Cognitive impairment and associated metabolic and hormonal factors in women with polycystic ovarian syndrome: a Montreal Cognitive Assessment-based case-control study

Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder affecting reproductive-aged women, frequently accompanied by metabolic dysfunction, hyperandrogenism, and psychological disturbances. Recent studies suggest possible links between PCOS and cognitive dysfunction, but evidence remains limited. We used the Montreal Cognitive Assessment (MoCA) to assess cognitive function in women with PCOS, and we investigated the interrelationships between hormonal dysregulation, metabolic dysfunction, and inflammatory status. A total of 120 women with PCOS (Rotterdam criteria) and 60 age-matched healthy controls underwent cognitive evaluation using MoCA. Demographic, anthropometric, hormonal, metabolic, and inflammatory markers and lipid profiles were assessed. PCOS patients demonstrated significantly lower total MoCA scores vs. controls (24.29 vs. 27.82, p<0.001). Cognitive impairment (MoCA<26) occurred in 34.16% of PCOS patients. Executive function, attention, language, and orientation domains were significantly impaired, while memory-related domains remained relatively preserved. Women with PCOS showed distinct cognitive vulnerability, particularly in executive, attention, language, and orientation domains. Cognitive dysfunction may represent an underrecognized PCOS aspect, warranting regular screening and future longitudinal studies.