Levine Deborah A, Gross Alden L, Briceño Emily M, Tilton Nicholas, Giordani Bruno J, Sussman Jeremy B, Hayward Rodney A, Burke James F, Hingtgen Stephanie, Elkind Mitchell S V, Manly Jennifer J, Gottesman Rebecca F, Gaskin Darrell J, Sidney Stephen, Sacco Ralph L, Tom Sarah E, Wright Clinton B, Yaffe Kristine, Galecki Andrzej T
Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor.
Department of Neurology and Stroke Program, University of Michigan, Ann Arbor.
JAMA Netw Open. 2021 Feb 1;4(2):e210169. doi: 10.1001/jamanetworkopen.2021.0169.
Sex differences in dementia risk are unclear, but some studies have found greater risk for women.
To determine associations between sex and cognitive decline in order to better understand sex differences in dementia risk.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used pooled analysis of individual participant data from 5 cohort studies for years 1971 to 2017: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Linear mixed-effects models were used to estimate changes in each continuous cognitive outcome over time by sex. Data analysis was completed from March 2019 to October 2020.
Sex.
The primary outcome was change in global cognition. Secondary outcomes were change in memory and executive function. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition.
Among 34 349 participants, 26 088 who self-reported Black or White race, were free of stroke and dementia, and had covariate data at or before the first cognitive assessment were included for analysis. Median (interquartile range) follow-up was 7.9 (5.3-20.5) years. There were 11 775 (44.7%) men (median [interquartile range] age, 58 [51-66] years at first cognitive assessment; 2229 [18.9%] Black) and 14 313 women (median [interquartile range] age, 58 [51-67] years at first cognitive assessment; 3636 [25.4%] Black). Women had significantly higher baseline performance than men in global cognition (2.20 points higher; 95% CI, 2.04 to 2.35 points; P < .001), executive function (2.13 points higher; 95% CI, 1.98 to 2.29 points; P < .001), and memory (1.89 points higher; 95% CI, 1.72 to 2.06 points; P < .001). Compared with men, women had significantly faster declines in global cognition (-0.07 points/y faster; 95% CI, -0.08 to -0.05 points/y; P < .001) and executive function (-0.06 points/y faster; 95% CI, -0.07 to -0.05 points/y; P < .001). Men and women had similar declines in memory (-0.004 points/y faster; 95% CI, -0.023 to 0.014; P = .61).
The results of this cohort study suggest that women may have greater cognitive reserve but faster cognitive decline than men, which could contribute to sex differences in late-life dementia.
痴呆症风险的性别差异尚不清楚，但一些研究发现女性风险更高。
确定性别与认知能力下降之间的关联，以便更好地理解痴呆症风险中的性别差异。
设计、背景和参与者：这项队列研究对1971年至2017年期间5项队列研究的个体参与者数据进行了汇总分析，这些研究包括：社区动脉粥样硬化风险研究、青年成人冠状动脉风险发展研究、心血管健康研究、弗雷明汉后代研究和北曼哈顿研究。采用线性混合效应模型按性别估计每个连续认知结果随时间的变化。数据分析于2019年3月至2020年10月完成。
性别。
主要结局是整体认知的变化。次要结局是记忆和执行功能的变化。结局以t分数（均值[标准差]，50[10]）进行标准化；1分的差异代表认知能力0.1个标准差的差异。
在34349名参与者中，纳入了26088名自我报告为黑人或白人、无中风和痴呆症且在首次认知评估时或之前有协变量数据的参与者进行分析。中位（四分位间距）随访时间为7.9（5.3 - 20.5）年。有11775名（44.7%）男性（首次认知评估时的中位[四分位间距]年龄为58[51 - 66]岁；2229名[18.9%]为黑人）和14313名女性（首次认知评估时的中位[四分位间距]年龄为58[51 - 67]岁；3636名[25.4%]为黑人）。女性在整体认知（高2.20分；95%置信区间，2.04至2.35分；P <.001）、执行功能（高2.13分；95%置信区间，1.98至2.29分；P <.001）和记忆（高1.89分；95%置信区间，1.72至2.06分；P <.001）方面的基线表现显著高于男性。与男性相比，女性在整体认知（每年快下降0.07分；95%置信区间，-0.08至-0.05分/年；P <.001）和执行功能（每年快下降0.06分；95%置信区间，-0.07至-0.05分/年；P <.001）方面的下降速度明显更快。男性和女性在记忆方面的下降速度相似（每年快下降0.004分；95%置信区间，-0.023至0.014；P = 0.61）。
这项队列研究的结果表明，女性可能比男性具有更大的认知储备，但认知能力下降更快，这可能导致晚年痴呆症的性别差异。
