Sex and gender differences in the causes of dementia: A narrative review

Abstract

This is a narrative review of new ideas and concepts related to differences between men and women in their risk of developing dementia or Alzheimer's disease (AD). We introduce the concept of dimorphic neurology and the distinction between sex and gender. We then provide three examples of risk factors related to sex and gender from the literature. Apolipoprotein E genotype is equally common in men and women but has a stronger effect in women. Apolipoprotein E genotype is a biological factor that cannot be modified but interacts with sex or gender related factors that can be modified. Low education has a similar harmful effect in men and women but has been historically more common in women. Education is a social factor related to gender that can be modified. Finally, bilateral oophorectomy is a factor restricted to women. Bilateral oophorectomy is a surgical practice related to sex that can be modified. Consideration of risk and protective factors in men and women separately may accelerate etiologic research for neurological diseases in general, and for dementia and AD in particular. Similarly, future preventive interventions for dementia should be tailored to men and women separately.

Prevalence of Multimorbidity in a Geographically Defined American Population

“…In addition, they may result from gender related differences in personality or behavior (subjective component of gender) or from differences due to social, cultural, and legal factors (societal component of gender). 24,25 The effects of sex and gender on multimorbidity are an important area for future research.…”

Investigating the Prevalence of Dementia and Its Associated Risk Factors in a Chinese Nursing Home

“…However, other authors have reported different findings; for example, one study estimated that almost two-thirds of individuals diagnosed with Alzheimer disease are women 14. These conflicting findings may result from the inclusion of small samples at the upper range of the age distribution, the use of different diagnostic criteria, and differences due to specific social, culture, and historical factors 1516…”

Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

“…Significant differences were evident between OA, depression, GID, and hematologic diseases, which were more prevalent among women, and genitourinary diseases and excessive use of alcohol, which were more prevalent among men. Women, due to menopause and the consequent decline in estrogen levels, have an increased risk of cognitive impairment and the prevalence of other diseases [31]. Of note, a highly significant correlation (25%) was evident between CDR ≥1 and GID+.…”