Neuropsychological profile of polycystic ovary syndrome: past, present, and future

Polycystic ovary syndrome (PCOS) is a reproductive, endocrine, and metabolic condition affecting 6%-10% of reproductive-aged women worldwide. Beyond infertility, PCOS may be associated with effects on the neuropsychological profile. Notwithstanding studies attesting to the adverse effects of hyperandrogenism on cognition, few well-controlled studies have explored the PCOS neuropsychological profile. We performed a review of current approaches to evaluation of cognition in PCOS compared with healthy controls and present our findings organized by cognitive domain. Recent reviews of studies comparing women with PCOS and healthy controls demonstrate an increased risk of cognitive decline in areas that include fluency, short-term memory, and executive functioning. Cognitive decline is defined as test results greater than 1.5 standard deviations below the mean on objective, validated psychometric tests compared with a normative sample. However, findings have been equivocal, with multiple factors considered to potentially be underlying the cognitive changes seen, including functional neuroimaging evidence of fluctuations entrained with the menstrual cycle, as well as the comorbidities of body mass index, insulin resistance, and depression. Overall, literature dedicated to characterizing the PCOS neuropsychological profile is scant, primarily consisting of small, underpowered, poorly controlled studies. In the future, there is a need for well-controlled longitudinal studies incorporating neuropsychological assessment and neuroimaging. Such an approach could better guide the development of future treatment approaches.