Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

Michelle M Mielke^{1

2}, Neelum T Aggarwal^{3

4}, Clara Vila-Castelar⁵, Puja Agarwal^{4

6}, Eider M Arenaza-Urquijo^{7

8

9}, Benjamin Brett¹⁰, Anna Brugulat-Serrat^{7

8

9

11}, Lyndsey E DuBose¹², Willem S Eikelboom¹³, Jason Flatt¹⁴, Nancy S Foldi^{15

16}, Sanne Franzen¹³, Paola Gilsanz¹⁷, Wei Li¹⁸, Alison J McManus¹⁹, Debora Melo van Lent^{20

21

22}, Sadaf Arefi Milani²³, C Elizabeth Shaaban²⁴, Shana D Stites²⁵, Erin Sundermann²⁶, Vidyani Suryadevara²⁷, Jean-Francoise Trani²⁸, Arlener D Turner²⁹, Jet M J Vonk^{30

31}, Yakeel T Quiroz^{5

32}, Ganesh M Babulal^{33

34

35}; Diversity and Disparity Professional Interest Area Sex and Gender Special Interest Group

Affiliations

¹ Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
⁴ Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.
⁵ Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Massachusetts, Boston, USA.
⁶ Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
⁷ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
⁸ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
⁹ CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
¹⁰ Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, Milwaukee, USA.
¹¹ Atlantic Fellow for Equity in Brain Health, The University of California San Francisco, San Francisco, California, USA.
¹² Department of Medicine, Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹³ Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁴ Social and Behavioral Health Program, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
¹⁵ Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, USA.
¹⁶ Department of Psychiatry, New York University Long Island School of Medicine, New York, USA.
¹⁷ Kaiser Permanente Division of Research, Oakland, California, USA.
¹⁸ Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁹ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁰ UT Health San Antonio, Glenn Biggs Institute for Alzheimer's and Neurodegenerative diseases, San Antonio, Texas, USA.
²¹ Framingham Heart Study, Framingham, Massachusetts, USA.
²² Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.
²³ Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
²⁴ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²⁵ Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁶ Department of Psychiatry, University of California, San Diego, California, USA.
²⁷ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
²⁸ Department of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.
²⁹ Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
³⁰ Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
³¹ Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
³² Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellin, Columbia, USA.
³³ Department of Neurology, Washington University in St. Louis, St. Louis, Mississippi, USA.
³⁴ Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
³⁵ Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.

PMID: 35394117
PMCID: PMC9547039
DOI: 10.1002/alz.12662

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

Michelle M Mielke et al. Alzheimers Dement. 2022 Dec.

. 2022 Dec;18(12):2707-2724.

doi: 10.1002/alz.12662. Epub 2022 Apr 8.

Authors

Affiliations

¹ Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
⁴ Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.
⁵ Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Massachusetts, Boston, USA.
⁶ Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
⁷ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
⁸ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
⁹ CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
¹⁰ Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, Milwaukee, USA.
¹¹ Atlantic Fellow for Equity in Brain Health, The University of California San Francisco, San Francisco, California, USA.
¹² Department of Medicine, Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹³ Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁴ Social and Behavioral Health Program, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
¹⁵ Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, USA.
¹⁶ Department of Psychiatry, New York University Long Island School of Medicine, New York, USA.
¹⁷ Kaiser Permanente Division of Research, Oakland, California, USA.
¹⁸ Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁹ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁰ UT Health San Antonio, Glenn Biggs Institute for Alzheimer's and Neurodegenerative diseases, San Antonio, Texas, USA.
²¹ Framingham Heart Study, Framingham, Massachusetts, USA.
²² Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.
²³ Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
²⁴ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²⁵ Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁶ Department of Psychiatry, University of California, San Diego, California, USA.
²⁷ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
²⁸ Department of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.
²⁹ Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
³⁰ Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
³¹ Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
³² Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellin, Columbia, USA.
³³ Department of Neurology, Washington University in St. Louis, St. Louis, Mississippi, USA.
³⁴ Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
³⁵ Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.

PMID: 35394117
PMCID: PMC9547039
DOI: 10.1002/alz.12662

Abstract

Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.

Keywords: Alzheimer's; ethnicity; gender; global health; risk factors, sex; sociocultural factors.

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Conflict of interest statement

Dr. Mielke has consulted for Biogen, Brain Protection Company and Labcorp unrelated to this manuscript. She is a Senior Associate Editor for Alzheimer's and Dementia: The Journal of the Alzheimer's Association. All other authors report no conflicts of interest.

References

1. Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y‐T, Prina M. World Alzheimer Report 2015 ‐ The Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends. London: Alzheimer's Disease International; 2015:84.
1. United Nations‐Department of Economic and Social Affairs‐Population Division. Population Division (2015). World Population Ageing; 2015; ST/ESA/SER.A/390
1. Rocca WA, Cha RH, Waring SC, Kokmen E. Incidence of dementia and Alzheimer's disease: a reanalysis of data from Rochester, Minnesota, 1975‐1984. Am J Epidemiol. 1998;148:51‐62. - PubMed
1. Bachman DL, Wolf PA, Linn RT, et al. Incidence of dementia and probable Alzheimer's disease in a general population: the Framingham Study. Neurology. 1993;43:515‐519. - PubMed
1. Ganguli M, Dodge HH, Chen P, Belle S, DeKosky ST. Ten‐year incidence of dementia in a rural elderly US community population: the MoVIES Project. Neurology. 2000;54:1109‐1116. - PubMed

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Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

Affiliations

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical