The Impact of Psychological Distress on Cognitive Function in Postmenopausal Women

Psychological distress and cognitive difficulties are prevalent among postmenopausal women. While some studies suggest distress affects memory or executive functions, findings are inconsistent. We evaluated associations of psychological distress with multiple cognitive domains in postmenopausal women.

The Early versus Late Intervention Trial with Estradiol was a randomized, double-blinded, placebo-controlled trial of 643 healthy postmenopausal women, conducted between 2005 and 2013. A psychosocial substudy included 448 women.

In this secondary analysis, psychological distress was assessed as a latent factor using validated scales (Perceived Stress, Center for Epidemiologic Studies Depression, Liebowitz Social Anxiety, Penn State Worry Questionnaire, National Anxiety Disorders Screening Day Survey). Cognitive composite scores for executive functions, visuospatial ability, verbal memory, and visual memory were assessed three times over 5 years. Linear mixed-effect models (630 observations, 388 participants) included covariates of age, education, income, treatment assignment, carotid artery intima-media thickness, and hysterectomy status.

Psychological distress was significantly associated with lower executive functions (β [95% confidence interval or CI] = -0.07 [-0.13, -0.01], p = 0.03) and visuospatial ability (β [95% CI] = -0.08 [-0.16, -0.01], p = 0.03), but not with verbal (β [95% CI] = 0.01 [-0.07, 0.09], p = 0.74) or visual memory (β [95% CI] = 0.02 [-0.06, 0.10], p = 0.63).

Findings highlight the importance of addressing psychological distress as part of interventions to maintain cognitive health in postmenopausal women and the need for comprehensive models that integrate emotional and biological factors to better understand cognitive aging in this population.