Factors associated with subjective cognitive symptoms during the menopause transition

OBJECTIVES: Subjective cognitive symptoms, also referred to as "brain fog," are commonly reported by women in perimenopause. The factors that contribute to "brain fog" are not clear. The aim of the current study was to explore whether demographic factors (age, educational level, parity, and marital status), lifestyle factors (mindfulness, alcohol consumption, caffeine intake, attitude towards menopause, and hormonal therapy use), psychological and menopausal symptoms (anxiety, depression, stress, sleep, physical, vasomotor, sexual, and psychosocial), are linked to menopausal brain fog. METHODS: A total of 208 perimenopausal women were included in the analysis, who were aged 41-60 years and completed an online survey that included assessment of demographic and lifestyle factors as well as menopause symptoms alongside the Everyday Memory Questionnaire-Revised (measuring subjective deficits in retrieval and attention). For initial exploration, univariable logistic regression was conducted for each of the factors described above in relation to the subjective cognitive outcomes. A random forest analysis was subsequently performed to assist in selecting variables based on their importance. Selected variables (all 8 psychological and menopausal symptom variables, mindfulness, age, alcohol consumption, educational level, and parity) were included in a multivariable logistic regression to estimate the adjusted effects of the selected variables on the outcome. RESULTS: In the multivariable models, higher mindfulness was significantly associated with reduced odds of reporting both memory retrieval (odds ratio [OR] = 0.51; 95% CI = 0.34-0.77; P = 0.002) and attentional difficulties (OR = 0.37; 95% CI = 0.24-0.57; P < 0.001). Higher Menopause-specific Quality Of Life-Psychosocial scores were linked to increased odds of attentional complaints (OR = 2.35; 95% CI = 1.31-4.34; P = 0.005), and showed a marginal association with retrieval difficulties (OR = 1.64; 95% CI = 0.94-2.89; P = 0.086). Menopause-specific Quality of Life-Sexual also showed a marginal association with retrieval complaints (OR = 1.36; 95% CI = 0.95-1.97; P = 0.097). No other demographic, lifestyle, or menopause-related variables were significantly associated with cognitive outcomes after adjustment. CONCLUSIONS: Current findings highlight the relevance of mindfulness and certain menopausal symptoms in subjective cognitive complaints, warranting further investigation to clarify their causal roles and potential as intervention targets.