Sex differences in Alzheimer's disease and other dementias

• Published in: Lancet neurology 2016-04, Vol.15 (5), p.451-452
• Main Authors: Mazure, Carolyn M, Swendsen, Joel
• Format: Article
• Language: English
• Subjects: Alzheimer Disease - therapy; Alzheimer's disease; Biomedical Research - organization & administration; Brain research; Dementia; Dementia - therapy; Gender differences; Health risk assessment; Humans; Mens health; Mortality; Neurology; Womens health
• ISSN: 1474-4422; 1474-4465
• DOI: 10.1016/S1474-4422(16)00067-3

[...]with regard to genetic findings, the results of a large prospective cohort study published in 2015 confirmed previous case-control reports that women who are positive for the [varepsilon]4 allele of the apolipoprotein E gene (APOE [varepsilon]4) are at greater risk of developing AD than are men with this allele,3 and they demonstrate more severe behavioural disinhibition.4 As pointed out in these investigations, the inconsistency of past findings about this allele could be attributable specifically to investigators overlooking the APOE-[varepsilon]4-by-sex interaction, resulting in missed opportunities to enhance understanding of the genetic underpinnings of AD.3 Testing for the effects of numerous other genes implicated in dementias by sex, rather than pooling data for both sexes, would likewise speed efforts to discern new directions for personalised treatment and management.5 In terms of localised brain changes and brain function, reports suggest that women diagnosed with AD experience a faster progression of hippocampal atrophy than do men,6 whereas men might be more likely to progress to AD in the presence of severe periventricular white matter hyperintensities and reduced global cognitive performance.7 Women and men also have different clinical presentations, in that men show more aggressive behaviours, more comorbidity, and higher mortality than women; women tend to have more affective symptoms and disability but longer survival times.8 These presentations might indicate different neuropathologies and certainly necessitate different management strategies to serve men and women with dementia.