Associations of psychosocial supports and stressors with cognition in midlife women

Objectives: Psychosocial supports and stressors can influence neurocognitive function, but associations are understudied among women in midlife. Methods: Among 492 parous women in the longitudinal Project Viva cohort, we surveyed several psychosocial supports and stressors in 2019-2022. At subsequent in-person visits (2022-2024) we performed the Montreal Cognitive Assessment (MoCA), which assesses global cognition, and four scales of the Cambridge Neuropsychological Test Automated Battery (CANTAB) that assess episodic memory, working memory, executive functioning, and attention. We examined associations using multivariable linear regression adjusted for age, education, spoken English, race, and ethnicity. Results: Mean (SD) age was 55.5 (4.9) years, 71% were postmenopausal, and 20% scored below 26 on the MoCA, a threshold for cognitive impairment. In age-adjusted analyses, associations with both MoCA and total CANTAB were in the hypothesized directions (higher scores with supports, lower scores with stressors). For MoCA, adjustment for demographics resulted in attenuation of all associations to null. However, financial and food insecurity measures remained associated with several CANTAB scales in adjusted models, for example, having difficulty paying bills was associated with lower executive functioning (−0.37; 95% CI: −0.69 to −0.06), attention (−0.42; 95% CI: −0.66 to −0.18), and total CANTAB (−0.19; 95% CI: −0.35 to −0.03) internal z-scores. Measures of social support, perceived stress, and everyday discrimination were not associated with total CANTAB or its subscores. Adjustment for menopause status had negligible effect. Conclusions: Financial and food insecurity, but not social support, perceived stress, or discrimination, were associated with poorer memory, executive function, and attention in midlife women.