{"id":53504,"date":"2023-12-31T11:30:12","date_gmt":"2023-12-31T11:30:12","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=53504"},"modified":"2024-01-05T06:16:21","modified_gmt":"2024-01-05T06:16:21","slug":"cognition-and-psychomotor-performance-in-premenstrual-syndrome-with-negative-emotions","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no4\/cognition-and-psychomotor-performance-in-premenstrual-syndrome-with-negative-emotions\/","title":{"rendered":"Cognition and Psychomotor Performance in Premenstrual Syndrome with Negative Emotions"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

Premenstrual syndrome (PMS) is a collection of ill-defined symptoms and indicators that appear before menstruation and then disappear once menstruation begins. The most important reason quoted   behind PMS in several studies is the physiological disturbances in the hormonal homeostasis occurring in the secretory phase of the menstrual cycle.  The   most common presentation of PMS 1<\/sup> include irritability, mood swings, anxiety, depression, social isolation stress, fatigue 2<\/sup>  weight gain, sore breasts, low back ache, skin eruptions, palpitation, headache, nausea, vomiting, abdominal pain 3<\/sup> . Most of the emotional symptoms were predominantly negative like depression, anxiety, stress, irritability, anger etc. The prevalence of PMS manifestation has been reported to be over 60% 4<\/sup> and 23-67 percent 5 <\/sup>in other research. These unpleasant emotional states not only damage one’s quality of life, but they are also the leading cause of school absenteeism among adolescents and teenagers 6<\/sup>. Further menstruation indicators are more common in Asian countries than in Western countries, according to a World Health Organization (WHO) report 7<\/sup> .  Also, studies have proved that negative emotions affect the cognition and psychomotor performance   thereby impairing their executive function.<\/p>\n\n\n\n

Studies have revealed that hormone fluctuation that occurs throughout the menstrual cycle causes women to experience negative emotions, which in turn impacts their cognition and psychomotor performance 8<\/sup> altering their executive function, a fact that has not been fully researched. Further the results from various studies shows inconsistent reporting, either no difference 9<\/sup> or only subtle differences 10, 11<\/sup>. So, in this study, we looked into the co relation between the negative emotions (anxiety, depression, stress) and cognition in different grades of women with PMS.  Reaction time test being a simple non-invasive tool that assess cognition as well as   psychomotor performance 12<\/sup>, was used in this study.<\/p>\n\n\n\n

Materials and Methods<\/strong><\/p>\n\n\n\n

The study was conducted on 100 female nursing students in the age group 18 -20 years. Questionnaire tool was used to collect data on demographic and menstruation characteristics, Menstrual Distress and Depression, Anxiety, and Stress (DASS). The menstrual misery was assessed using the Rudolf Moos questionnaire 13<\/sup>  . This questionnaire contains 16 questions in four dimensions [pain, control, autonomic reactions, and (water) weight gain and records menstrual signs a week before menstruation, during bleeding, and a week after menstruation in the previous year on a four-point Likert scale (no sign = 0, very severe = 4). Minor menstruation indications receive a score of 16, moderate menstruation signals receive a score of 32, and acute menstruation signs receive a score of 33. Scores of 49 or higher are considered severe menstrual symptoms 14<\/sup> .<\/p>\n\n\n\n

The DASS questionnaire was used to examine negative emotions such as\ndepression, anxiety, and tension. This survey has 21 questions that assess depression,\nanxiety and stress with seven questions for each. The questions are graded on a\nfour-point Likert scale ranging from “never” (zero) to “very\nmuch\u201d (three). Questions 17, 16, 13, 10, 5, and 3 dealt with depression;\nquestions 20, 19, 15, 9, 7, 4, and 2 dealt with anxiety; while questions 18,\n14, 12, 11, 8, 6, and 1 dealt with stress. A score of 5-6 indicated light\ndepression, 7-10 moderate depression, 11-13 acute depression, and over 14\nindicated severe depression.<\/p>\n\n\n\n

Minor anxiety received a score of 4-5, moderate   6-7, acute anxiety 8-9, and severe anxiety received a score of over 10. Minor stress was scored 8-9, moderate 10-12, acute 13-16, and extremely acute stress was scored beyond 17. Menstruation distress questionnaires and depression, anxiety, and stress scales are robust and trustworthy tools that have been utilised in Kordi (2011) and Mollahadi (2011) investigations (2010) 15<\/sup>. Cognition and psychomotor performance were assessed based on reaction time (both visual & auditory) using PC1000Hz Reaction timer. The study excluded students who had a history of hearing or vision loss, cardiovascular or respiratory problems, or were taking medication that affected their cognitive ability. The study received ethical approval from the Institutional Ethical Committee. Every subject gave their informed written consent before participating in the study. The PC1000Hz Reaction timer was used to measure auditory and visual reaction times.<\/p>\n\n\n\n

1)Visual reaction time\nmeasurement: The Examiner hits the ‘start’ button in component (A) while the\nsubject is told to press the ‘Stop’ button in component (B) with the right\nindex finger first as soon as she sees the red light in the instrument. The\ndata are analysed when the reaction time is recorded in audacity programme.<\/p>\n\n\n\n

2) Auditory reaction time measurement: The Examiner clicks the\nstart button (A), which is hidden from the subject’s view, while the subject is\ndirected to press the stop button (B) as soon as she hears the sound (1000 hertz\ntone) through the headphone. The data are analysed when the reaction time is\nrecorded using audacity programme.<\/p>\n\n\n\n

All subjects must be right-handed and hit the switch to halt the\nequipment’ quartz clock using their right index finger. When each subject saw\nthe light or heard the music, they were asked to press the switch. Both VRT and\nART measurements require at least five trials. The final VRT and ART are\ndetermined from the minimum time recorded. The readings were taken in a quiet,\nsecluded room between 10 a.m. and 12 p.m.<\/p>\n\n\n\n

Statistical Analysis<\/strong><\/p>\n\n\n\n

In the current study, descriptive statistical analysis was used. Continuous measurement results are reported as Mean SD. The significance is determined at a 5% level of significance. Pearson correlation test was done between the severity of PMS and negative emotions like depression, anxiety and stress scores (DASS) and reaction time (RT) scores 16<\/sup>. Also, a correlation test was done between DASS and RT. Significance is assessed at 5% level of significance.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Among the 100 female students,\n50 each belonged to mild and moderate PMS category. Independent t test revealed\na significant difference in the DASS scores and reaction time scores (both\nvisual & auditory) in mild and moderate PMS category, i.e. the scores were\nhigher in moderate category when compared to mild (table 1). The intensity of PMS and depression, anxiety and stress scores\n(DASS), and response time (RT) scores all showed a positive correlation with p\nsignificant at 0.01 in a Pearson correlation test (Fig 1). Figure 1 explains\nthat as the intensity of premenstrual syndrome increases, the severity of\ndepression, anxiety and stress also increases. Further   as the\nseverity of premenstrual syndrome increases, the auditory and visual reaction\ntime score also increases indicating decreased reaction time thereby decreased cognition.  In addition, there was a strong positive\ncorrelation between DASS scores and RT duration that is as severity of\ndepression, anxiety and stress increased, there was an increase in reaction\ntime duration (table 2 & 3).  This\nsuggests that, as there is an increase in the severity of PMS, there was an\nincrease in the negative emotional states score which could have been the cause\nfor increase in the RT duration (both visual and auditory) thereby proving   a cognitive decline as the reaction time was\nused as a tool to assess cognition.<\/p>\n\n\n\n

Table 1: DASS and RT scores in mild & moderate PMS<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n<\/td>\n\n

Moos<\/strong><\/p>\n<\/td>\n

\n

N<\/strong><\/p>\n<\/td>\n

\n

Mean<\/strong><\/p>\n<\/td>\n

\n

SD<\/strong><\/p>\n<\/td>\n

\n

correlation<\/strong><\/p>\n<\/td>\n

\n

p value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Depression<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

4.36<\/p>\n<\/td>\n

\n

4.08<\/p>\n<\/td>\n

\n

0.632<\/p>\n<\/td>\n

\n

0.001***<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

13.56<\/p>\n<\/td>\n

\n

6.94<\/p>\n<\/td>\n<\/tr>\n

\n

Anxiety<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

5.68<\/p>\n<\/td>\n

\n

4.07<\/p>\n<\/td>\n

\n

0.571<\/p>\n<\/td>\n

\n

0.001***<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

13.76<\/p>\n<\/td>\n

\n

7.24<\/p>\n<\/td>\n<\/tr>\n

\n

Stress<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

6.66<\/p>\n<\/td>\n

\n

4.36<\/p>\n<\/td>\n

\n

0.577<\/p>\n<\/td>\n

\n

0.001***<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

14.86<\/p>\n<\/td>\n

\n

7.05<\/p>\n<\/td>\n<\/tr>\n

\n

VRT<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

163.14<\/p>\n<\/td>\n

\n

17.41<\/p>\n<\/td>\n

\n

0.633<\/p>\n<\/td>\n

\n

0.001***<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

203.60<\/p>\n<\/td>\n

\n

30.74<\/p>\n<\/td>\n<\/tr>\n

\n

ART<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

165.72<\/p>\n<\/td>\n

\n

16.15<\/p>\n<\/td>\n

\n

0.474<\/p>\n<\/td>\n

\n

0.001***<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

191.46<\/p>\n<\/td>\n

\n

30.11<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*** – p \u2264 0.001 highly significant<\/p>\n\n\n\n
\"\"<\/td>\n\n

Figure 1: Correlation of DASS and RT with PMS.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 2: Correlation of DASS with VRT scores<\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n<\/td>\n\n

VRT<\/p>\n<\/td>\n

\n

Correlation<\/p>\n<\/td>\n

\n

p value<\/p>\n<\/td>\n<\/tr>\n

\n

Depression<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.348<\/p>\n<\/td>\n

\n

0.01**<\/p>\n<\/td>\n<\/tr>\n

\n

Anxiety<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.369<\/p>\n<\/td>\n

\n

0.01**<\/p>\n<\/td>\n<\/tr>\n

\n

Stress<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.319<\/p>\n<\/td>\n

\n

0.01**<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 3: Correlation of DASS with ART scores<\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n<\/td>\n\n

ART<\/strong><\/p>\n<\/td>\n

\n

Correlation<\/strong><\/p>\n<\/td>\n

\n

p value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Depression<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.243<\/p>\n<\/td>\n

\n

0.05*<\/p>\n<\/td>\n<\/tr>\n

\n

Anxiety<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.188<\/p>\n<\/td>\n

\n

NS<\/p>\n<\/td>\n<\/tr>\n

\n

Stress<\/p>\n<\/td>\n

\n

100<\/p>\n<\/td>\n

\n

0.265<\/p>\n<\/td>\n

\n

0.01**<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Premenstrual syndrome is defined by a wide range of symptoms, mostly mood-related, but also embracing a wide range of other systems that occur in tandem within the two weeks preceding menstruation. It is inherited and lasts into adulthood 17<\/sup>. It is identified in 30\u201340% of females, with less than 10% of those who are severely affected 18<\/sup>. Further statistics reveal that girls are affected more than boys after puberty with anxiety and depression owing to premenstrual syndrome 19<\/sup> . Thus, there is growing association of PMS with negative emotional states like depression, stress, anxiety 20<\/sup>. Accordingly, women were consistently more restless, irritable, fatigued, fearful, depressed and hypersensitive to various stimuli during the premenstrual period than during other phases of the menstrual cycle 21<\/sup>. During the luteal phase of menstrual cycle, women suffering from PMS reported significantly higher scores in depression, anxiety, and stress when compared to women without PMS 22,<\/sup> the results of which are comparable to our study as well. Also self-reported studies have evaluated   predominantly negative emotions during premenstrual phase 23, 24<\/sup> and it was found to be recurrent and noticeable in 95% cases 25<\/sup> which is in par with our study too. Mid-cycle phase of menstrual cycle brings the highest levels of happiness and self-esteem, while premenstrual brings the most negative emotions (depression, anxiety, and stress) when oestrogen and progesterone levels fall. Hormone fluctuations promote unpleasant feelings in women and can alter mood management and stress sensitivity 26<\/sup> which we did not evaluate in our study. Women, in particular, have greater stress responses before menstruation or during the luteal phase, which may raise the likelihood of unpleasant emotions or moods 27<\/sup>. Also, many research studies have confirmed increased risk of suicidal attempts during the premenstrual phase 28, 29<\/sup>. The authors of the above studies have reported that the cause could be due to low circulating levels of estrogenic and serotonergic mechanism 30<\/sup>. The autonomic nervous system may also play a role in mood cycling in women that is linked to hormonal changes, particularly during the premenstrual period 18 <\/sup>. Thus, an increased sympathetic nervous system activity may be responsible for negative emotions in women with premenstrual syndrome 31<\/sup> . Women with PMS are most sensitive to changes in sex hormone levels 32<\/sup>. Variations in hormone levels during the menstrual cycle cause women to experience more negative feelings 8, 9, 33<\/sup>. Women, in particular, have greater stress responses before menstruation.<\/p>\n\n\n\n

Estrogen receptors are found throughout the brain and have been shown to alter neurocognition 34<\/sup>. It directs and modulates neurotransmitter production and action, regulating electrical excitability and synaptic function, and changing the morphological properties of neuronal components involved in function 35<\/sup>. It has been shown to impact a variety of neurotransmitter systems, including dopaminergic, catecholaminergic, serotonergic, cholinergic, and gamma-aminobutyric acidergic 22, 36<\/sup>. Thus, decrease in estrogen levels during luteal phase in PMS alters neurocognition. Also, studies on postmenopausal women have shown that there is mood and behavioural disturbances with cognitive decline due to sudden estrogen withdrawal 37<\/sup>. However, experiments in postmenopausal women with estrogen replacement has shown to increase verbal IQ scores after one year of treatment. Further, studies have shown that estrogen administration after surgical menopause improved memory, abstract reasoning, and reaction times, while those patients who were given placebo had significant deterioration of cognitive function 34<\/sup>.  Studies have shown that   female performance on cognitive tasks  vary significantly over time, scoring being less  during mid-luteal phase of  the menstrual cycle 38<\/sup> Attention, concentration, semantic processing in word-matching tests , visual and verbal memory, speed and fine motor skills are decreased in premenstrual phase 39,40<\/sup> . However in our study we have not evaluate the hormonal correlation, which is the future scope of our study.  Further negative affective states such as depression, anxiety, stress appears to lead to poor decision making, executive function thereby affecting cognition and psychomotor skills.  Thus, women with PMS are known to suffer from negative emotions thereby leading to cognitive decline and psychomotor skill.<\/p>\n\n\n\n

Limitation of the study<\/strong><\/p>\n\n\n\n

Since hormonal fluctuation is found to be\none of the main reason for negative emotions during PMS, their evaluation and\ncorrelation would be of much useful information and strength to this study\nwhich will be undertaken as a study in future. Also increased sympathetic\nactivity during PMS leading to negative emotions thereby causing a decline in\ncognition will also assessed in future using tools like heart rate variability\nand autonomic function testing.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

The present study concluded that\nthe negative emotions were very much prevalent in the premenstrual syndrome. As\nthe severity of PMS increased there was a significant increase in the negative\nemotional scoring. However, we had evaluated only two groups mild and moderate\ncategory as we didn\u2019t get severe grade category, which is one of the\nlimitations of the study. Another limitation of the study is that the cause of\nthe PMS which is predominantly known to be hormonal fluctuation was not\nevaluated which otherwise would have increased the power of the study.  Further the visual and auditory reaction time\nincreased as the severity of PMS increased thereby proving a poor cognition and\npsychomotor performance. Thus, negative emotions predominantly depression,\nanxiety and stress which is prevalent in the PMS affects the cognition and\npsychomotor skill.  This suggest that\nwoman suffering from premenstrual syndrome should take appropriate steps to\nimprove their lifestyle through diet, exercise, yoga and in severe cases\nmedical assistance, so as maintain their executive function.<\/p>\n\n\n\n

Acknowledgement<\/strong><\/p>\n\n\n\n

I am thankful to the first-year nursing students of SRM University, Potheri for their voluntary participation in the study. I am thankful to my colleague residents for helping me in my work.<\/p>\n\n\n\n

Conflict of Interest <\/strong><\/p>\n\n\n\n

The authors report no conflicts of interest in this\nwork.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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  40. Ussher JM, Wilding JM (1991) Performance and state changes during the menstrual cycle, conceptualised within a broad band testing framework. Soc Sci Med 32:525\u2013534.
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    Abbreviations<\/strong><\/p>\n\n\n\n

    PMS – Premenstrual syndrome<\/p>\n\n\n\n

    MDQ- Menstrual Distress Questionnaire<\/p>\n\n\n\n

    DASS – Depression, Anxiety, and Stress Scale Questionnaire<\/p>\n\n\n\n

    RT \u2013 Reaction time<\/p>\n\n\n\n

    WHO – World\nHealth Organization<\/p>\n\n\n\n

    VRT- Visual reaction time<\/p>\n\n\n\n

    ART \u2013 Auditory reaction time<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

    Introduction Premenstrual syndrome (PMS) is a collection of ill-defined symptoms […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-53504","post","type-post","status-publish","format-standard","hentry","category-vol16no4"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/53504","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=53504"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/53504\/revisions"}],"predecessor-version":[{"id":55067,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/53504\/revisions\/55067"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=53504"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=53504"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=53504"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}