Potential links between PCOS/PMOS and Alzheimer disease and related dementias

BACKGROUND: Polycystic ovary syndrome/polyendocrine metabolic ovarian syndrome (PCOS/PMOS) is a common endocrine disorder with significant metabolic and reproductive implications. Increasing attention has focused on its potential long-term neurological consequences, including possible links to cognitive impairment and Alzheimer disease (AD), through overlapping biological pathways. METHODS: We conducted a comprehensive PubMed search, from inception through October 2025, identifying studies on cognitive performance, brain structure and function, neurodegenerative biomarkers, and dementia risk in PCOS/PMOS patients. RESULTS: Evidence supports multiple potential mechanistic pathways that could connect PCOS/PMOS to AD-relevant biology, such as insulin resistance (IR), chronic inflammation, hormonal dysregulation, and cardiovascular dysfunction. These pathways converge on neurodegeneration processes such as impaired Aβ clearance, tau hyperphosphorylation, oxidative stress, and cerebral metabolic deficits. Clinically, PCOS/PMOS patients exhibit mild but reproducible impairments in executive function and memory, alongside structural and functional brain alterations, including hippocampal and white matter changes, and altered network connectivity. However, these findings are influenced by coexisting metabolic dysfunction, and direct epidemiological evidence linking PCOS/PMOS to increased dementia incidence remains limited and inconsistent. CONCLUSION: Current evidence indicates that any association between PCOS/PMOS and AD risk is likely mediated by metabolic comorbidities, particularly IR and obesity, rather than an independent effect of PCOS/PMOS itself. However, clinical evidence for increased PCOS/PMOS risk for cognitive vulnerability and dementia remain inconsistent and cognitive benefits from PCOS/PMOS-specific interventions are lacking. Clinical focus should therefore remain on optimizing metabolic health, while longitudinal and interventional studies are required to clarify long-term neurological relationships and outcomes.