Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: A cross-sectional study


Background: While polycystic ovary syndrome (PCOS) is often associated with psychological distress, its most frequent clinical characteristics include acne, hirsutism and increased level of androgen hormones.

Objective: To evaluate the level of depression and anxiety, hirsutism, acne, and level of androgen hormones in PCOS and control group and its association with cognitive function.

Materials and Methods: This cross-sectional study was conducted on 53 women with PCOS and 50 healthy women as a control group. Data were collected using a questionnaire including the samples’ demographic information, clinical features, clinical findings of hyperandrogenism, and the Beck Depression and Anxiety questionnaire. In addition, the acne and hirsutism levels of the subjects were evaluated using the global acne grading system and the Ferriman-Gallwey scoring system, respectively. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that covers major cognitive domains.

Results: A significant difference was found between the two groups in the mean levels of acne, hirsutism, total testosterone, free androgen index, depression, and anxiety. However, some mean values of the MoCA were lower in the women of case group compared to the control group. Additionally, a significant difference was observed between the two groups in the domains of visual-spatial ability (p = 0.009), executive function (p = 0.05), attention (p = 0.03), and total MoCA scores (p = 0.002).

Conclusion: The PCOS women demonstrated significantly lower performance on the tests of executive function, attention, and visual-spatial function than the healthy control women.

Key words: PCOS, Cognitive function, Androgen, Depression and anxiety.

[1] Barnard L, Balen AH, Ferriday D, Tiplady B, Dye L. Cognitive functioning in polycystic ovary syndrome. Psychoneuroendocrinology 2007; 32: 906–914.

[2] Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod 2014; 29: 791–801.

[3] Ramos FK, da Silva Lara LA, Kogure GS, Silva RC, Ferriani RA, Silva de Sá MF, et al. Quality of life in women with polycystic ovary syndrome after a program of resistance exercise training. Rev Bras Ginecol Obstet 2016; 38: 340–347.

[4] Mehrabadi S, Jahanian Sadatmahalleh S, Kazemnejad A. [Association of depression and anxiety with cognitive function in patients with polycystic ovary syndrome]. J Mazandaran Univ Med Sci 2017; 27: 159–170. (in Persian)

[5] Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, depression, and quality of life in women with polycystic ovarian syndrome. Indian J Psychol Med 2018; 40: 239–246.

[6] Deveci E, Ozturk A, Kirpinar I, Koyuncu A, Engin I, Melikoğlu M, et al. Neurocognition in patients with acne vulgaris. J Psychiatry 2014; 17: 1–7.

[7] Gupta MA, Gupta AK, Vujcic B. Increased frequency of attention deficit hyperactivity disorder (ADHD) in acne versus dermatologic controls: analysis of an epidemiologic database from the US. J Dermatolog Treat 2014; 25: 115–118.

[8] Barry JA, Parekh HSK, Hardiman PJ. Visual-spatial cognition in women with polycystic ovarian syndrome: the role of androgens. Hum Reprod 2013; 28: 2832–2837.

[9] Schattmann L, Sherwin BB. Effects of the pharmacologic manipulation of testosterone on cognitive functioning in women with polycystic ovary syndrome: a randomized, placebo-controlled treatment study. Horm Behav 2007; 51: 579–586.

[10] Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 2014; 44: 2029–2040.

[11] Spritzer PM. Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances. Arq Bras Endocrinol Metabol 2014; 58: 182–187.

[12] Dadfar M, Kalibatseva Z. Psychometric properties of the persian version of the short beck depression inventory with Iranian psychiatric outpatients. Scientifica 2016; 2016: 8196463. 1–7.

[13] Fallahi Khesht-Masjedi M, Omar Z, Kafi Masoleh SM. Psychometrics properties of the Persian version of beck anxiety inventory in north of Iranian adolescents. Int J Educ Psychol Res 2015; 1: 145–153.

[14] Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699.

[15] Wong A, Yiu S, Nasreddine Z, Leung KT, Lau A, Soo YO, et al. Validity and reliability of two alternate versions of the montreal cognitive assessment (Hong Kong version) for screening of mild neurocognitive disorder. PloS One 2018; 13: e0196344. 1–12.

[16] Lumezi BG, Berisha VL, Pupovci HL, Goçi A, Hajrushi AB. Grading of hirsutism based on the ferrimangallwey scoring system in kosovar women. Postepy Dermatol Alergol 2018; 35: 631–635.

[17] Zohra FT, Sultana T, Islam S, Nasreen T. Evaluation of severity in patients of acne vulgaris by global acne grading system in Bangladesh. Clin Pathol 2017; 1: 1–5.

[18] Vankrieken L. Testosterone and the free androgen index. ZB158th edition. Los Angeles: Diagnostics Products; 1997.

[19] Dharshana S, Singh AK, Sharma S, Mohan SK, Joshi A. Depression, mood change and self-esteem among adolescents aged 12-25 years with acne vulgaris in India. Ann Trop Med Public Health 2016; 9: 31–36.

[20] Ergun T, Seckin D, Ozaydin N, Bakar O, Comert A, Atsu N, et al. Isotretinoin has no negative effect on attention, executive function and mood. Journal of the European Academy of Dermatology and Venereology 2012; 26: 431–439.

[21] Ormerod AD, Thind CK, Rice SA, Reid IC, Williams JHG, McCaffery PJA. Influence of isotretinoin on hippocampal-based learning in human subjects. Psychopharmacology 2012; 221: 667–674.

[22] Fuermaier A, Tucha L, Koerts J, Aschenbrenner S, Kaunzinger I, Hauser J, et al. Cognitive impairment in adult ADHD-perspective matters. Neuropsychology 2015; 29: 45–58.

[23] Bowe WP, Logan AC. Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles. Lipids Health Dis 2010; 9: 141–152.

[24] Khoubnasabjafari M, Ansarin K, Jouyban A. Reliability of malondialdehyde as a biomarker of oxidative stress in psychological disorders. Bioimpacts 2015; 5: 123–127.

[25] Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Psychological investigation in patients with polycystic ovary syndrome. Health Qual Life Outcomes 2013; 11: 141–148.

[26] Porter RJ, Bourke C, Gallagher P. Neuropsychological impairment in major depression: its nature, origin and clinical significance. Aust N Z J Psychiatry 2007; 41: 115–128.

[27] Kizilbash AH, Vanderploeg RD, Curtiss G. The effects of depression and anxiety on memory performance. Arch Clin Neuropsychol 2002; 17: 57–67.

[28] Beaudreau SA, O’Hara R. The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults. Psychol Aging 2009; 24: 507–512.

[29] Basso MR, Bornstein RA. Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task. Neuropsychology 1999; 13: 557–563.

[30] Huang G, Wharton W, Travison TG, Ho MH, Gleason C, Asthana S, et al. Effects of testosterone administration on cognitive function in hysterectomized women with low testosterone levels: a dose-response randomized trial. J Endocrinol Invest 2015; 38: 455–461.

[31] Christiansen K, Knussmann R. Sex hormones and cognitive functioning in men. Neuropsychobiology 1987; 18: 27–36.

[32] Moffat SD, Hampson E. A curvilinear relationship between testosterone and spatial cognition in humans: possible influence of hand preference. Psychoneuroendocrinology 1996; 21: 323–337.

[33] Hashemi F, Yaghmaei P, Saadati N, Haghighi Poodeh S, Ramezani Tehrani F, Hedayati M. Association of serum adipsin levels with polycystic ovarian syndrome. Razi J Med Sci 2012; 19: 1–6.

[34] Postma A, Meyer G, Tuiten A, van Honk J, Kessels RP, Thijssen J. Effects of testosterone administration on selective aspects of object-location memory in healthy young women. Psychoneuroendocrinology 2000; 25: 563–575.

[35] Aleman A, Bronk E, Kessels RPC, Koppeschaar HPF, van Honk J. A single administration of testosterone improves visuospatial ability in young women. Psychoneuroendocrinology 2004; 29: 612–617.

[36] Thilers PP, Macdonald SWS, Herlitz A. The association between endogenous free testosterone and cognitive performance: a population-based study in 35 to 90 year-old men and women. Psychoneuroendocrinology 2006; 31: 565–576.

[37] Ghazeeri Gh, Fakih A, Abbas HA, Harajly S, Awwad J. Anxiety, cognitive, and depressive assessment in adolescents with polycystic ovarian syndrome: a pilot study. J Pediatr Adolesc Gynecol 2013; 26: 269–273.

[38] Prickett Ch, Brennan L, Stolwyk R. Examining the relationship between obesity and cognitive function: a systematic literature review. Obes Res Clin Pract 2015; 9: 93–113.

[39] Kim B, Feldman EL. Insulin resistance as a key link for the increased risk of cognitive impairment in the metabolic syndrome. Exp Mol Med 2015; 47: e149. 1–10.

[40] Gholizadeh S, Jahanian Sadatmahalleh Sh, Ziaei S. The association between estradiol levels and cognitive function in postmenopausal women. Int J Reprod Biomed 2018; 16: 455–458.