Road, Cambridge CB2 2QQ, UK
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Schultheiss OC, Zimni M. Associations Between Implicit Motives and Salivary Steroids, 2D:4D Digit Ratio, Mental Rotation Performance, and Verbal Fluency. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2014. [DOI: 10.1007/s40750-014-0012-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kocoska-Maras L, Rådestad AF, Carlström K, Bäckström T, von Schoultz B, Hirschberg AL. Cognitive function in association with sex hormones in postmenopausal women. Gynecol Endocrinol 2013; 29:59-62. [PMID: 22967437 DOI: 10.3109/09513590.2012.705385] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Several studies have suggested gender differences in cognitive function, but data on the association between sex hormones and cognitive function are contradictory. The aim of our randomized double-blind study was to explore the possible relations between cognitive function and serum levels of sex hormones, oxytocin and insulin-like growth factor-I (IGF-I) in postmenopausal women. Two-hundred healthy postmenopausal women were randomly assigned to receive estrogen, testosterone or placebo treatment for 1 month. The associations of spatial ability, verbal fluency and verbal memory with serum levels of estradiol, testosterone, estradiol/testosterone ratio, androstanediol, oxytocin and IGF-I were analyzed. Spatial ability showed a negative correlation with serum estradiol, estradiol/testosterone ratio, oxytocin levels and a positive association with androstanediol levels. Verbal fluency displayed a negative relationship with serum levels of testosterone, IGF-I and a positive with estradiol/testosterone ratio. Verbal memory displayed a positive correlation to androstanediol. Data suggest that not only absolute levels of sex hormones but also the balance between estrogen and testosterone and their metabolites may be important for cognitive function in women.
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Affiliation(s)
- Ljiljana Kocoska-Maras
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, Stockholm, Sweden.
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Bremser JA, Gallup GG. Mental state attribution and body configuration in women. FRONTIERS IN EVOLUTIONARY NEUROSCIENCE 2012; 4:1. [PMID: 22319496 PMCID: PMC3268185 DOI: 10.3389/fnevo.2012.00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/03/2012] [Indexed: 11/30/2022]
Abstract
Body configuration is a sexually dimorphic trait. In humans, men tend to have high shoulder-to-hip ratios. Women in contrast, often have low waist-to-hip ratios (WHR); i.e., narrow waists and broad hips that approximate an hour-glass configuration. Women with low WHR’s are rated as more attractive, healthier, and more fertile. They also tend to have more attractive voices, lose their virginity sooner, and have more sex partners. WHR has also been linked with general cognitive performance. In the present study we expand upon previous research examining the role of WHR in cognition. We hypothesized that more feminine body types, as indexed by a low WHR, would be associated with cognitive measures of the female “brain type,” such as mental state attribution and empathy because both may depend upon the activational effects of estrogens at puberty. We found that women with low WHRs excel at identifying emotional states of other people and show a cognitive style that favors empathizing over systemizing. We suggest this relationship may be a byproduct of greater gluteofemoral fat stores which are high in the essential fatty acids needed to support brain development and cellular functioning. It is interesting to note that our findings suggest lower WHR females, who are more likely to be targeted for dishonest courtship, may be better at identifying disingenuous claims of commitment.
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Laughlin GA, Kritz-Silverstein D, Barrett-Connor E. Endogenous oestrogens predict 4-year decline in verbal fluency in postmenopausal women: the Rancho Bernardo Study. Clin Endocrinol (Oxf) 2010; 72:99-106. [PMID: 19508596 PMCID: PMC2805055 DOI: 10.1111/j.1365-2265.2009.03599.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite overwhelming biological plausibility, evidence for a protective effect of oestrogen on cognitive function in postmenopausal women is inconsistent. This study examines the association between endogenous oestrogen levels and subsequent 4-year decline in cognitive function test performance in community-dwelling older women. DESIGN Longitudinal cohort study. PARTICIPANTS Three hundred and forty-three postmenopausal women (median age 70 years). MEASUREMENTS Between 1984 and 1987, serum for measurement of sex hormones was obtained along with relevant covariates. Cognitive function was assessed in 1988-1991 and again in 1992-1996 using the Category Fluency test, the Mini-Mental Status Exam (MMSE) and Trail Making Test B (Trails B). RESULTS Women in the highest tertile of oestrone and bioavailable oestradiol had respectively 1.75 (95% CI 1.02, 3.07) and 1.79 (95% CI 1.04, 3.10) higher odds of 4 year decline in Category Fluency, a test of frontal lobe function, compared to those in the lowest tertile, independent of age and education. The 20% of women with highest tertile levels of both oestrone and bioavailable oestradiol had a twofold higher odds of verbal fluency loss (OR = 2.17; 95% CI 1.21, 3.89). Adjustment for testosterone levels or for obesity-related factors associated with high endogenous oestrogens (higher body mass index, waist girth, and triglycerides and lower high-density lipoprotein cholesterol) did not alter results. Neither oestrogen was associated with change in MMSE or Trails B scores. CONCLUSIONS Higher endogenous oestrogen levels were associated with a greater decline in verbal fluency in postmenopausal women. This association was not explained by elevated androgens or by obesity or obesity-related factors.
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Affiliation(s)
- Gail A Laughlin
- Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, CA 92093, USA.
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Eyvazzadeh AD, Pennington KP, Pop-Busui R, Sowers M, Zubieta JK, Smith YR. The role of the endogenous opioid system in polycystic ovary syndrome. Fertil Steril 2009; 92:1-12. [PMID: 19560572 DOI: 10.1016/j.fertnstert.2009.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 04/29/2009] [Accepted: 05/07/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the complex role of the opioid system in reproduction and carbohydrate metabolism, abnormalities in the opioid system in women with polycystic ovary syndrome (PCOS), and the role of opioid antagonists in the management of PCOS-related infertility. DESIGN Pertinent articles were identified through a computer PubMed search. References of selected articles were hand searched for additional citations. CONCLUSION(S) Endogenous opioids are generally considered inhibitory central neurotransmitters. Peripherally, opioids are involved in the regulation of pancreatic islet function, hepatic insulin clearance, and glucose metabolism, potentially contributing to the pathogenesis of hyperinsulinemia and insulin resistance in PCOS. The presence of sex steroids is required for normal function of the opioid system in both GnRH secretion and carbohydrate metabolism. In women with PCOS, growing evidence suggests dysregulation of the opioid system both centrally and peripherally, with complex interactions. The opioid system effects on carbohydrate metabolism appear to be modulated by obesity. Finally, naltrexone has been demonstrated to successfully augment traditional ovulation induction regimens, but has limited support as a single ovulation induction agent for PCOS.
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Affiliation(s)
- Aimee D Eyvazzadeh
- Department of Obstetrics and Gynecology, School of Medicine and School of Public Health, University of Michigan, 1500 East Medical Center Drive, Women's Hospital, Ann Arbor, MI 48109-0276, USA
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Palomba S, Falbo A, Zullo F, Orio F. Evidence-based and potential benefits of metformin in the polycystic ovary syndrome: a comprehensive review. Endocr Rev 2009; 30:1-50. [PMID: 19056992 DOI: 10.1210/er.2008-0030] [Citation(s) in RCA: 281] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metformin is an insulin sensitizer widely used for the treatment of patients affected by type 2 diabetes mellitus. Because many women with polycystic ovary syndrome (PCOS) are insulin resistant, metformin was introduced in clinical practice to treat these patients also. Moreover, metformin's effect has other targets beside its insulin-sensitizing action. The present review was aimed at describing all evidence-based and potential uses of metformin in PCOS patients. In particular, we will analyze the uses of metformin not only for the treatment of all PCOS-related disturbances such as menstrual disorders, anovulatory infertility, increased abortion, or complicated pregnancy risk, hyperandrogenism, endometrial, metabolic and cardiovascular abnormalities, but also for the prevention of the syndrome.
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Affiliation(s)
- Stefano Palomba
- Department of Gynecology and Obstetrics, University "Magna Graecia" of Catanzaro, Via Pio X, 88100 Catanzaro, Italy.
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Brown AD, McMorris CA, Longman RS, Leigh R, Hill MD, Friedenreich CM, Poulin MJ. Effects of cardiorespiratory fitness and cerebral blood flow on cognitive outcomes in older women. Neurobiol Aging 2008; 31:2047-57. [PMID: 19111937 DOI: 10.1016/j.neurobiolaging.2008.11.002] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 11/07/2008] [Accepted: 11/13/2008] [Indexed: 11/30/2022]
Abstract
The mechanisms by which aerobic fitness confers beneficial effects on cognition with aging are unclear but may involve cerebrovascular adaptations. In a cross-sectional study of women from the community (n=42; age range=50-90 years), we sought to determine whether physical fitness is associated with higher cerebrovascular function, and its relationship to cognition. Main outcome measures included resting cerebral blood flow, cerebrovascular reserve, physical fitness (i.e., VO₂max) and cognition. Physically fit women had lower resting mean arterial pressure (MAP) and higher cerebrovascular conductance (CVC) than sedentary women. Overall cognition was negatively correlated with age and positively correlated with VO₂max. VO₂max was a predictor of resting CVC and MAP, and CVC and MAP when end-tidal gases were held constant at near-resting values. MAP and CVC were predictors of cognition. This study identified strong associations between physical fitness, vascular function and cognition, and provides new understanding regarding the mechanisms by which fitness positively impacts cognition with aging. The implications of this research are considerable and warrant future investigation.
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Affiliation(s)
- Allison D Brown
- Department of Physiology & Biophysics, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
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Mordecai KL, Rubin LH, Maki PM. Effects of menstrual cycle phase and oral contraceptive use on verbal memory. Horm Behav 2008; 54:286-93. [PMID: 18455727 DOI: 10.1016/j.yhbeh.2008.03.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 03/07/2008] [Accepted: 03/12/2008] [Indexed: 10/22/2022]
Abstract
Surgical or pharmacological suppression of ovarian hormones leads to declines in verbal memory, and estrogen treatment reverses these deficits. In the current study, we investigated the effects of menstrual cycle phase and oral contraceptives on verbal memory, as measured by the California Verbal Learning Test, in two groups of premenopausal women - 16 naturally cycling women and 20 current users of estrogen-based oral contraceptives (OCs). Naturally cycling women were assessed twice - once during the early follicular phase (Days 2-4) and once during the midluteal phase (Days 20-22) of the menstrual cycle. OC users were tested on the same cycle days, corresponding to inactive and active pill phases, respectively. We predicted that naturally cycling women would show improved verbal memory during the midluteal phase, when estradiol levels are high, compared with the follicular phase, when estradiol levels are low. We also predicted that OC users, who show no change in endogenous estradiol across the cycle, would show no change in verbal memory. Contrary to predictions, naturally cycling women showed no changes in verbal memory across the cycle, whereas OC users showed enhanced memory during the active pill phase (p<.05). None of the secondary cognitive outcome measures varied with cycle phase or OC use including measures of visuospatial memory, verbal fluency, visuospatial abilities, and attention. Overall, these results suggest that verbal memory performance in premenopausal women varies across the cycle with OC use, but does not vary systematically with changes in endogenous estradiol.
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Affiliation(s)
- Kristen L Mordecai
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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