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Sex differences in the clinical manifestations of Alzheimer disease pathology.

Abstract

CONTEXT

Sex differences in risk of clinically diagnosed Alzheimer disease (AD) have been studied extensively, but little is known about the relation of the pathologic indices of AD to the clinical manifestations of the disease in men compared with women.

OBJECTIVE

To test whether the relation of AD pathology to the clinical manifestations of the disease differs in men and women.

DESIGN

Longitudinal, clinicopathologic cohort study.

PARTICIPANTS AND SETTING

Analyses were conducted on 141 older Catholic clergy members who underwent detailed annual clinical evaluations and brain autopsy at death. The number of neuritic plaques, diffuse plaques, and neurofibrillary tangles in a 1-mm2 area sampled from 4 cortical regions was counted, and a global measure of AD pathology (range, 0-2.98 U) and specific measures of each pathology were derived.

MAIN OUTCOME MEASURES

Clinical diagnosis of probable AD and level of global cognitive function at the last evaluation before death.

RESULTS

Women had more global AD pathology than did men (P = .04), due primarily to more neurofibrillary tangles (P = .02). At the last evaluation before death, 57 persons met clinical criteria for probable AD (34 [60%] of them women). In logistic regression models, sex was not related to odds of clinical AD (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.56-3.25), but the relation of global AD pathology to clinical diagnosis differed for men and women. Each additional unit of AD pathology was associated with a nearly 3-fold increase in the odds of clinical AD in men (OR, 2.82; 95% CI, 1.03-7.65) compared with a more than 20-fold increase in the odds of clinical AD in women (OR, 22.67; 95% CI, 5.11-100.53). Results were unchanged after controlling for potential confounders or using level of cognition as the outcome.

CONCLUSION

These data suggest that AD pathology is more likely to be clinically expressed as dementia in women than in men.

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  • Authors+Show Affiliations

    ,

    Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA. Lisa_L_Barnes@rush.edu

    , , , ,

    Source

    Archives of general psychiatry 62:6 2005 Jun pg 685-91

    MeSH

    Aged
    Aged, 80 and over
    Alzheimer Disease
    Apolipoproteins E
    Brain
    Cognition Disorders
    Cohort Studies
    Confidence Intervals
    Female
    Genotype
    Humans
    Lewy Body Disease
    Longitudinal Studies
    Male
    Neurofibrillary Tangles
    Neuropsychological Tests
    Odds Ratio
    Plaque, Amyloid
    Risk Factors
    Sex Factors

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15939846

    Citation

    Barnes, Lisa L., et al. "Sex Differences in the Clinical Manifestations of Alzheimer Disease Pathology." Archives of General Psychiatry, vol. 62, no. 6, 2005, pp. 685-91.
    Barnes LL, Wilson RS, Bienias JL, et al. Sex differences in the clinical manifestations of Alzheimer disease pathology. Arch Gen Psychiatry. 2005;62(6):685-91.
    Barnes, L. L., Wilson, R. S., Bienias, J. L., Schneider, J. A., Evans, D. A., & Bennett, D. A. (2005). Sex differences in the clinical manifestations of Alzheimer disease pathology. Archives of General Psychiatry, 62(6), pp. 685-91.
    Barnes LL, et al. Sex Differences in the Clinical Manifestations of Alzheimer Disease Pathology. Arch Gen Psychiatry. 2005;62(6):685-91. PubMed PMID: 15939846.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Sex differences in the clinical manifestations of Alzheimer disease pathology. AU - Barnes,Lisa L, AU - Wilson,Robert S, AU - Bienias,Julia L, AU - Schneider,Julie A, AU - Evans,Denis A, AU - Bennett,David A, PY - 2005/6/9/pubmed PY - 2005/6/16/medline PY - 2005/6/9/entrez SP - 685 EP - 91 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 62 IS - 6 N2 - CONTEXT: Sex differences in risk of clinically diagnosed Alzheimer disease (AD) have been studied extensively, but little is known about the relation of the pathologic indices of AD to the clinical manifestations of the disease in men compared with women. OBJECTIVE: To test whether the relation of AD pathology to the clinical manifestations of the disease differs in men and women. DESIGN: Longitudinal, clinicopathologic cohort study. PARTICIPANTS AND SETTING: Analyses were conducted on 141 older Catholic clergy members who underwent detailed annual clinical evaluations and brain autopsy at death. The number of neuritic plaques, diffuse plaques, and neurofibrillary tangles in a 1-mm2 area sampled from 4 cortical regions was counted, and a global measure of AD pathology (range, 0-2.98 U) and specific measures of each pathology were derived. MAIN OUTCOME MEASURES: Clinical diagnosis of probable AD and level of global cognitive function at the last evaluation before death. RESULTS: Women had more global AD pathology than did men (P = .04), due primarily to more neurofibrillary tangles (P = .02). At the last evaluation before death, 57 persons met clinical criteria for probable AD (34 [60%] of them women). In logistic regression models, sex was not related to odds of clinical AD (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.56-3.25), but the relation of global AD pathology to clinical diagnosis differed for men and women. Each additional unit of AD pathology was associated with a nearly 3-fold increase in the odds of clinical AD in men (OR, 2.82; 95% CI, 1.03-7.65) compared with a more than 20-fold increase in the odds of clinical AD in women (OR, 22.67; 95% CI, 5.11-100.53). Results were unchanged after controlling for potential confounders or using level of cognition as the outcome. CONCLUSION: These data suggest that AD pathology is more likely to be clinically expressed as dementia in women than in men. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/15939846/Sex_differences_in_the_clinical_manifestations_of_Alzheimer_disease_pathology_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=15939846.ui DB - PRIME DP - Unbound Medicine ER -