Sex differences in memory clinic patients with possible vascular cognitive impairment

Abstract

Introduction We aimed to establish sex differences in vascular brain damage of memory clinic patients with possible vascular cognitive impairment (VCI). Methods A total of 860 memory clinic patients (aged 67.7 ± 8.5; 46% female) with cognitive complaints and vascular brain damage (ie, possible VCI) from the prospective TRACE‐VCI (Utrecht‐Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment) cohort study with 2‐year follow‐up were included. Age‐adjusted female‐to‐male differences were calculated with general linear models, for demographic variables, vascular risk factors, clinical diagnosis, cognitive performance, and brain magnetic resonance imaging markers. Results We found no difference in age nor distribution of clinical diagnoses between females and males. Females performed worse on the MMSE (Mini‐Mental State Examination) and CAMCOG (Cognitive and Self‐Contained Part of the Cambridge Examination for Mental Disorders of the Elderly). Females had a larger white matter hyperintensity volume, while males more often showed (lacunar) infarcts. There was no difference in microbleed prevalence. Males had smaller normalized total brain and gray matter volumes. During follow‐up, occurrence of cognitive decline and institutionalization was comparable, but mortality was higher in males. Discussion Our results suggest that susceptibility and underlying etiology of VCI might differ by sex. Males seem to have more large vessel brain damage compared to females that have more small vessel brain damage.

Non‐hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients

“… 43 Very little was found in the literature on the question of sex differences and the presence of the multispot pattern. However, there is emerging evidence, consistent with our observation, that women with and without cognitive impairment have a greater WMH burden, 44 , 45 which may reduce their resilience to other types of neuropathology. 46 …”

Revealing the Influences of Sex Hormones and Sex Differences in Atrial Fibrillation and Vascular Cognitive Impairment

“…Some studies suggested that male sex is a risk factor for CI [63,64]; others found that female sex is predictive of the increased risk of CI [65,66]. Although dementia disproportionally affects females, there are conflicting findings on the influence of sex on the incidence and prevalence of VCI [67]. Sex-related differences in risk factors, cognitive profiles, rates of deterioration, pathogenesis, and outcomes remain unknown.…”

“…Evidence has revealed a sex-specific pattern in the incidence of CVD, with women having lower incidence rates of both ischemic stroke and intracerebral hemorrhage (ICH) than men [68]. Among 860 patients with CVD, significantly more women than men had poor cognitive performance (approximately 15% difference) [67]. Despite the similar incidence of VCI between women and men [67], women tend to experience more severe strokes [69], whereas men frequently experience their first stroke earlier [69].…”

“…Among 860 patients with CVD, significantly more women than men had poor cognitive performance (approximately 15% difference) [67]. Despite the similar incidence of VCI between women and men [67], women tend to experience more severe strokes [69], whereas men frequently experience their first stroke earlier [69]. Risk factors for CVD such as AF, HF, myocardial infarction, high blood pressure, hyperlipidemia, obesity, and diabetes mellitus (DM) are more common among men [53,70,71]; however, the incidence rates of dementia associated with these risk factors are conflicting [53,70].…”

Neuropsychiatric symptoms in patients with possible vascular cognitive impairment, does sex matter?

“…Recently, we showed that female and male patients with possible VCI have different manifestations of vascular brain lesions. Women had a larger white matter hyperintensity (WMH) volume, while men more often showed (lacunar) infarcts [14] . Sex differences in manifestations and predictive value of NPS in VCI are largely unknown.…”