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Measuring cognition in menopause research: a review of test use

Objective: To examine critically how various aspects of memory functions have been assessed in menopause-related research. Method: Twenty peer-reviewed articles on the menopause and cognitive functioning published between 1991 and 2000 were identified through a computerized Medline search. All studies utilized healthy non-demented women, and assessed specific aspects of cognitive functioning using standardized tests rather than self-reporting of perceived functioning. Results: Measures used to assess attention and concentration, verbal memory, learning and verbal expression, visual memory, concept formation and reasoning have all been reviewed. Findings from studies assessing attention and concentration demonstrate inconsistent results with regard to hormone levels or menopausal status. Although five measures of verbal learning and memory have been considered, no articles published in the past decade have reported unequivocal results for any one measure. Only one study reviewed found significant differences in measures of verbal expression between hormone therapy users and non-users. In addition, no strong association between estrogen level and visual memory was identified in the studies reviewed. Conclusions: This careful analysis demonstrates that, within the studies of cognitive abilities of menopausal women reviewed in this article, a wide variety of tests have been used. However, the body of literature considered neither consistently nor conclusively demonstrates a clear effect of exogenous hormone therapy on memory. It is suggested that verbal memory, visual memory, concept formation and reasoning should be simultaneously investigated in future research, and that covariate measures of attention and concentration, verbal expression and reasoning are also included. In addition, within each specific domain, the psychometric properties of tests, the populations they were intended to assess and the specific aspects of cognitive function they were designed to address need to be more closely considered.