Chronological age is differentially associated with cognitive performance according to climacteric stage: evidence...

Women traversing menopause experience neuropsychological changes affecting cognitive domains such as memory, attention, and processing speed. However, the relationship between chronological age and cognitive performance across different climacteric stages remains poorly understood, particularly in Latin American populations. The menopausal transition is increasingly recognized as a critical period for women's cognitive health, characterized by profound neuroendocrine changes that may influence trajectories of cognitive aging. Chronological age was associated with better cognitive performance in early menopause, whereas in advanced postmenopause it was associated with lower performance. This pattern may reflect stage-specific differences related to reproductive aging, particularly across different phases of the climacteric.

To examine whether chronological age differentially modulates cognitive performance according to climacteric stage in Chilean women from the Magallanes Region.

Three hundred sixty women aged 50-81 years were recruited and classified by climacteric stage: early menopause (≤4 years since last menstrual period, n = 126), intermediate postmenopause (5-8 years, n = 123), and advanced postmenopause (>9 years, n = 111). Cognitive performance was assessed using the Addenbrooke's Cognitive Examination-Revised (ACE-R) and the Symbol Digit Modalities Test (SDMT). A Bayesian multivariate model with two-way interaction terms was fitted, simultaneously evaluating ACE-R and SDMT as response variables.

More advanced climacteric stage was associated with lower ACE-R and SDMT scores. Although the main effect of age at assessment showed high uncertainty, a significant age × climacteric stage interaction revealed that the age-cognition slope differed by stage. Specifically, in early menopause, older age was associated with better cognitive performance, whereas in advanced postmenopause, older age was associated with lower cognitive performance.

The association between chronological age and cognitive performance differed according to climacteric stage in Chilean women. These findings challenge the traditional view of age as a uniformly negative correlate of cognition and may have implications for cognitive screening strategies during the menopausal transition.