Cognitive Health in Black and Latina Midlife Women: The Role of Sleep and Vasomotor Symptoms

Background: Women experience changes in memory during the menopause transition, with these changes tending to be more severe and persistent in Black and Hispanic women compared to White women. Women also represent two-thirds of individuals with Alzheimer’s disease (AD), and Black and Hispanic women are 1.5 to 2 times more likely to develop AD than their White counterparts. With growing evidence that AD-related pathological changes begin in midlife and no current cure available, identifying modifiable, female-specific risk factors for cognitive dysfunction is critical to promote brain health and reduce health disparities. Objective: The goal of this study was to examine associations between objectively measured sleep disturbance, vasomotor symptoms (VMS), rest-activity rhythms (RAR), and memory performance in Black and Hispanic midlife women, thereby identifying potential midlife risk factors for cognitive decline and AD. Methods: Fifty-five peri- and postmenopausal Black and Hispanic women completed three consecutive days and nights of at-home monitoring using wearable devices to objectively assess sleep, VMS, and RAR. Cognitive function was evaluated using the California Verbal Learning Test–II (CVLT-II) and a pattern separation task sensitive to hippocampal subfield function. Results: Sleep disturbance was not significantly associated with cognitive performance. However, a greater frequency of VMS during sleep—though not across 24 hours—was significantly associated with poorer pattern separation performance. In a subset of participants with sleep EEG data, more frequent sleep-related VMS were also associated with elevated beta power, a marker of cortical hyperarousal during sleep. Conclusions: This is the first study to integrate objective assessments of VMS, sleep, and memory performance in midlife Black and Hispanic women. While general sleep disturbance was not linked to cognitive function, sleep-related VMS emerged as a unique, previously underrecognized contributor to hippocampal-dependent memory impairment, particularly pattern separation. These findings underscore the importance of evaluating menopause symptoms in the context of brain aging and highlight the need for continued research in larger, diverse, and longitudinal cohorts to identify modifiable risk factors and address racial and ethnic disparities in cognitive aging.