CHANGES IN VISUAL ATTENTION DURING MENOPAUSAL PERIOD: A CROSS-SECTIONAL STUDY IN PRIMARY HEALTH CARE

Abstract

Given the growing interest in understanding the effects of aging and hormonal changes on cognitive functions, this study focuses on analyzing the level of sustained, undivided visual attention in women undergoing the menopausal transition. Attention, as a fundamental component of executive functions, is sensitive to biological and neurophysiological changes related to aging, as well as to specific hormonal fluctuations characteristic of the perimenopausal and postmenopausal periods. In light of existing evidence on decreased inhibitory capacity and disruption in the balance between top-down and bottom-up attention regulation in older age, this research seeks to further clarify the role of menopause as a potential risk factor for cognitive decline, particularly in the domain of attention.
Research Objectives: The aim of this study was to assess the level of sustained, undivided visual attention in women during the menopausal transition through a cross-sectional analysis conducted in a primary healthcare setting.
Materials and Methods: The study was conducted as a prospective cross-sectional study on a sample of 556 women aged between 40 and ≥65 years, divided into six age groups. Data were collected during routine gynecological examinations as part of primary healthcare in Bosnia and Herzegovina. Visual attention was measured using a standardized Attention Test (CPS, Ljubljana), which allows for the quantification of undivided attention based on the number of correct responses to a specific visual stimulus. Statistical analysis included descriptive indicators and one-way analysis of variance (ANOVA) to examine differences between age groups.
Results and Discussion: The results showed a consistent downward trend in attention levels with increasing age. The highest average scores were recorded in the group of women aged up to 44 years (M = 18.24), while the lowest attention levels were found in women over 65 years of age (M = 8.97). Statistically significant differences between age groups were confirmed using the ANOVA test (F = 14.764; p < 0.001). Notably, the most pronounced decline in attention occurred among women aged 50 to 59, coinciding with the perimenopausal period, which is characterized by intense hormonal fluctuations, particularly a drop in estrogen levels. The findings support existing knowledge about the impact of aging on cognitive functions and further emphasize the importance of the perimenopausal period as a potentially critical phase for the preservation of attention. Given the complex interplay of neurobiological, hormonal, and psychosocial factors during this stage of women’s lives, the results point to the need for developing integrated approaches for the early identification and prevention of cognitive decline. Such an approach would not only include neurocognitive monitoring and possible hormonal assessment but also incorporate education and psychological support within the framework of primary healthcare.
Conclusions: The results confirm a significant downward trend in the level of sustained visual attention with increasing age, with the sharpest decline observed during the perimenopausal age (50–59 years). The study highlights the menopausal transition as a period sensitive to cognitive changes and provides a basis for the development of personalized preventive and therapeutic strategies aimed at preserving attention and broader cognitive health in middle-aged and older women.
Recommendations: To preserve cognitive health in women during the menopausal transition, it is recommended to introduce routine cognitive evaluations within primary healthcare, as well as individualized hormonal and psychological support for women during this stage of life.