Biological sex may play role in late-life risk for cognitive decline
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Women appear to have greater cognitive reserve but faster cognitive decline vs. men, according to results of a cohort study published in JAMA Network Open.
Researchers noted this may contribute to sex differences in late-life dementia.
“Sex differences in biological factors (eg, sex hormones), health factors (eg, cardiovascular risk) and social factors (eg, education levels) are hypothesized to contribute to sex differences in dementia risk,” Deborah A. Levine, MD, MPH, of the division of general medicine at the University of Michigan, and colleagues wrote. “However, most studies have focused on the effects of cardiovascular risk and education on sex disparities in late-life dementia. Whether cognitive trajectories differ by sex after accounting for sex differences in cardiovascular risk and education levels is unknown.”
The researchers aimed to assess potential links between sex and cognitive decline to elucidate sex differences in dementia risk. They used pooled analysis on data of 26,088 individuals who self-reported Black or white race, were free of stroke and dementia and had covariate data at or before the first cognitive assessment. Participants had all been included in five cohort studies between 1971 and 2017 and had a mean age of 58 years at first cognitive assessment. Levine and colleagues used linear mixed-effects models to estimate changes in each continuous cognitive outcome over time by sex. Change in global cognition served as the primary outcome and change in memory and executive function as the secondary outcomes.
Results showed significantly higher baseline performance for women vs. men in global cognition (2.2 points higher), executive function (2.13 points higher) and memory (1.89 points higher). However, women exhibited significantly faster declines in global cognition (0.07 points per year faster) and executive function (0.06 points per year faster) than men. Men and women exhibited similar declines in memory.
“Loved ones and physicians might recognize women's cognition declining late after substantial loss and impairment has occurred, so they need to closely monitor older women for the earliest symptoms of cognitive decline,” Levine told Healio Psychiatry.