Subjective cognition and objective cognitive performance in early versus late perimenopause

Menopause-related cognitive difficulties, colloquially referred to as menopausal brain fog, are commonly reported during perimenopause. While hormonal fluctuations across the menopause transition have been proposed to impact both self-reported and objective cognitive functioning, few studies have directly compared cognition across early and late perimenopause stages. As such, the current study aimed to examine whether subjective cognitive complaints and objective cognitive performance differ across menopause stages, as defined by the updated STRAW +10 criteria.

Secondary analyses were conducted using data from 687 participants in the Menopause and Cognition Online Study (Meno-COG). Self-reported memory complaints, objective cognitive performance, menopause symptoms, and mood were assessed in women across different stages of the menopause transition. Additionally, the factor structure of the online cognitive test battery was evaluated using a confirmatory factor analysis (CFA).

The CFA supported a three-factor model for the cognitive data, reflecting learning efficiency, retrieval fluency, and working memory. When early and late perimenopause were combined, the perimenopause (combined) group demonstrated significantly poorer performance on measures of learning efficiency compared to reproductive and postmenopausal women. In contrast, no significant differences were observed between early and late perimenopause groups in either self-reported memory complaints or objective cognitive performance. However, vasomotor symptoms were significantly higher in late perimenopause.

The findings support preliminary evidence suggesting that learning efficiency may be sensitive to cognitive changes during the menopause transition. Challenges in classifying early versus late perimenopause highlight the limitations of the STRAW +10 framework for characterizing perimenopause. Future research incorporating hormonal measures and comprehensive supervised neuropsychological assessment is needed to characterize cognitive changes across perimenopause more precisely.