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Menopause. 2014 Sep;21(9):997-1006. doi: 10.1097/GME.0000000000000203.

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

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From the 1Department of Psychiatry, University of Illinois at Chicago, Chicago, IL; 2Department of Psychiatry, Rush University, Chicago, IL; 3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; 4The Core Center, Cook County Health and Hospital System and Hektoen Institute of Medicine, Chicago, IL; 5Department of Medicine, Stroger Hospital and Rush University, Chicago, IL; 6Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY; 7School of Social Work, University of Southern California, Los Angeles, CA; 8Department of Medicine and Epidemiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; 9Georgetown University School of Medicine, Washington, DC; 10Departments of Clinical Pharmacy, Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, CA; and 11Department of Psychology, University of Illinois at Chicago, Chicago, IL.



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.


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.


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.


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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