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Executive function in women post-menopause

Study underscores the importance of considering psychological state during medical procedures.

Assessing adverse childhood experiences and current anxiety and depression symptoms may help ease cognitive distress in women who have undergone a surgical menopause for cancer risk-reduction, or RRSO, according to a new study published in Menopause.

Researchers, including Dr Neill Epperson of the University of Colorado Anschutz Medical Campus, remotely collected extensive cognitive data from women across the nation. 552 women who are BRCA1 and BRCA2 mutation carriers and have undergone RRSO completed the assessments, which measured executive function (a cognitive process that allows individuals to manage information in a planful versus reactive manner), exposure to early life stress, and mood symptoms.

Results show that adverse childhood experiences (ACE) were associated with more severe symptoms of executive dysfunction and worse performances on cognitive tasks post-surgical menopause. Changes in mood, such as anxiety and depressive symptoms, partially mediated ACE associations on subjective and objective measures of executive function. These findings indicate that assessing history of childhood adversity and current anxiety and depression symptoms may help to identify women who will experience executive cognitive complaints after surgical menopause.

This research emphasizes the importance of considering psychological state during other medical procedures. "We can't change the past for women who have experienced serious childhood adversities such as abuse, neglect, divorce, parental substance abuse, or exposure to domestic violence, but we can identify a patient population that is easily assessed for these ACEs as well as current negative mood symptoms," said Epperson, study lead investigator and professor and Chair of psychiatry at the University of Colorado School of Medicine. "Our hope is that assessment of childhood adversity and history of depression and anxiety would become part of the pre-surgical risk-benefit discussion between patients and their doctors."

"Many women have told me over the years that their doctor did not warn them about the potential brain effects of undergoing a surgical menopause. While these women may have made the same decision regarding surgery given its life preserving benefits, they indicated that they wish they had been informed about the potential cognitive and mood effects so that they could be prepared and seek treatment sooner", says Epperson.



Despite the fact that negative mood and executive dysfunction are common after risk-reducing salpingo-oophorectomy (RRSO), occurring in up to a third of women, little is known about risk factors predicting these negative outcomes. Adverse childhood experiences (ACE) predict poorer health in adulthood and may be a risk factor for negative outcomes after RRSO. Given the complex relationship between early life stress, affective disorders, and cognitive dysfunction, we hypothesized that ACE would be associated with poorer executive function and that mood symptoms would partially mediate this relationship.


Women who had undergone RRSO were included in the study (N = 552; age 30-73 y). We measured executive function (continuous performance task, letter n-back task, and Brown Attention Deficit Disorder Scale Score), exposure to early life stress (ACE questionnaire), and mood symptoms (Hospital Anxiety and Depression Scale). Generalized estimating equations were used to evaluate the association between ACE and executive dysfunction and the role of mood symptoms as a mediator in this relationship.


ACE was associated with greater severity of subjective executive dysfunction (adjusted mean difference [aMD] = 7.1, P = 0.0005) and worse performance on both cognitive tasks (continuous performance task: aMD = -0.1, P = 0.03; n-back: aMD = -0.17, P = 0.007). Mood symptoms partially mediated ACE associations with sustained attention (21.3% mediated; 95% CI: 9.3%-100%) and subjective report of executive dysfunction (62.8% mediated; 95% CI: 42.3%-100%).


The relationship between childhood adversity and executive dysfunction is partially mediated by mood symptoms. These data indicate that assessing history of childhood adversity and current anxiety and depression symptoms may play a role in treating women who report cognitive complaints after RRSO.


Sheila Shanmugan, Mary D Sammel, James Loughead, Kosha Ruparel, Ruben C Gur, Thomas E Brown, Jessica Faust, Susan Domchek, C Neill Epperson. Executive Function After Risk-Reducing Salpingo-Oophorectomy in BRCA1 and BRCA2 Mutation Carriers: Does Current Mood and Early Life Adversity Matter? Menopause 2020 Mar 16[Online ahead of print]  PMID: 32187134 DOI: 10.1097/GME.0000000000001535

Content created 27 March 2020

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