Age effects on cognitive functioning are well-documented, but effects of sex on trajectories of cognitive aging are less clear. We examined cognitive ability across a variety of measures for 1065–2127 participants (mean baseline age 64.1–69.7 years) from the Baltimore Longitudinal Study of Aging who were repeatedly tested over a mean follow-up interval of 3.0–9.0 years with a mean of 2.3–4.4 assessments. Memory and other cognitive tests were administered at each visit, assessing mental status, verbal learning and memory, figural memory, language, attention, perceptuomotor speed and integration, executive function, and visuospatial ability. Importantly, participants free from cognitive impairment at all time points were used in the analyses. Results showed that for all tests, higher age at baseline was significantly associated with lower scores and performance declined over time. In addition, advancing age was associated with accelerated longitudinal declines in performance (trend for mental status). After adjusting for age, education and race, sex differences were observed across most tests of specific cognitive abilities examined. At baseline, males outperformed females on the two tasks of visuospatial ability, and females outperformed males in most other tests of cognition. Sex differences in cognitive change over time indicated steeper rates of decline for men on measures of mental status, perceptuomotor speed and integration, and visuospatial ability, but no measures on which women showed significantly steeper declines. Our results highlight greater resilience to age-related cognitive decline in older women compared with men.

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We examined longitudinal associations between ApoE4 + status and several cognitive outcomes and tested effect modification by sex. Data on 644 Non-Hispanic White adults, from the Baltimore Longitudinal Study of Aging (BLSA) were used. Dementia onset, cognitive impairment and decline were assessed longitudinally. After 27.5 years median follow-up, 113 participants developed dementia. ApoE4 + predicted dementia significantly (HR=2.89; 95% CI: 1.93-4.33), with non-significant sex differences. Taking all time points for predicting cognition, women had significantly stronger positive associations than men between ApoE4 + status and impairment or decline on the California Verbal Learning Test (CVLT-delayed recall and List A total recall) and on Verbal Fluency Test-Categories. This ApoE4×sex interaction remained significant with bonferroni correction only for CVLT-delayed recall. Taking time points prior to dementia for cognitive predictions, the positive association between impairment in CVLT-delayed recall and ApoE4 + status remained stronger among women, though only before bonferroni correction. While ApoE4+ status appears to be a sex neutral risk factor for dementia, its association with verbal memory and learning decline and impairment was stronger among women.

Background-Statin use and serum cholesterol reduction have been proposed as preventions for dementia and mild cognitive impairment (MCI).