Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA.
University of Miami Miller School of Medicine, Miami, FL, USA.
J Alzheimers Dis. 2024 Nov;102(1):110-118. doi: 10.1177/13872877241283823. Epub 2024 Oct 17.
Women comprise approximately two-thirds of Alzheimer's disease cases.
This is the first known study to investigate the role of intersectionality between gender and other social determinants of health (SDOH) in the presentation of cognitive symptoms (i.e., being asymptomatic or symptomatic) among those with pathologically confirmed Alzheimer's disease.
We studied 3107 individuals with Alzheimer's disease neuropathology (ADNP) confirmed at autopsy. Asymptomatic ADNP was defined as the absence of a clinical diagnosis of mild cognitive impairment (MCI) or dementia before death (versus symptomatic: diagnosis of MCI/dementia). SDOH included gender, education, ethnoracial group, living alone, and primary language. Multivariable logistic regression tested associations between SDOH and asymptomatic ADNP (versus symptomatic); models were also stratified by gender.
Women, Hispanics, those living alone, and more educated individuals were found to have higher odds of asymptomatic ADNP. Non-English speakers had lower odds of asymptomatic ADNP. Both women and men had higher odds of asymptomatic ADNP if Hispanic or living alone. In only women, non-English speakers had lower odds while in only men, more education was associated with higher odds of asymptomatic ADNP.
Gender, education, ethnicity, primary language, and living alone, and intersectionality of gender with primary language, may differentially influence MCI and dementia diagnosis prior to death among those with underlying ADNP. These findings emphasize the need for future Alzheimer's disease research to prioritize social determinants of brain health including their intersectionality with gender and how to inform targeted interventions.
女性约占阿尔茨海默病病例的三分之二。
这是第一项已知的研究，旨在调查性别与健康社会决定因素（SDOH）之间的交叉点在那些有病理证实的阿尔茨海默病患者的认知症状（即无症状或有症状）表现中的作用。
我们研究了 3107 名经尸检证实患有阿尔茨海默病神经病理学（ADNP）的个体。无症状 ADNP 定义为在死亡前没有轻度认知障碍（MCI）或痴呆的临床诊断（与有症状相比：MCI/痴呆的诊断）。SDOH 包括性别、教育、民族种族群体、独居和主要语言。多变量逻辑回归测试了 SDOH 与无症状 ADNP 之间的关联（与有症状相比）；模型也按性别分层。
发现女性、西班牙裔、独居者和受教育程度较高的人更有可能出现无症状 ADNP。非英语使用者出现无症状 ADNP 的可能性较低。如果是西班牙裔或独居者，女性和男性出现无症状 ADNP 的可能性更高。只有在女性中，非英语使用者出现无症状 ADNP 的可能性较低，而只有在男性中，受教育程度较高与无症状 ADNP 出现的可能性更高有关。
性别、教育、种族、主要语言和独居，以及性别与主要语言的交叉点，可能会对有潜在 ADNP 的人在死亡前的 MCI 和痴呆诊断产生不同的影响。这些发现强调了未来阿尔茨海默病研究需要优先考虑大脑健康的社会决定因素，包括它们与性别之间的交叉点，以及如何为有针对性的干预措施提供信息。
