Neurology Central

Signs of dementia may be detected earlier in women with new diagnostic criteria


Despite women making up two-thirds of Alzheimer’s disease patients, they are less likely to be diagnosed than men when assessing amnestic mild cognitive impairment (aMCI). This piqued the interest of a team of researchers at the University of California San Diego (CA, USA) and led them to investigate how life-long advantage in verbal memory performance may hide early symptoms of dementia in women.

In a study published in Neurology, the team analyzed data of nearly 1000 patients who participated in the Alzheimer’s Disease Neuroimaging Initiative and discovered that more female and fewer male patients were considered to have aMCI when verbal memory test cut-offs were tailored to the patients’ sex.

Most diagnostic criteria for dementia diagnosis take many factors into consideration such as age and education level, however, sex is often not taken into account. Nevertheless, the findings from this study suggests that sex-specific diagnosis should be used when assessing aMCI diagnosis to more effectively catch the disease in its early stages.

“The point of the study was to see if we adjusted for this sex difference in verbal memory and made the cut point for impairment more conservative in women, would we be able to detect them earlier in the disease trajectory?” commented first author, Erin Sundermann (The University of California San Diego School of Medicine). “That’s important because currently the interventions that we have are likely most effective in the earlier stages.”

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Sundermann and colleagues calculated sex-specific diagnosis criteria by considering the differences in verbal memory performance, which resulted in women having a more conservative score cut-off. The new criteria defined 10% of women who were previously deemed as cognitively normal, as aMCI. Conversely, 10% of men who were previously defined to have aMCI were now classified as cognitively normal.

“This suggests that adjusting for sex in verbal memory norms can improve diagnosis in both men and women and can detect women earlier in the disease trajectory and avoid false diagnosis in men that lead to stress and unnecessary treatment,” Sundermann explained.

Following this study, future clinical trials should improve study design by improving participant selection and take sex into consideration, which would result in more accurate studies on disease prevention and intervention.

Sources: Sundermann EE, Maki P, Biegon A et al. Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI. Neurology doi:10.1212/WNL.0000000000008467 (2019);