Sex differences in cognitive reserve: implications for Alzheimer’s Disease in women

Abstract

Women represent ⅔ of the cases of Alzheimer’s disease (AD). Current research has focused on differential risks to explain higher rates of AD in women. However, factors that reduce risk for AD, like cognitive reserve, are less well explored. We asked: what is known about sex differences in how cognitive reserve mitigates risk for AD? To address this, we conducted a narrative review of the literature. Keywords were: “sex/gender differences”, “cognitive/brain reserve”, “Alzheimer’s Disease”, and the following cognitive reserve contributors: “education”, “IQ”, “occupation”, “cognitive stimulation”, “bilingualism”, “socioeconomic status”, “physical activity”, “social support”. Fifteen papers disaggregated their data by sex. Those papers observed sex differences in cognitive reserve contributors. There is also evidence that a subset of women may have greater resistance to AD, possibly due to greater cognitive reserve. We discuss how traditional cognitive reserve contributors are gendered and may not capture factors that support cognition in aging women.