Sex differences in the clinical manifestations of Alzheimer disease pathology
Sex differences in the clinical manifestations of Alzheimer disease pathology
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DOI：
10.1001/archpsyc.62.6.685
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发表时间：
2005-06-01
影响因子：
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通讯作者：
Bennett, DA
中科院分区：
文献类型：
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作者：
Barnes, LL;Wilson, RS;Bennett, DA
内容：临床诊断的阿尔茨海默病（AD）风险的性别差异已被广泛研究，但与女性相比，关于AD病理指标与男性疾病临床表现的关系知之甚少。目的：测试AD病理与疾病临床表现的关系是否在男性和女性中不同。设计：纵向临床病理队列研究参与者和设置：研究人员对141名年长的天主教神职人员进行了分析，他们接受了详细的年度临床评估和死亡时的脑尸检。从4个皮质区域取样，计数1平方毫米区域内的神经炎性斑块、弥漫性斑块和神经纤维缠结的数量，（范围，0-2.98 U）和每种病理学的具体措施。主要结果测量：可能的AD的临床诊断和死亡前最后评估时的整体认知功能水平。女性比男性有更多的整体AD病理（P=.04），主要是由于更多的神经系统缠结（P=.02）。在死亡前的最后一次评估中，57人符合可能AD的临床标准（其中34人[60%]为女性）。在逻辑回归模型中，性别与临床AD的几率无关（比值比[OR]，1.35; 95%置信区间[CI]，0.56-3.25），但男性和女性的总体AD病理与临床诊断的关系不同。每增加一个AD病理学单位，男性临床AD的几率增加近3倍（OR，2.82; 95% CI，1.03-7.65），而女性临床AD的几率增加20倍以上（OR，22.67; 95% CI，5.11-100.53）。控制潜在的混杂因素或使用水平的认知作为output.Conclusion结果不变：这些数据表明，AD病理更有可能在临床上表示为痴呆症的女性比男性。
Context: Sex differences in risk of clinically diagnosed Alzheimer disease (AD) have been studied extensively, but little is known about the relation of the pathologic indices of AD to the clinical manifestations of the disease in men compared with women.Objective: To test whether the relation of AD pathology to the clinical manifestations of the disease differs in men and women.Design: Longitudinal, clinicopathologic cohort studyParticipants and Setting: Analyses were conducted on 141 older Catholic clergy members who underwent detailed annual clinical evaluations and brain autopsy at death. The number of neuritic plaques, diffuse plaques, and neurofibrillary tangles in a 1-mm(2) area sampled from 4 cortical regions was counted, and a global measure of AD pathology (range, 0-2.98 U) and specific measures of each pathology were derived.Main Outcome Measures: Clinical diagnosis of probable AD and level of global cognitive function at the last evaluation before death.Results: Women had more global AD pathology than did men (P=.04), due primarily to more neurofibrillary tangles (P=.02). At the last evaluation before death, 57 persons met clinical criteria for probable AD (34 [60%] of them women). In logistic regression models, sex was not related to odds of clinical AD (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.56-3.25), but the relation of global AD pathology to clinical diagnosis differed for men and women. Each additional unit of AD pathology was associated with a nearly 3-fold increase in the odds of clinical AD in men (OR, 2.82; 95% CI, 1.03-7.65) compared with a more than 20-fold increase in the odds of clinical AD in women (OR, 22.67; 95% Cl, 5.11-100.53). Results were unchanged after controlling for potential confounders or using level of cognition as the outcome.Conclusion: These data suggest that AD pathology is more likely to be clinically expressed as dementia in women than in men.