Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women

Leah H. Rubin, Erin E. Sundermann, Judith A. Cook, Eileen M. Martin, Elizabeth T. Golub, Kathleen M. Weber, Mardge H. Cohen, Howard Crystal, Julie A. Cederbaum, Kathryn Anastos, Mary Young, Ruth M. Greenblatt, Pauline M. Maki

Research output: Contribution to journalArticle

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Abstract

Objective: We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. Methods: This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64% African American; median age, 44 y) from the Women's Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. Results: In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P's < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P's < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P's < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P's < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. Conclusions: Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.

Original languageEnglish (US)
Pages (from-to)997-1006
Number of pages10
JournalMenopause
Volume21
Issue number9
DOIs
StatePublished - 2014

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Cognition
HIV
Verbal Learning
Anxiety
Executive Function
Virus Diseases
Depression
African Americans
Sleep
Cross-Sectional Studies
Regression Analysis

Keywords

  • African American
  • Anxiety
  • Human immunodeficiency virus
  • Menopause
  • Mood
  • Verbal learning

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Rubin, L. H., Sundermann, E. E., Cook, J. A., Martin, E. M., Golub, E. T., Weber, K. M., ... Maki, P. M. (2014). Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women. Menopause, 21(9), 997-1006. https://doi.org/10.1097/GME.0000000000000203

Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women. / Rubin, Leah H.; Sundermann, Erin E.; Cook, Judith A.; Martin, Eileen M.; Golub, Elizabeth T.; Weber, Kathleen M.; Cohen, Mardge H.; Crystal, Howard; Cederbaum, Julie A.; Anastos, Kathryn; Young, Mary; Greenblatt, Ruth M.; Maki, Pauline M.

In: Menopause, Vol. 21, No. 9, 2014, p. 997-1006.

Research output: Contribution to journalArticle

Rubin, LH, Sundermann, EE, Cook, JA, Martin, EM, Golub, ET, Weber, KM, Cohen, MH, Crystal, H, Cederbaum, JA, Anastos, K, Young, M, Greenblatt, RM & Maki, PM 2014, 'Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women', Menopause, vol. 21, no. 9, pp. 997-1006. https://doi.org/10.1097/GME.0000000000000203
Rubin, Leah H. ; Sundermann, Erin E. ; Cook, Judith A. ; Martin, Eileen M. ; Golub, Elizabeth T. ; Weber, Kathleen M. ; Cohen, Mardge H. ; Crystal, Howard ; Cederbaum, Julie A. ; Anastos, Kathryn ; Young, Mary ; Greenblatt, Ruth M. ; Maki, Pauline M. / Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women. In: Menopause. 2014 ; Vol. 21, No. 9. pp. 997-1006.
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abstract = "Objective: We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. Methods: This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64{\%} African American; median age, 44 y) from the Women's Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. Results: In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P's < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P's < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P's < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P's < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. Conclusions: Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.",
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AU - Rubin, Leah H.

AU - Sundermann, Erin E.

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AU - Martin, Eileen M.

AU - Golub, Elizabeth T.

AU - Weber, Kathleen M.

AU - Cohen, Mardge H.

AU - Crystal, Howard

AU - Cederbaum, Julie A.

AU - Anastos, Kathryn

AU - Young, Mary

AU - Greenblatt, Ruth M.

AU - Maki, Pauline M.

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N2 - Objective: We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. Methods: This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64% African American; median age, 44 y) from the Women's Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. Results: In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P's < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P's < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P's < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P's < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. Conclusions: Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.

AB - Objective: We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. Methods: This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64% African American; median age, 44 y) from the Women's Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. Results: In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P's < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P's < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P's < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P's < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. Conclusions: Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.

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KW - Human immunodeficiency virus

KW - Menopause

KW - Mood

KW - Verbal learning

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