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Sex differences between early- and late-onset Alzheimer’s disease.

Wattmo, Carina LU (2022) The Kock Foundation International Symposium on Osteoarthritis & Alzheimer's disease 2022
Abstract
Objectives: To examine potential sex differences in longitudinal cognitive and activities of daily living (ADL) performance and life expectancy between early- and late-onset Alzheimer’s disease (AD). Methods: The Swedish Alzheimer Treatment Study is a prospective, observational, multicentre study that was used in a routine clinical setting including 1,017 patients diagnosed with mild-to-moderate AD at the initiation of cholinesterase inhibitor therapy. The participants were investigated using cognitive and functional assessment scales at baseline and every 6 months over 3 years. The date of death was documented for 20 years. Results: In late-onset AD (LOAD), but not in early-onset AD (EOAD), women exhibited a greater proportion of... (More)
Objectives: To examine potential sex differences in longitudinal cognitive and activities of daily living (ADL) performance and life expectancy between early- and late-onset Alzheimer’s disease (AD). Methods: The Swedish Alzheimer Treatment Study is a prospective, observational, multicentre study that was used in a routine clinical setting including 1,017 patients diagnosed with mild-to-moderate AD at the initiation of cholinesterase inhibitor therapy. The participants were investigated using cognitive and functional assessment scales at baseline and every 6 months over 3 years. The date of death was documented for 20 years. Results: In late-onset AD (LOAD), but not in early-onset AD (EOAD), women exhibited a greater proportion of apolipoprotein E (APOE) ε4 carriers than men (71% vs. 58%, p<0.001). In women, but not in men, a larger frequency of solitary living (49% vs. 24%, p<0.001) and a lower education level (mean, 95% confidence interval; 9.1, 8.9–9.2 vs. 10.1, 9.5–10.8 years; p<0.001) were found in LOAD compared with EOAD. In only LOAD, men had worse instrumental ADL capacity at baseline than women (17.1, 16.5–17.7 vs. 15.9, 15.4–16.3 points; p<0.001). No difference in cognitive ability at baseline was detected. In only women, the deterioration per year in Alzheimer’s Disease Assessment Scale–cognitive subscale was faster in EOAD compared with LOAD (5.8, 3.9–7.8 vs. 3.0, 2.3–3.7 points; p=0.013). Functional rates of progression did not differ between the groups. In only LOAD, women demonstrated an older age at death than men (84.4, 83.9–84.8 vs. 82.9, 82.3–83.5 years; p<0.001). Conclusions: The higher proportion of APOE ε4 carriers in women with LOAD compared with men with LOAD suggests more hereditary forms of AD in older women. Women with EOAD showed almost twice as fast long-term cognitive decline than both LOAD groups (irrespective of sex), which might imply a more aggressive disease in younger women. In only LOAD, older age at death and longer survival time after AD diagnosis were observed in women compared with men. Thus, the common risk factor for earlier death, male sex, was not found in EOAD. (Less)
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author
organization
publishing date
type
Contribution to conference
publication status
published
subject
keywords
Alzheimer's disease, Sex, Age at onset
conference name
The Kock Foundation International Symposium on Osteoarthritis & Alzheimer's disease 2022
conference location
Trelleborg, Sweden
conference dates
2022-09-14 - 2022-09-16
language
English
LU publication?
yes
id
30b8e5d5-0b24-4e99-8e6b-76e0d8c9c1a6
date added to LUP
2022-09-22 12:29:21
date last changed
2022-09-22 13:06:20
@misc{30b8e5d5-0b24-4e99-8e6b-76e0d8c9c1a6,
  abstract     = {{Objectives: To examine potential sex differences in longitudinal cognitive and activities of daily living (ADL) performance and life expectancy between early- and late-onset Alzheimer’s disease (AD). Methods: The Swedish Alzheimer Treatment Study is a prospective, observational, multicentre study that was used in a routine clinical setting including 1,017 patients diagnosed with mild-to-moderate AD at the initiation of cholinesterase inhibitor therapy. The participants were investigated using cognitive and functional assessment scales at baseline and every 6 months over 3 years. The date of death was documented for 20 years. Results: In late-onset AD (LOAD), but not in early-onset AD (EOAD), women exhibited a greater proportion of apolipoprotein E (APOE) ε4 carriers than men (71% vs. 58%, p&lt;0.001). In women, but not in men, a larger frequency of solitary living (49% vs. 24%, p&lt;0.001) and a lower education level (mean, 95% confidence interval; 9.1, 8.9–9.2 vs. 10.1, 9.5–10.8 years; p&lt;0.001) were found in LOAD compared with EOAD. In only LOAD, men had worse instrumental ADL capacity at baseline than women (17.1, 16.5–17.7 vs. 15.9, 15.4–16.3 points; p&lt;0.001). No difference in cognitive ability at baseline was detected. In only women, the deterioration per year in Alzheimer’s Disease Assessment Scale–cognitive subscale was faster in EOAD compared with LOAD (5.8, 3.9–7.8 vs. 3.0, 2.3–3.7 points; p=0.013). Functional rates of progression did not differ between the groups. In only LOAD, women demonstrated an older age at death than men (84.4, 83.9–84.8 vs. 82.9, 82.3–83.5 years; p&lt;0.001). Conclusions: The higher proportion of APOE ε4 carriers in women with LOAD compared with men with LOAD suggests more hereditary forms of AD in older women. Women with EOAD showed almost twice as fast long-term cognitive decline than both LOAD groups (irrespective of sex), which might imply a more aggressive disease in younger women. In only LOAD, older age at death and longer survival time after AD diagnosis were observed in women compared with men. Thus, the common risk factor for earlier death, male sex, was not found in EOAD.}},
  author       = {{Wattmo, Carina}},
  keywords     = {{Alzheimer's disease; Sex; Age at onset}},
  language     = {{eng}},
  title        = {{Sex differences between early- and late-onset Alzheimer’s disease.}},
  year         = {{2022}},
}