Sex Differences in the Clinical Manifestations of Alzheimer Disease Pathology

Abstract

Alzheimer disease (AD) is the leading cause of dementia in older people. Despite years of research, the question of whether men and women differ in risk of disease remains controversial. Prospective studies of disease risk have had mixed results. Of 8 population-based studies with at least 2 years of observation,^1-8 5 reported a greater risk of AD in women^1,2,5-7 and the other 3 found no difference.^3,4,8 There are several potential explanations for the discrepant results. Because more women live to ages at which the disease is common, some studies may not have had sufficient numbers of cases of disease in older men to adequately adjust for the confounding effect of age. Men and women also differ with respect to education, occupation, and related lifestyle variables that are also associated with risk of AD. These variables may not be completely accounted for by statistical analyses. Other issues include methodological differences between incidence studies, including observation time, number of evaluations, attrition rate, and diagnostic accuracy.