Associations between declining testosterone concentrations and cognitive performance in community-dwelling older Australian women: a prospective cohort study

Testosterone may have a role in brain health. Whether older women who exhibit a decline in blood testosterone are at an increased risk of cognitive decline is uncertain. A subset of Australian female participants in the Aspirin in Reducing Events in the Elderly (ASPREE) trial had testosterone concentrations measured by liquid chromatography–tandem mass spectrometry and underwent a comprehensive cognitive test battery at baseline and study year 3. Cognitive decline was defined as a lower test score at year 3 compared with baseline. The mean change (baseline to year 3) of testosterone concentration was examined by paired-sample <i>t</i>-test. Stable or increased (reference) versus a decline in testosterone concentration was used to investigate the association with cognitive decline using logistic regression. A total of 395 women (median [interquartile range] age 78.1 [73.7–82.3] years) provided data for analysis. In total, 154 women (39%) had a decline in blood testosterone which was not associated with a decline in any cognitive measure (Modified Mini-Mental State Examination: odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.63 to 1.49, <i>p</i> = 0.86; Hopkins Verbal Learning Test – Revised: Immediate Recall, OR = 0.71, 95% CI 0.44 to 1.13, <i>p</i> = 0.151 and Delayed Recall, OR = 1.42, 95% CI 0.89 to 2.26, <i>p</i> = 0.14; Controlled Oral Word Association Test: OR = 0.79, 95% CI 0.49 to 1.25, <i>p</i> = 0.31; and Symbol Digit Modalities Test: OR = 0.83, 95% CI 0.53 to 1.29, <i>p</i> = 0.40). Limiting the analysis to 237 women aged 70–79 years (74.5 [interquartile range 72.2–77.1] years), no association was observed between a decline in blood testosterone and any cognitive outcome. : A decline in blood testosterone concentrations over 3 years was not associated with a decline in cognitive function in community-dwelling Australian women aged 70 years and older. This study examined whether a decline in testosterone levels is linked to poorer cognition in older women. The study used data from 395 Australian women aged 70 years and over who took part in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. The study measured testosterone levels in the blood and tested memory at the start of the study and again after 3 years. About 39% of the women had lower testosterone levels over time, but this was not linked to any decline in their cognitive performance. The same results were seen even when the analysis was limited to women aged 70–79 years. Overall, the findings suggest that a decrease in testosterone over 3 years does not lead to memory or cognitive performance in older women living in the community. Trial Registration:International Standard Randomized Controlled Trial Number Register (ISRCTN83772183) and ClinicalTrials.gov (NCT01038583).ClinicalTrials.gov identifier: NCT01038583.