title: White Matter Microstructure and Cognitive Function in Young Women With Polycystic Ovary Syndrome.
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) is a disorder characterized by insulin resistance and hyperandrogenism, which leads to an increased risk of type 2 diabetes in later life. Androgens and insulin signaling affect brain function but little is known about brain structure and function in younger adults with PCOS.
  
  
  OBJECTIVE
  To establish whether young women with PCOS display altered white matter microstructure and cognitive function. PATIENTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Eighteen individuals with PCOS (age, 31 ± 6 y; body mass index [BMI] 30 ± 6 kg/m(2)) and 18 control subjects (age, 31 ± 7 y; BMI, 29 ± 6 kg/m(2)), matched for age, IQ, and BMI, underwent anthropometric and metabolic evaluation, diffusion tensor MRI, a technique especially sensitive to brain white matter structure, and cognitive assessment. Cognitive scores and white matter diffusion metrics were compared between groups. White matter microstructure was evaluated across the whole white matter skeleton using tract-based spatial statistics. Associations with metabolic indices were also evaluated.
  
  
  RESULTS
  PCOS was associated with a widespread reduction in axial diffusivity (diffusion along the main axis of white matter fibers) and increased tissue volume fraction (the proportion of volume filled by white or grey matter rather than cerebrospinal fluid) in the corpus callosum. Cognitive performance was reduced compared with controls (first principal component, t = 2.9, P = .007), reflecting subtle decrements across a broad range of cognitive tests, despite similar education and premorbid intelligence. In PCOS, there was a reversal of the relationship seen in controls between brain microstructure and both androgens and insulin resistance.
  
  
  CONCLUSIONS
  White matter microstructure is altered, and cognitive performance is compromised, in young adults with PCOS. These alterations in brain structure and function are independent of age, education and BMI. If reversible, these changes represent a potential target for treatment.
authors.affiliation: Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
authors.forename: D Aled
authors.initials: DA
authors.lastname: Rees
authors.affiliation: Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Udiawar
authors.affiliation: Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
authors.forename: Rok
authors.initials: R
authors.lastname: Berlot
authors.affiliation: Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Jones
authors.affiliation: Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000728:Androgens / Q000097:blood; D015992:Body Mass Index; D003071:Cognition; D003337:Corpus Callosum / Q000473:pathology; D056324:Diffusion Tensor Imaging; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006801:Humans; D007333:Insulin Resistance; D007361:Intelligence Tests; D008875:Middle Aged; D009483:Neuropsychological Tests; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D066127:White Matter / Q000473:pathology* / Q000648:ultrastructure; D055815:Young Adult
chemical_list: D000728:Androgens