The Influence of the Menopausal Transition on Subjective Cognitive Complaints in Women with Multiple Sclerosis

Current disease-modifying treatments are not effective in treating cognitive problems associated with multiple sclerosis (MS). Previous studies suggest that the neuroprotective oestrogen could affect MS symptoms. During the menopausal transition, characterised by low oestrogen, healthy women report similar cognitive complaints as people with MS. This thesis study examined the effect of menopausal stages on subjective cognitive complaints in women with and without MS. We hypothesized that perimenopausal women report the most subjective cognitive complaints, with perimenopausal women with SPMS reporting the highest across subtypes. We also hypothesised that the positive association between fatigue and subjective cognitive complaints would be strongest in perimenopausal women with MS. In this cross-sectional study, 222 women with MS and 305 women without MS were categorised as pre-, peri-, or postmenopausal. Participants completed online questionnaires on subjective cognitive...Show moreCurrent disease-modifying treatments are not effective in treating cognitive problems associated with multiple sclerosis (MS). Previous studies suggest that the neuroprotective oestrogen could affect MS symptoms. During the menopausal transition, characterised by low oestrogen, healthy women report similar cognitive complaints as people with MS. This thesis study examined the effect of menopausal stages on subjective cognitive complaints in women with and without MS. We hypothesized that perimenopausal women report the most subjective cognitive complaints, with perimenopausal women with SPMS reporting the highest across subtypes. We also hypothesised that the positive association between fatigue and subjective cognitive complaints would be strongest in perimenopausal women with MS. In this cross-sectional study, 222 women with MS and 305 women without MS were categorised as pre-, peri-, or postmenopausal. Participants completed online questionnaires on subjective cognitive complaints (MSNQ), reproductive stage (STRAW+10), mood (HADS-D), anxiety (HADS-A), and fatigue (CIS). To compare MSNQ scores with menopausal stage and MS subtype, two separate two-way ANOVAs were performed. A multiple linear regression examined whether fatigue, group, and menopausal stage predicted MSNQ scores. MSNQ scores differed between menopausal stages, p = .008, with perimenopausal women reporting higher complaints than pre- and postmenopausal women, ps < .02. No significant interaction effect was found, p = .16. After controlling for anxiety and mood, there was no more significant effect of menopausal stage, ps > .46. High fatigue scores were significantly associated with high MSNQ scores, p < .001, without interaction effects, ps > .06. No significant main or interaction effect of MS subtypes on MSNQ scores was found, ps > .07. In conclusion, perimenopausal women reported the most cognitive complaints, although this was mostly explained by mood and anxiety. However, no evidence was found that the menopausal transition affects women with MS or across MS subtypes differently. The association between fatigue and subjective cognitive complaints did not differ between menopausal stages. Although this thesis study highlights an understudied field, limitations include the possible confounding effect of social media recruitment and the inability to generalize to objective cognitive measures. Future research should focus on exploring the effect of hormone replacement therapy on cognitive complaints.Show less

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The Influence of the Menopausal Transition on Subjective Cognitive Complaints in Women with Multiple Sclerosis