Dr Huddleston and her team followed 907 female participants over a span of 30 years, assessing various cognitive functions. Photo by Andrea Piacquadio/Pexels

In a study published in the esteemed medical journal Neurology, researchers from the University of California, San Francisco (UCSF) have uncovered a concerning association between polycystic ovarian syndrome (PCOS) and cognitive function decline in middle-aged women.

PCOS, a prevalent hormonal endocrine disorder affecting about 116 million women globally, is known for its wide-ranging impacts on reproductive health and metabolism. However, this new research suggests that its effects might extend to the realm of brain health as well.

Dr Heather G. Huddleston, a prominent figure in the Department of Obstetrics, Gynaecology and Reproductive Sciences at UCSF and lead author of the study, shed light on the rationale behind their investigation.

"While it has been linked to metabolic diseases like obesity and diabetes that can lead to heart problems, less is known about how this condition affects brain health. Our results suggest that people with this condition have lower memory and thinking skills and subtle brain changes in midlife," she added.

With this in mind, the research team embarked on a mission to explore whether PCOS might predispose individuals to memory and cognitive impairments as they age, a question largely unexplored until now.

The study, conducted over a span of three decades, tracked 907 female participants aged 18 to 30 at the study's commencement. Upon reaching middle age, participants underwent a battery of cognitive tests to evaluate memory, verbal learning, cognitive control, processing speed and attention. Among the participants, 66 had been diagnosed with PCOS.

The results were striking; individuals with PCOS exhibited notably lower scores on several cognitive tests compared to their counterparts without the condition, particularly in memory, attention and verbal abilities. Surprisingly, these differences emerged even in mid-life, prompting further investigation into the underlying mechanisms.

To corroborate their findings, the research team conducted MRI brain scans on a subset of 291 participants at years 25 and 30 of the study. Among this cohort, 25 individuals had PCOS. Analysis of the MRI scans revealed lower white matter integrity in participants with PCOS compared to those without the condition.

White matter, crucial for information processing and interconnecting different brain regions, showed signs of compromise, albeit at an early stage.

"White matter integrity on MRI can be an early sign of changes in the brain that can happen with ageing," 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."

Dr Huddleston highlighted the importance of replicating these findings in diverse populations and datasets to establish robust conclusions. Additionally, she expressed keen interest in launching longitudinal studies to pinpoint when cognitive differences start to manifest in individuals with PCOS and explore strategies for preserving brain health in this demographic.

As the link between PCOS and cognitive decline gains prominence, healthcare providers are urged to adopt a multidimensional approach to PCOS management.

Dr Michael Krychman, a distinguished OB/GYN and medical director of Women's Health Services at MemorialCare Saddleback Medical Center, highlighted the need for a comprehensive treatment paradigm that addresses not only hormonal imbalances but also lifestyle factors and preventive measures for cognitive decline.

From maintaining physical activity to managing cardiovascular risk factors and incorporating cognitive enrichment activities, the focus is shifting towards safeguarding brain health alongside traditional PCOS management strategies.

"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."