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Women more likely to express Alzheimer's pathology

Women are significantly more likely to experience the clinical manifestations of Alzheimer's disease (AD), such as dementia, than men, US researchers have discovered.

Lisa Barnes, from Rush University Medical Center in Chicago, Illinois, and colleagues point out that, while sex differences in the likelihood of clinically diagnosed AD have been examined, the link between underlying pathology and clinical manifestation has not.

The researchers studied 141 Catholic clergy members who took part in the longitudinal Religious Orders Study. The participants underwent a series of detailed clinical evaluations every year to assess the presence of AD and global cognitive function.

In addition, a brain autopsy was performed at death, in which the number of neuritic plaques, diffuse plaques, and neurofibrillary tangles in samples taken from four cortical areas was determined.

The results showed that women had more evidence of AD pathology than men, largely a result of having more neurofibrillary tangles, the team writes in the Archives of General Psychiatry.

At the final clinical assessment before death, 57 participants had probable AD, 60% of whom were women. However, at an odds ratio of 1.35, gender was not significantly related to the likelihood of clinical AD.

In contrast, the relationship between global AD pathology and clinical diagnosis was markedly different for male and female participants. Each additional unit of AD pathology was linked to a 22.67-fold increase in the likelihood of clinical AD in women, compared with just a 2.82-fold increased risk in men.

The team concludes: "We found a stronger relation between pathology and clinical AD in women than in men. These findings suggest that AD pathology is more likely to be expressed clinically as dementia in women."

Arch Gen Psychiatry 2005; 62: 685-691

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