Barnes Lisa L, Wilson Robert S, Bienias Julia L, Schneider Julie A, Evans Denis A, Bennett David A
Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA.
Arch Gen Psychiatry. 2005 Jun;62(6):685-91. doi: 10.1001/archpsyc.62.6.685.
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.
To test whether the relation of AD pathology to the clinical manifestations of the disease differs in men and women.
Longitudinal, clinicopathologic cohort study.
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.
Clinical diagnosis of probable AD and level of global cognitive function at the last evaluation before death.
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.
These data suggest that AD pathology is more likely to be clinically expressed as dementia in women than in men.
临床上诊断为阿尔茨海默病（AD）的风险存在性别差异，这已得到广泛研究，但与女性相比，AD的病理指标与男性疾病临床表现之间的关系却知之甚少。
检验AD病理与疾病临床表现之间的关系在男性和女性中是否存在差异。
纵向临床病理队列研究。
对141名年长的天主教神职人员进行分析，这些人员每年接受详细的临床评估，并在死亡时进行脑部尸检。对从4个皮质区域采集的1平方毫米区域内的神经炎斑块、弥漫性斑块和神经原纤维缠结数量进行计数，并得出AD病理的综合指标（范围为0 - 2.98 U）以及每种病理的具体指标。
临床诊断为可能的AD以及死亡前最后一次评估时的整体认知功能水平。
女性的AD综合病理指标高于男性（P = 0.04），主要原因是神经原纤维缠结更多（P = 0.02）。在死亡前最后一次评估时，57人符合可能的AD临床标准（其中34人[60%]为女性）。在逻辑回归模型中，性别与临床AD的几率无关（优势比[OR]，1.35；95%置信区间[CI]，0.56 - 3.25），但AD综合病理指标与临床诊断之间的关系在男性和女性中有所不同。与女性临床AD几率增加超过20倍（OR，22.67；95% CI，5.11 - 100.53）相比，男性中AD病理指标每增加一个单位，临床AD的几率增加近3倍（OR，2.82；95% CI，1.03 - 7.65）。在控制潜在混杂因素或使用认知水平作为结果后，结果不变。
这些数据表明，与男性相比，AD病理在女性中更有可能在临床上表现为痴呆。
