Reviewer’ s report
Title: Changes in six domains of cognitive function with reproductive and chronological ageing
and sex hormones: a longitudinal study in 2411 UK mid-life women
Version: 2Date: 15 Mar 2020
Reviewer: Nancy F. Woods
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs,supporting materials or other aspects of your report which cannot be included in a text format.Overall, the authors have responded to my comments. There are a few considerations that willenhance the readability of the ms
1. I am unfamiliar with the use of the domains described. In current publications, I note that
domains of neurobehavioral function consist of attention/concentration, learning and memory,visual spatial acuity, executive function and centrally-mediated motor function. Could you pleaseprovide clarification about domains of cognitive function as used in this manuscript? What is theorigin of that label? is it based on the instruments used for the cognitive assessments? Thisterminology may simply reflect different points in history –just curious about the origins of
domains.2. Abstract - age since the menopause - do you mean years since the FMP? normal ageing - doyou mean chronological aging?p. 4 "stable biomarkers" do you mean that these vary little across the menstrual cycle? There is a
literature on hormonal levels across different stages of the menopausal transition that would
suggest that these levels are not stable across the menstrual cycle, e.g. varying from follicular toluteal phases. For instance, FSH and LH both exhibit pulsatile patterns which makes them highlyvariable even within a 24 hr periodl When measured over an extended period of time (in years),there is a discernable pattern such as reported by Randolph.p. 5, line 43 likely to go through the menopausal transition - how did you determine that?p. 7, line 5 - when in the cycle ... do you mean what day?and what was the year or version of this assay? - with the development of new asays for AMH,see Randolph (2014) and Robertson (2014) have both studied new ELISA kits with more sensitivemeasures than were available prior to that time.p. 12-13 FSH and LH ...increase around menopause? when? this is described in Randolph's workp. 14-15 you refer to reproductive ageing and hormones as indicators of the menopausal transition... do you mean the perimenopause? and in line 14 you refer to the menopausal transition asinfluencing cognitive function, but I think you mean the FMP based on your findings.p. 15, line 18 "went into the menopause" what does this mean? began the perimenopause?experienced the FMP? confusingline 54 reproductive age is? permanent or transient?how do the number of women who experienced FMP in your study compare to the numbers in
SWAN?
p. 16 - AMH becomes undetectable - did you note this in your analyses?
line 32 predictor of menopause, do you mean the FMP?line 59 reproductive age - do you really mean reproductive aging stages, e.g. sTRAW? –ditto on
p. 17, line 25p. 17Conclusions - line 42 with increasing time since FMP when controlling for age? please clarifyWith the development of more precise terminology about stages of reproductive aging, we areenabled to communicate more clearly about this period of human development. I hope that theserecommended changes will be useful in helping your readers understand more precisely with you
found. Thanks
see Hale on AMH levels across menstrual cycles of late reproductive age women. I wonder if you
are trying to establish that these measures have been used without respect to the day of themenstrual cycle.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
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Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
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