Association of menarche, menopause, and reproductive history with cognitive performance in older US women: a cross-sectional study from NHANES 2011–2014

Abstract

Abstract Background With the increasing global aging population, cognitive impairment, particularly Alzheimer’s disease (AD), has become an escalating public health and economic concern. Recent research has increasingly focused on the relationship between female reproductive factors and cognitive health. This study explores the association between reproductive history factors and cognitive performance in women aged 60 and older in the US, providing insights for the prevention and management of cognitive impairment. Methods We analyzed participants in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. The cognitive performance was assessed by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning sub-test, Animal Fluency test (AFT), and Digit Symbol Substitution Test (DSST), in relation to reproductive history variables like age of menarche, menopause, reproductive span, number of pregnancies, and parity. Statistical analyses included weighted linear regression for continuous variables and weighted chi-square tests for categorical variables, with adjustments for age, BMI, alcohol intake, smoking, PIR, education, race/ethnicity, hypertension, and diabetes. Results A total of 698 (weighted sample was 25,558,437) women aged 60 years or older were included in the study. Parity negatively impacted cognitive performance, women with ≥ 5 parity showing reductions in AFT (β = -2.1, p = 0.032), DSST (β = -14, p < 0.001), CERAD trial 1 (β = -0.41, p = 0.031), and CERAD Total scores (β = -1.3, p = 0.033) all in model 2. Delayed menopause was positively associated with cognitive function, showing improvements in CERAD trial 1 (β = 1.2, p = 0.002) and total recall (β = 2.1, p = 0.031) both in model 3. Longer reproductive span was linked to better cognitive function, particularly in immediate recall and processing speed (β = 0.12, p < 0.001 for DSST) in model 3. Conclusion Higher parity was negatively correlated with processing speed and memory. In contrast, delayed menopause and a longer reproductive span were positively correlated with global cognition and processing speed. These findings suggest that reproductive factors play a potential role in cognitive aging among older women.

Keywords

• Cognitive function
• Menarche
• Menopause
• Reproductive history
• NHANES