Figure. Earlier surgical menopause is associated with worse slope of cognitive decline.

Estimated slope of decline in global cognition according to age at surgical menopause, categorized by quantile, for a woman with the median age at enrollment (78 years) and educational level (16 years) of the Religious Orders Study and Memory and Aging Project cohorts. The x-axis is study time, and the y-axis is the change in global cognitive performance from the baseline at study entry. An earlier age at surgical menopause is associated with both a steeper slope of decline during the study and a lower intercept, which suggests that a substantial amount of decline has occurred prior to study enrollment. The slope of cognitive decline for women undergoing natural menopause at any age is included as a reference.