Association of Reproductive Factors and Postmenopausal Sex Hormones With Cognitive Impairment in Postmenopausal Women With Parkinson's Disease

Abstract

Aims

To explore the associations of reproductive factors (RFs) and postmenopausal sex hormone (PSH) with cognitive impairment (CI) in postmenopausal women with PD (PWPD), and to develop a predictive nomogram.

Methods

Ninety-five PWPD were divided into CI (n = 72; Montreal Cognitive Assessment [MoCA] < 26) and normal cognition (n = 23; MoCA ≥ 26) groups. RFs and serum PSH levels were collected. Risk factors were screened by logistic regression and confirmed via sensitivity and subgroup analyses. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis.

Results

Shorter reproductive lifespan (RLS) and lower education independently predicted CI in PWPD. Compared with RLS ≥ 39 years, RLS ≤ 32 years (adjusted OR = 12.41, p = 0.011) and 33–38 years (adjusted OR = 8.42, p = 0.008) were associated with significantly higher CI risks. The RLS-CI association remained stable across sensitivity analyses and was more prominent in milder-stage patients. No intergroup PSH differences were observed. A nomogram integrating RLS, education, age, disease duration, and Hoehn and Yahr stage (H&Y stage) demonstrated satisfactory discrimination (AUC = 0.903), calibration, and net benefit.

Conclusion

Shorter RLS independently predicts CI in PWPD, particularly in milder-stage patients, while PSH shows no association. This nomogram may serve as a practical screening tool for CI in PWPD, pending external validation.