Gender, cognitive decline, and risk of AD in older persons

Background: Cross-sectional studies suggest gender differences in cognitive function and risk of AD in older persons. However, longitudinal studies comparing change in cognitive function and risk of AD in men and women have had mixed results. The authors investigated gender differences in rate of decline for different cognitive systems and for risk of developing AD. Methods: Participants were from the Religious Orders Study, a longitudinal, clinical - pathologic study of aging and AD in older Catholic nuns, priests, and brothers. Longitudinal data were available from 577 older women and 271 older men, who completed an average of 5.8 annual evaluations with more than 95% follow-up participation in survivors. The evaluations included 21 neuropsychological tests, from which summary measures of global cognitive function and 5 functional domains were formed, and clinical classification of AD. Results: Random effects models were used to analyze change in cognitive function, and proportional hazards models were used to assess risk of incident AD. On average, men and women declined in all abilities during the 8-year period but did not differ in annual rates of change in analyses that controlled for age, education, and initial level of cognitive function. Risk of incident AD did not differ between men and women. Furthermore, results were unchanged after controlling for possession of the apolipoprotein-epsilon4 allele. Duration of estrogen use was related to rate of global cognitive decline and visuospatial abilities in women but did not influence comparisons between men and women in cognitive decline. Conclusions: The results suggest that patterns of cognitive decline and incidence of AD are similar in older men and women.