When it comes to preventing Alzheimer’s disease, women and men are not created equal – Neuroscience News

Summary: A new study describes and defines gender differences in outcomes of tailored clinical interventions in Alzheimer’s disease.

Source: FAU

After age, the most important risk factor for Alzheimer’s disease (AD) is gender – two-thirds of AD patients are women. In fact, even when taking into account sex-related mortality rates, age at death and differences in life expectancy, women are still twice as likely to have the incidence.

A study led by leading Florida Atlantic University neurologist and researcher Richard S. Isaacson, MD, and NewYork-Presbyterian/Weill Cornell Medicine collaborators, is the first to examine whether gender significantly affects cognitive outcomes in people undergoing personalized treatment, Multi-domain clinical interventions.

The study also determined whether the change in risk of developing cardiovascular disease and AD, as well as blood markers of AD risk, were also affected by gender. Other studies have focused on the role of sex-specific hormones and risk factors when examining differences in AD risk, but none have explored whether these interventions lead to differences in clinical practice worldwide. real.

The study is an analysis of the CEDAR (Comparative Effectiveness Dementia & Alzheimer’s Registry) trial launched at Weill Medicine in 2015 and led by Isaacson, which previously demonstrated that individualized, multi-domain interventions improved cognition and reduced the risk of Alzheimer’s disease in both women. and men.

In the subgroup analysis, the researchers assess the differential effectiveness of the clinical approach itself taking into account gender in the most compliant participants (n=80) of the original study cohort (n= 154).

Within this cohort, similar to the original study, participants were categorized by baseline diagnoses: normal cognition, subjective cognitive decline, and preclinical AD participants were categorized as ‘prevention’. Mild cognitive impairment due to AD and mild AD were categorized as ‘Early treatment’.

The results of the study, published in the Alzheimer’s Disease Prevention Journalshowed that risk-reduction care in the setting of an Alzheimer’s disease prevention clinic led to improvements in cognition in women and men without a gender difference.

However, in the Prevention group, the women demonstrated bigger improvement in Multiethnic Atherosclerosis Study (MESA) risk score compared to men. Women in the early treatment group also demonstrated bigger improvement in CV Risk Factors, Aging and Incidence of Dementia (CAIDE) risk score and MESA-RS. The CAIDE is a validated risk index that calculates the risk of dementia at the end of life based on mid-life vascular risk factors such as body mass index, blood pressure, cholesterol and smoking, while that the MESA estimates the risk of cardiovascular disease incidence over the next ten years using traditional risk factors.

“Although care in an Alzheimer’s disease prevention clinic was equally effective in improving cognitive function in women and men, our personalized interventions led to greater improvements in women compared to men on Alzheimer’s disease and cardiovascular disease risk scales, as well as blood biomarkers of risk such as blood sugar, LDL cholesterol and the HbA1C diabetes test,” said Isaacson, lead author and director of the new FAU Center for Brain Health and Alzheimer’s Disease Prevention Clinic at Schmidt College of Medicine, which conducted the study at Weill, Cornell Medicine and NewYork-Presbyterian.

“Our findings are important because women are disproportionately affected by Alzheimer’s disease and population-attributable risk patterns and suggest that managing risk factors can prevent up to a third of dementia cases, highlighting the enormous potential that lies in tackling modifiable risk factors.”

After undergoing baseline clinical evaluations, which included a detailed clinical history, physical examination, anthropometric data, blood biomarkers, apolipoprotein-ε4 (APOE-e4) genotyping and cognitive assessment, patients in the CEDAR study received personalized multi-domain intervention recommendations informed by these clinical data and biomarkers.

Recommendation categories included patient education/genetic counseling, individualized pharmacological approaches (drugs/vitamins/supplements), non-pharmacological approaches (exercise advice, dietary advice, vascular risk reduction, sleep hygiene , cognitive care, stress reduction and general medical care) and other evidence-based interventions.

“Our latest results suggest that the individualized management approach used by the CEDAR study in a real-world clinic may provide equal cognitive benefits to women and men, as well as better mitigation of calculated risk of Alzheimer’s disease. and cardiovascular disease in women compared to men,” said Isaacson.

“Our work also highlights the need for larger studies focusing on gender differences in AD-related cognitive trajectories, as the existing body of knowledge lacks conclusive evidence on this issue.”

Isaacson and colleagues are planning larger cohorts to better define sex differences in AD risk reduction in clinical practice and hope to launch an international multisite study soon to draw more definitive conclusions.

Study collaborators include FAU’s Schmidt College of Medicine; Cleveland Clinic; Lou Ruvo Center for Brain Health, Las Vegas; Jersey Memory Assessment Service, Jersey, UK; Alzheimer’s Disease Prevention Clinic and Research Center of Puerto Rico, San Juan; Weill Cornell Medicine & New York-Presbyterian; New York; Norton Neuroscience Institute, Louisville; McGill University Faculty of Medicine, Montreal, Canada; University of New South Wales/University of Notre Dame, Sydney, Australia; and Atria Institute, New York.

Funding: The study was primarily supported by the Women’s Alzheimer’s Movement with additional support from the Altman Family Fund, Zuckerman Family Foundation Ace’s for Alzheimer’s, Harry T. Mangurian, Jr. Foundation, Philanthropic Patient Support for the Prevention Clinic Alzheimer’s disease from Weill Cornell Medicine, National Institutes of Health (NIH) and National Center for Advancing Translational Research (UL1TR002384) and NIH (PO1AG026572).

About this Alzheimer’s disease research news

Author: Gisele Galoustian
Source: FAU
Contact: Gisele Galoustian – FAU
Picture: Image is in public domain

Original research: Free access.
“Sex-related differences in the effectiveness of individualized clinical management of Alzheimer’s disease risk” by Richard Isaacson et al. Alzheimer’s Disease Prevention Journal

---

Abstract

Sex differences in the effectiveness of individualized clinical risk management for Alzheimer’s disease

Background

The CEDAR (Comparative Effectiveness Dementia & Alzheimer’s Registry) trial demonstrated that individualized, multi-domain interventions improved cognition and reduced the risk of Alzheimer’s disease (AD). As biological sex is an important risk factor for AD, it is essential to explore the differential effectiveness of targeted clinical interventions in women compared to women. Men.

Methods

The patients were recruited from an Alzheimer’s disease prevention clinic. Subjects with normal cognition, subjective cognitive decline, or asymptomatic preclinical AD were categorized as ‘Prevention’. Subjects with mild cognitive impairment due to AD or mild AD were categorized as ‘Early treatment’. The primary endpoint was change from baseline to 18 months on the modified Alzheimer’s disease prevention cognitive composite. Secondary outcomes included a composite of cognitive aging, AD and cardiovascular (CV) risk scales, and serum biomarkers. Subjects who adhered to more than 60% of the CEDAR trial recommendations were included in this a priori subgroup analysis to examine whether the effects of the individualized intervention were modified by gender (n = 80 ).

Results

In the Prevention group, both women (p=0.0205) and men (p=0.0044) demonstrated improvements in cognition with no gender difference (p=0.5244). In the early treatment group, there were also no significant gender differences in cognition (p = 0.3299). In the Prevention group, women demonstrated greater improvements in the Multiethnic Atherosclerosis Study Risk Score (MESA-RS) than men (difference = 1.5, p = 0.0013). Women in the early treatment group demonstrated greater improvements in CV risk factors, aging, and incidence of dementia (CAIDE) risk score (difference = 2.3, p = 0.0067) and of the MESA-RS (difference = 4.1, p <0.001).

conclusion

Individualized multi-domain interventions are equally effective in improving cognition in women and men. However, personalized interventions resulted in greater improvements in calculated AD and CV risk, and CV blood biomarkers, in women compared to men. Future studies in larger cohorts are needed to better define gender differences in AD risk reduction in clinical practice.