Berezuk Courtney, Khan Maleeha, Callahan Brandy L, Ramirez Joel, Black Sandra E, Zakzanis Konstantine K
Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
J Int Neuropsychol Soc. 2023 May;29(4):360-368. doi: 10.1017/S1355617722000297. Epub 2022 Aug 15.
To evaluate whether cerebrospinal fluid biomarkers, apolipoprotein e4, neuroimaging abnormalities, and neuropsychological data differentially predict progression from mild cognitive impairment (MCI) to dementia for men and women.
Participants who were diagnosed with MCI at baseline ( = 449) were classified as either progressing to Alzheimer's dementia at follow-up or as not progressing. Men and women were first compared using bivariate analyses. Sex-stratified Cox proportional hazard regressions were performed examining the relationship between baseline data and the likelihood of progressing to dementia. Sex interactions were subsequently examined.
Cox proportional hazard regression controlling for age and education indicated that all variables significantly predicted subsequent progression to dementia for men and women. Sex interactions indicated that only Rey Auditory Verbal Learning Test (RAVLT) delayed recall and Functional Activities Questionnaire (FAQ) were significantly stronger risk factors for women. When all variables were entered into a fully adjusted model, significant risk factors for women were Aβ42, hippocampal volume, RAVLT delayed recall, Boston Naming Test, and FAQ. In contrast, for men, Aβ42, p-tau181, p-tau181/Aβ42, hippocampal volume, category fluency and FAQ were significant risk factors. Interactions with sex were only significant for p-tau181/Aβ42 and RAVLT delayed recall for the fully adjusted model.
Men and women with MCI may to differ for which factors predict subsequent dementia although future analyses with greater power are needed to evaluate sex differences. We hypothesize that brain and cognitive reserve theories may partially explain these findings.
评估脑脊液生物标志物、载脂蛋白e4、神经影像学异常以及神经心理学数据是否能对男性和女性从轻度认知障碍（MCI）进展为痴呆症进行差异性预测。
基线时被诊断为MCI的参与者（n = 449）在随访时被分类为进展为阿尔茨海默病痴呆症或未进展。首先使用双变量分析对男性和女性进行比较。进行性别分层的Cox比例风险回归分析，以检验基线数据与进展为痴呆症可能性之间的关系。随后检验性别交互作用。
控制年龄和教育程度的Cox比例风险回归分析表明，所有变量均能显著预测男性和女性随后进展为痴呆症的情况。性别交互作用表明，只有雷伊听觉词语学习测验（RAVLT）延迟回忆和功能活动问卷（FAQ）对女性而言是显著更强的风险因素。当将所有变量纳入完全调整模型时，女性的显著风险因素为Aβ42、海马体积、RAVLT延迟回忆、波士顿命名测验和FAQ。相比之下，男性的显著风险因素为Aβ42、p-tau181、p-tau181/Aβ42、海马体积、类别流畅性和FAQ。在完全调整模型中，仅p-tau181/Aβ42和RAVLT延迟回忆与性别的交互作用显著。
患有MCI的男性和女性在预测随后痴呆症的因素方面可能存在差异，不过需要进行更具效力的未来分析来评估性别差异。我们推测大脑和认知储备理论可能部分解释了这些发现。
