This systematic review and meta-analysis aimed to review existing measures of subjective cognition during menopause and to estimate the correlation between subjective and objective cognition in perimenopausal and postmenopausal women.

Eligible studies reported scores for at least one subjective and objective measure of cognition for perimenopausal or postmenopausal women. EMBASE, Medline, and PsycINFO were searched for eligible studies on November 22nd 2024. The risk of bias in individual studies was evaluated using a modified QUADAS-2 form. The results of the review were summarized in narrative form. Studies that reported correlations between subjective and objective cognition were synthesized using a multilevel meta-analysis.

The sample included 5629 participants over 24 studies, including 295 perimenopausal women, 5086 postmenopausal women, and 248 women across mixed peri- and post-menopausal samples. Twelve measures of subjective cognition were used across studies. Six studies were included in the meta-analysis. A small significant correlation was observed between subjective cognition and objective measures of learning efficiency (r = .12; CI = .02 to .23). Correlations across other cognitive domains were non-significant.

Our findings suggest subjective cognition may be associated with performance on measures of learning efficiency, offering a starting point for further research on menopausal brain fog. The present findings highlight the need for a reliable measure of subjective cognitive symptoms associated with menopause. Additionally, a better characterization of the neuropsychological profile of menopausal brain fog is needed to progress research in this field and ultimately improve clinical support for women experiencing these symptoms.

Severe fatigue and cognitive dysfunction are frequent symptoms in patients with postural orthostatic tachycardia syndrome. They can be debilitating, and often do not resolve despite improvement in haemodynamic symptoms. Our analysis was intended to assess clinical outcomes of medication treatment for these symptoms in a large, single-centre paediatric programme.

We performed a retrospective review of patients treated for fatigue and cognitive dysfunction. Patients aged 18 years or younger at the time of initial diagnosis were included. Patients who had a specific medication ordered five or more times for these symptoms were confirmed by chart review for clinical improvement. Percentage of patients with clinical improvement for each medication and overall for all medications, as well as the number of medications per patient required to achieve improvement, were assessed. Data were analysed based on gender as well. t-Test and χ2 analyses were used to assess for differences between means in variables, or specific variables.

A total of 708 patients met study criteria, of whom 517 were treated for fatigue or brain fog. Overall efficacy was 68.8%, with individual medication effectiveness ranging from 53.1 (methylphenidate) to 16.5% (atomoxetine). There was no significant difference in efficacy with respect to gender. The median number of medications used per patient was 2, without gender difference. Therapy was limited by side effects or lack of efficacy.

Medications are effective in the improvement of fatigue and cognitive dysfunction in these patients. However, trials of multiple medications may be needed before achieving clinical improvement.