White Matter Microstructure and Cognitive Function in Young Women with PCOS

Young women with polycystic ovary syndrome (PCOS) may have altered white matter microstructure which impairs cognitive performance, according to a study recently published in the Journal of Clinical Endocrinology & Metabolism.

Researchers led by Michael O’Sullivan, PhD, of the Maurice Wohl Clinical Neuroscience Institute in London, UK, and Aled Rees of Cardiff University’s Neuroscience and Mental Health Research Institute, point out that PCOS leads to an increased risk of type 2 diabetes (T2D), as well as hyperandrogenism, and that insulin and androgens affect brain function. “Some early evidence suggests that metabolic risk states may have an influence on brain structure,” the authors write.

The investigators set out to determine whether young women with PCOS display altered white matter microstructure and cognitive function, so they analyzed 36 women (18 with PCOS and 18 controls) matched for age, IQ, and BMI. The participants underwent tests to evaluate their metabolic and anthropometric states, as well as a diffusion MRI to look at their white brain matter and a cognitive performance assessment. “Cognitive scores and white matter diffusion metrics were compared between groups,” the authors write. “White matter microstructure was evaluated across the whole white matter skeleton using tract-based spatial statistics. Associations with metabolic indices were also evaluated.”

The researchers found that PCOS was associated with a measure of water diffusion along the main axis of white matter pathways in the brains of those with PCOS, and localised alterations in the proportion of white or grey matter (as opposed to cerebrospinal fluid). Cognitive performance was reduced among the women with PCOS when compared with controls. The women with PCOS showed deficits across a variety of cognitive tests, despite these women have similar education and premorbid intelligence as their control counterparts. “In PCOS,” the authors write, “there was a reversal of the relationship seen in controls between brain microstructure and both androgens and insulin resistance.”

O’Sullivan and his team conclude, “White matter microstructure is altered, and cognitive performance is compromised, in young adults with PCOS. These alterations in brain structure and function are independent of age, education and BMI.” However, they go on to write, if these changes could be reversed, that could lead to a potential target for treatment. “Based on the current results,” they write, “both insulin resistance and hyperandrogenism are potential targets, and advanced MRI has a potential role as a biomarker of treatment effect.”

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