Original Articles
23 September 2025
Early Access
Cognitive impairment and associated metabolic and hormonal factors in women with polycystic ovarian syndrome: a Montreal Cognitive Assessment-based case-control study
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
49
Views
53
Downloads
Authors
Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder affecting reproductive-aged women, frequently accompanied by metabolic dysfunction, hyperandrogenism, and psychological disturbances. Recent studies suggest possible links between PCOS and cognitive dysfunction, but evidence remains limited. We used the Montreal Cognitive Assessment (MoCA) to assess cognitive function in women with PCOS, and we investigated the interrelationships between hormonal dysregulation, metabolic dysfunction, and inflammatory status. A total of 120 women with PCOS (Rotterdam criteria) and 60 age-matched healthy controls underwent cognitive evaluation using MoCA. Demographic, anthropometric, hormonal, metabolic, and inflammatory markers and lipid profiles were assessed. PCOS patients demonstrated significantly lower total MoCA scores vs. controls (24.29 vs. 27.82, p<0.001). Cognitive impairment (MoCA<26) occurred in 34.16% of PCOS patients. Executive function, attention, language, and orientation domains were significantly impaired, while memory-related domains remained relatively preserved. Women with PCOS showed distinct cognitive vulnerability, particularly in executive, attention, language, and orientation domains. Cognitive dysfunction may represent an underrecognized PCOS aspect, warranting regular screening and future longitudinal studies.
Altmetrics
Downloads
Download data is not yet available.
Citations
Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 2018;14:270-84. DOI: https://doi.org/10.1038/nrendo.2018.24
Aversa A, La Vignera S, Rago R, et al. Fundamental concepts and novel aspects of polycystic ovarian syndrome: expert consensus resolutions. Front Endocrinol 2020;11:516. DOI: https://doi.org/10.3389/fendo.2020.00516
Dong J, Rees DA. Polycystic ovary syndrome: pathophysiology and therapeutic opportunities. BMJ Med 2023;2:e000548. DOI: https://doi.org/10.1136/bmjmed-2023-000548
Naz MSG, Rahnemaei FA, Tehrani FR, et al. Possible cognition changes in women with polycystic ovary syndrome: a narrative review. Obstet Gynecol Sci 2023;66:347-63. DOI: https://doi.org/10.5468/ogs.22165
Rees DA, Udiawar M, Berlot R, et al. White matter microstructure and cognitive function in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2016;101:314-23. DOI: https://doi.org/10.1210/jc.2015-2318
Sukhapure M. Androgens and the female brain: the relationship between testosterone levels, depression, anxiety, cognitive function, and emotion processing in females with polycystic ovarian syndrome. 2019. Available from: https://ourarchive.otago.ac.nz/esploro/outputs/doctoral/Androgens-and-the-Female-Brain-The/9926480226101891.
Rosenzweig A. Montreal cognitive assessment (MOCA) test for dementia. 2019. Available from: https://www.verywellhealth.com/alzheimers-and-montreal-cognitive-assessment-moca-98617.
Christ JP, Cedars MI. Current guidelines for diagnosing PCOS. Diagnostics 2023;13:1113. DOI: https://doi.org/10.3390/diagnostics13061113
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-9. DOI: https://doi.org/10.1111/j.1532-5415.2005.53221.x
Falcetta P, Benelli E, Molinaro A, et al. Effect of aging on clinical features and metabolic complications of women with polycystic ovary syndrome. J Endocrinol Invest 2021;44:2725-33. DOI: https://doi.org/10.1007/s40618-021-01594-5
Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol 2021;95:531-41. DOI: https://doi.org/10.1111/cen.14421
Mirdamadi A, Riahinejad S, Varnaseri S. The association between anthropometric parameters and cardiovascular risk indicators in women with polycystic ovarian syndrome. ARYA Atheroscler 2020;16:39-43.
Liu Y, Guo Y, Yan X, et al. Assessment of health literacy in patients with polycystic ovary syndrome and its relationship with health behaviours: a cross-sectional study. BMJ Open 2023;13:e071051. DOI: https://doi.org/10.1136/bmjopen-2022-071051
McCartney CR, Campbell RE, Marshall JC, Moenter SM. The role of gonadotropin‐releasing hormone neurons in polycystic ovary syndrome. J Neuroendocrinol 2022;34:e13093. DOI: https://doi.org/10.1111/jne.13093
Yang J, Chen C. Hormonal changes in PCOS. J Endocrinol 2024;261:e230342. DOI: https://doi.org/10.1530/JOE-23-0342
Upadhyay N, Almeida EA, Singh A, et al. Evaluation of CRP/albumin ratio in polycystic ovarian syndrome. J Obstet Gynecol India 2024;74:165-9. DOI: https://doi.org/10.1007/s13224-023-01897-y
Amisi CA. Markers of insulin resistance in polycystic ovary syndrome women: an update. World J Diabetes 2022;13:129-49. DOI: https://doi.org/10.4239/wjd.v13.i3.129
Toosy S, Sodi R, Pappachan JM. Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord 2018;17:277-85. Zhao H, Zhang J, Cheng X, et al. DOI: https://doi.org/10.1007/s40200-018-0371-5
Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. J Ovarian Res 2023;16:9. DOI: https://doi.org/10.1186/s13048-022-01091-0
Carmina E, Nasrallah MP, Guastella E, Lobo RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clin Endocrinol 2019;91:553-60. DOI: https://doi.org/10.1111/cen.14063
Zhuang C, Luo X, Wang W, et al. Cardiovascular risk according to body mass index in women of reproductive age with polycystic ovary syndrome: a systematic review and meta-analysis. Front Cardiovasc Med 2022;9:822079. DOI: https://doi.org/10.3389/fcvm.2022.822079
Vrbikova J, Cifkova R, Jirkovska A, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod 2003;18:980-4. DOI: https://doi.org/10.1093/humrep/deg218
Huddleston HG, Jaswa EG, Casaletto KB, et al. Associations of polycystic ovary syndrome with indicators of brain health at midlife in the CARDIA cohort. Neurology 2024;102:e208104. DOI: https://doi.org/10.1212/WNL.0000000000208104
Soleman RS, Kreukels BP, Veltman DJ, et al. Does polycystic ovary syndrome affect cognition? A functional magnetic resonance imaging study exploring working memory. Fertil Steril 2016;105:1314-21. DOI: https://doi.org/10.1016/j.fertnstert.2016.01.034
Jarrett BY, Vantman N, Mergler RJ, et al. Dysglycemia, not altered sex steroid hormones, affects cognitive function in polycystic ovary syndrome. J Endocr Soc 2019;3:1858-68. DOI: https://doi.org/10.1210/js.2019-00112
Mehrabadi S, Sadatmahalleh SJ, Kazemnejad A, Moini A. Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: a cross-sectional study. Int J Reprod Biomed 2020;18:1049-58. DOI: https://doi.org/10.18502/ijrm.v18i12.8026
Redkar M, Khan A. The impact of polycystic ovary syndrome on attention: an empirical investigation. BioPsychoSocial Med 2025;19:3. DOI: https://doi.org/10.1186/s13030-024-00320-w
Showkath N, Sinha M, Ghate JR, et al. EEG-ERP correlates of cognitive dysfunction in polycystic ovarian syndrome. Ann Neurosci 2022;29:225-32. DOI: https://doi.org/10.1177/09727531221115318
Sukhapure M, Eggleston K, Douglas K, et al. Free testosterone is related to aspects of cognitive function in women with and without polycystic ovary syndrome. Arch Womens Ment Health 2022;25:87-94. DOI: https://doi.org/10.1007/s00737-021-01158-9
Schattmann L, Sherwin BB. Testosterone levels and cognitive functioning in women with polycystic ovary syndrome and in healthy young women. Horm Behav 2007;51:587-96. DOI: https://doi.org/10.1016/j.yhbeh.2007.02.007
Ranjbar F, Moazeni F, Abdi M, et al. Evaluation of spatial memory in women with polycystic ovary syndrome. Iran J Obstet Gynecol Infertil 2020;23:1-9.
Dybciak P, Raczkiewicz D, Humeniuk E, et al. Depression in polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Med 2023;12:6446. DOI: https://doi.org/10.3390/jcm12206446
Alnaeem L, Alnasser M, AlAli Y, et al. Depression and anxiety in patients with polycystic ovary syndrome: a cross-sectional study in Saudi Arabia. Cureus 2024;16:e51530. DOI: https://doi.org/10.7759/cureus.51530
Fernandez RC, Moore VM, Van Ryswyk EM, et al. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep 2018:45-64. DOI: https://doi.org/10.2147/NSS.S127475
How to Cite
Cognitive impairment and associated metabolic and hormonal factors in women with polycystic ovarian syndrome: a Montreal Cognitive Assessment-based case-control study. (2025). Italian Journal of Medicine. https://doi.org/10.4081/itjm.2025.2085
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.