Age at menopause and cognitive function and decline among middle-aged and older women in the China Health and...

Chinese women experience higher dementia rates than men, yet sex-specific risk factors are understudied. We examined how menopause age affects cognitive function and decline in aging Chinese women.

Data were from 7419 postmenopausal women 45-101 years of age at baseline in the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018). Menopause age was categorized using clinical cutoffs (<40, 40-44, 45-49, 50-55, >55 years). Cognitive function was assessed with neuropsychological tests up to four times over 7 years, and associations were analyzed using multivariable-adjusted linear mixed-effects regression.

Compared to menopause at 50-55 years (3661/7419; 49.3%), premature (<40; 235/7419; 3.2%), early (40-44; 623/7419; 8.4%), and late menopause (>55; 366/7419; 4.9%) were associated with lower baseline cognitive scores. Although the rate of cognitive decline did not differ significantly across menopause age groups, late menopause showed a trend toward faster decline.

Cognitive health interventions should consider extreme menopausal age as a risk factor.

Extreme menopausal ages-premature (<40), early (40-44), and late (>55)-are linked to lower baseline cognition versus menopause ages 50-55, persisting over 7 years. Cognitive disadvantage for late menopause (>55) versus 50-55 tends to increase over time. Health interventions should consider extreme menopause ages in women's cognitive health.