Social isolation, loneliness seems to pack a double punch for perimenopausal cognition

Loneliness and social isolation may be linked to cognitive difficulties in women going through perimenopause, especially if both factors are present, according to a new study published in Menopause.

Perimenopause is the period leading up to menopause when hormone levels, particularly estrogen, fluctuate significantly. These hormonal changes can trigger a wide range of symptoms, including hot flashes, mood changes, sleep disturbances and cognitive complaints. Many women report experiencing problems with memory, focus or mental clarity during this time, often referred to as “brain fog.”

In the study, a team of researchers, including corresponding author Li Ping, Ph.D., from the School of Nursing and Rehabilitation at Shandong University in China, examined data from 903 women between the ages of 45 and 55 years who were in perimenopause. Participants completed questionnaires measuring levels of loneliness, social isolation and self-reported cognitive function. Loneliness refers to the subjective feeling of being emotionally disconnected from others, whereas the objective state of social isolation refers to having limited social interactions or relationships.

The results indicated that both loneliness and social isolation were associated with greater reports of cognitive difficulties. For every one-point increase on the loneliness scale, the odds of subjective cognitive decline (SDC) increased by 12%. For each one-point increase on the social isolation scale, the odds increased by 4%, even after adjusting for age, body mass index, education, socioeconomic status, lifestyle factors, major life events and menopausal symptoms.

The study also examined the combined effect of loneliness and social isolation. Women with mild loneliness and no social isolation had more than twice the odds of SCD (OR, 2.25), and those with mild loneliness plus social isolation had slightly higher odds (OR, 2.82). Among women with moderate to severe loneliness, those without social isolation had increased odds (OR, 1.77), whereas women experiencing both moderate/severe loneliness and social isolation had the highest risk, with more than eight times the odds of reporting cognitive problems (OR, 8.25). These findings indicate that emotional and social factors can compound one another, intensifying cognitive challenges during perimenopause.

“These findings highlight the importance of psychosocial factors in cognitive health during the menopause transition, providing evidence for the early identification of high-risk individuals and offering guidance for the development of multidimensional, comprehensive psychosocial interventions, with important implications for promoting healthy aging in women,” Ping and her team wrote in the study.

The authors suggest several possible explanations for the findings. Hormonal changes during perimenopause may make the brain more sensitive to stress and emotional strain. Loneliness and social isolation can contribute to psychological distress, including depression and anxiety, which are known to affect memory and cognitive performance. In addition, social engagement is thought to play an important role in maintaining cognitive health by stimulating brain activity and supporting emotional well-being.

Another possibility is that social connection helps buffer the stress that often accompanies life transitions during midlife. Perimenopause can coincide with major changes such as caregiving responsibilities, career pressures and shifts in family dynamics. Strong social networks may help women cope with these challenges, whereas a lack of support could make symptoms feel more severe, the authors wrote.