Are There Sex Differences in Are There Sex Differences in sociodemographic background sociodemographic background and cognitive Functions Among and cognitive Functions Among

Patients With dementia ,a Patients With dementia ,a comparative study among an comparative study among an

Egyptian sampleEgyptian sample..Ashour A. MD, Abd-Elrazek Gh. MD, Ashour A. MD, Abd-Elrazek Gh. MD,

Mahmoud A. MD, Hewedi D. MD.Mahmoud A. MD, Hewedi D. MD.

IntroductionIntroduction

Sex difference in the Sex difference in the degenerative dementias not degenerative dementias not

well established until now and well established until now and the prevalence of dementiathe prevalence of dementia

still is the same in males and still is the same in males and females except for dementia females except for dementia of Alzheimer’s type, which is of Alzheimer’s type, which is

reported to be higher in reported to be higher in femalesfemales..

But, several studies based on But, several studies based on prevalent cases of dementia prevalent cases of dementia report a higher frequency of report a higher frequency of dementia in women compared dementia in women compared with men. However, these with men. However, these finding may reflect differences finding may reflect differences between men and women in between men and women in survival after dementia is survival after dementia is detected.detected.

Material and Material and methodmethod

p.p. 22 males and 26 females patient selected 22 males and 26 females patient selected from memory clinic which is a special outpatient from memory clinic which is a special outpatient

psychogeriatric clinic diagnosed to have psychogeriatric clinic diagnosed to have dementia with its different subtypes according dementia with its different subtypes according

to ICD10 symptoms check list, the total sample to ICD10 symptoms check list, the total sample was screened with brief cognitive tests, and was screened with brief cognitive tests, and

screen positives were investigated in a follow-up screen positives were investigated in a follow-up diagnostic assessment for assessment of diagnostic assessment for assessment of

different cognitive function, laboratory and different cognitive function, laboratory and radiological investigation were done if indicated.radiological investigation were done if indicated.

SubjectsSubjects

Subjects include those attending the Subjects include those attending the memory clinic at the Ain Shams institute of memory clinic at the Ain Shams institute of psychiatry complaining of cognitive psychiatry complaining of cognitive impairment, from march 2003 to march impairment, from march 2003 to march 2005, with the following 2005, with the following Inclusion Inclusion criteriacriteria : :Age Age : above the age of 50 years: above the age of 50 years..

NationalityNationality : of Egyption nationality : of Egyption nationality..

The individuals must be coming mainly The individuals must be coming mainly with with memory impairmentmemory impairment as their as their primary presenting symptom.primary presenting symptom.

Exclusion criteriaExclusion criteria::Difficult uncooperative patient Difficult uncooperative patient due to due to – Late stage of dementiaLate stage of dementia– Patient with aphasia.Patient with aphasia.– Other causes.Other causes.

ProceduresProcedures

Study properStudy proper

An information consent had An information consent had obtained from each individual or obtained from each individual or their care giverstheir care givers..Full psychiatric assessment using Full psychiatric assessment using symptoms chick listsymptoms chick list of ICD10 in of ICD10 in order to obtain diagnosis according order to obtain diagnosis according to ICD10 criteria for researchto ICD10 criteria for research..Full Neurological examination had Full Neurological examination had done according to Ain-Shams done according to Ain-Shams university hospital neurological university hospital neurological sheetsheet..Full medical examination.Full medical examination.

MiniMini--Mental StateMental State ExaminationExamination was was administered ( the Arabic version )administered ( the Arabic version ) (MMSE):(MMSE): The MMSE is found to be The MMSE is found to be valid and reliable in assessing a valid and reliable in assessing a limitedlimited range of cognitive functions range of cognitive functions in a global wayin a global way. .

This was followed by assessment of This was followed by assessment of cognitive function using CAMCOG cognitive function using CAMCOG scale (Arabic version of cognitive scale (Arabic version of cognitive section of CAMDEX scale).section of CAMDEX scale).

which measures the following cognitive functionswhich measures the following cognitive functions::Memory (learning, recent & remote memory ). Language Memory (learning, recent & remote memory ). Language (expression & comprehension(expression & comprehensionAttension.Attension.Praxis.Praxis.Calculation.Calculation.Abstraction (Abstraction ( perception & thinking).perception & thinking).Orientation. Orientation.

Neuropsychological assessment using Wchseler memory scale Neuropsychological assessment using Wchseler memory scale revised battery (WMS- R) which comprises eleven revised battery (WMS- R) which comprises eleven subtests measuring the following cognitive function:subtests measuring the following cognitive function:AttentionAttention & concentration.& concentration.Verbal memory.Verbal memory.Visual memory (performance ).Visual memory (performance ).General or total memory.General or total memory.Recall.Recall.

Neuroimaging if indicated (CT brain, MRI….ect).Neuroimaging if indicated (CT brain, MRI….ect).Laboratory investigation if indicated.Laboratory investigation if indicated.

StatisticalStatistical analysisanalysis

Statistical analysis was Statistical analysis was carried out by using means carried out by using means and SDs,and SDs, analysis of analysis of variance by one way variance by one way (ANOVA) test with repeated (ANOVA) test with repeated measures. measures.

Frequency distributions Frequency distributions were calculatedwere calculated with chi-with chi-square tests `square tests `

ResultsResults

Table Table ( ( 1 1 ):):shows the number & percent of patient diagnosed as shows the number & percent of patient diagnosed as dementia with its subtype attending the memory clinic through the dementia with its subtype attending the memory clinic through the

period of researchperiod of research

DiagnosesDiagnoses NoNo %%

Dementia of alz typeDementia of alz type

Dementia of alz type Dementia of alz type with early onsetwith early onset

13*13* 23.6%*23.6%*

Dementia of alz type Dementia of alz type with late onsetwith late onset

2222**** 40%40%****

Multi-infarcts dementiaMulti-infarcts dementia99 16.4%16.4%

Pick’s diseasePick’s disease 77 12.7%12.7%

Lewy bodies dementiaLewy bodies dementia 22 3.6%3.6%

Subcortical dementiaSubcortical dementia 22 3.6%3.6%

Table ( 1 ) : shows that Dementia Table ( 1 ) : shows that Dementia of alz type with late onset was of alz type with late onset was the commonest cognitive the commonest cognitive disorder presented to our clinic disorder presented to our clinic during this peroidduring this peroid

Table ( 2 ) : shows the distribution of dementia Table ( 2 ) : shows the distribution of dementia subtypes through defferent age groupssubtypes through defferent age groups

40 – 49

%50 – 59%

60 – 69%

70 – 79%

80 <%

Total%

Dementia of alz type with early onset

2 (3.6%)

6 (10.9%)**

-5 (9.1%)

-13 (23.6%)

Dementia of alz type with late onset

--11 (20%)**10 (18.2%)22 (40%)

Multi-infarcts dementia

-2(3.6%)

6(10.9%)**

-9 (16.4%)

Pick’s disease

-6 (10.9%)**1 (1.8%)-7 (12.7%)

Lewy bodies dementia

-2 (3.6%)

---2 (3.6%)

Subcortical dementia.

1(1.8%)

1(1.8%)

---2(3.6%)

Table ( 2 ) shows that:Table ( 2 ) shows that:Dementia of alz type with early onset more Dementia of alz type with early onset more common at the age from 50 – 59 .common at the age from 50 – 59 .

Dementia of alz type with late onset was Dementia of alz type with late onset was more common at the age from 70 – 79more common at the age from 70 – 79

Multi-infarcts dementia Multi-infarcts dementia was more common was more common at the age from 70 – 79at the age from 70 – 79

Figure (1): Gender percentage Figure (1): Gender percentage distribution of the studied groupdistribution of the studied group..

49%

51%

Male

Female

Figure (2): education percentage Figure (2): education percentage distribution of the femaledistribution of the female

studied groupstudied group

40%31%

23% 6%

0%

Illitrate

Read write

Primary

Secondary

University

Figure (3): education percentage Figure (3): education percentage distribution of the male studied distribution of the male studied

groupgroup

30%

26%

0%

4%

40%

0% Illitrate

Read writePrimary

Secondary

University

12

Table ( 3 ): the relation between Table ( 3 ): the relation between dementia subtypes and gender.dementia subtypes and gender.

DiagnosisMaleFemale

Dementia of alz type with early onset8 (14.5%*)5 (9.1%)

Dementia of alz type with late onset7 (12.7%)15 (27.3%)*

Multi-infarcts dementia6 (10.9%*)3 (5.5%)

Pick’s disease5 (9.1%)2 (3.6%)

Lewy bodies dementia.-2 (3.6%)

Subcortical dementia.2 (3.6%)-

This table shows the number of each This table shows the number of each gender group in each dementia subtype:gender group in each dementia subtype:

The number of female patient The number of female patient diagnosed as Dementia of alz type diagnosed as Dementia of alz type

with late onset were more than males with late onset were more than males while it was less than males in while it was less than males in

Dementia of alz type with early onset Dementia of alz type with early onset & & Multi-infarcts dementia.Multi-infarcts dementia.

The data obtained from cognitive assessment and The data obtained from cognitive assessment and follow up clinically revealed thatfollow up clinically revealed that: :

Symptoms profiles and cognitive Symptoms profiles and cognitive decline were to some extend similar decline were to some extend similar

in both males and females, but by in both males and females, but by follow up the course and rate of follow up the course and rate of

deterioration was slowly in women deterioration was slowly in women than in men and the response to than in men and the response to

medication, symptoms improvement, medication, symptoms improvement, prognosis and mortality rate were prognosis and mortality rate were

better in females.better in females.

Discussion &ConclusionDiscussion &Conclusion

We examined gender differences in a sample of demented We examined gender differences in a sample of demented patient attending the memory clinic through 2 years. Our patient attending the memory clinic through 2 years. Our analyses suggest that dementia of Alzheimer type with late analyses suggest that dementia of Alzheimer type with late onset appears to be more in females, this difference is due onset appears to be more in females, this difference is due to a higher risk in women for AD. In addition to that by to a higher risk in women for AD. In addition to that by follow up of these patients we found that the course of follow up of these patients we found that the course of progression, prognosis and outcome were better in females progression, prognosis and outcome were better in females than in males. than in males. However the number of males attending memory clinic However the number of males attending memory clinic diagnosed as dementia with its different subtypes were diagnosed as dementia with its different subtypes were more than females which may attributed to the following more than females which may attributed to the following factors:factors:The males considered as the caring of their families in Arab The males considered as the caring of their families in Arab countries. So, the social & occupational deterioration countries. So, the social & occupational deterioration rapidly noticed in males than females.rapidly noticed in males than females.Higher level of education in males than females in our Higher level of education in males than females in our countries increase the level of their awareness and early countries increase the level of their awareness and early detection of their cognitive changes , however the low detection of their cognitive changes , however the low level of education is known to influence performance on level of education is known to influence performance on cognitive screening tests resulting in higher proportion of cognitive screening tests resulting in higher proportion of screen positives among women. However, diagnosis was screen positives among women. However, diagnosis was based on subsequent clinical examination, informant based on subsequent clinical examination, informant interviews, and more detailed neuropsychological testing interviews, and more detailed neuropsychological testing these procedures would reduce the chance of diagnostic these procedures would reduce the chance of diagnostic bias.bias.

Many studies Many studies reported gender effects reported gender effects on cerebral glucose metabolic on cerebral glucose metabolic patterns, and that there was a strong patterns, and that there was a strong correlation between brain adrenal correlation between brain adrenal axis activity and cognitive impairment axis activity and cognitive impairment in women but not in men. However, in women but not in men. However, the more credited explanation for the the more credited explanation for the gender difference relates to hormonal gender difference relates to hormonal influencesinfluences effects on cerebral glucose effects on cerebral glucose metabolic patterns.metabolic patterns.

Estrogen stimulates the action and viability Estrogen stimulates the action and viability of cholinergic neurons; it modulates axonal of cholinergic neurons; it modulates axonal elongation elongation and promotes the formation of and promotes the formation of dendritic spines and synapses, it promotes dendritic spines and synapses, it promotes the breakdown of the amyloid precursor the breakdown of the amyloid precursor proteinprotein. . In addition, estrogen has In addition, estrogen has antioxidant properties and modifies some antioxidant properties and modifies some aspects of the inflammatory response aspects of the inflammatory response mechanisms that have been implicated in mechanisms that have been implicated in the pathology of AD , Finally, estrogen the pathology of AD , Finally, estrogen increases cerebral glucose utilization and increases cerebral glucose utilization and cerebral blood flow.cerebral blood flow.

so from these studies we can so from these studies we can revealed that before menopause, revealed that before menopause, estrogen delay the incidence of estrogen delay the incidence of AD, while after that the AD, while after that the incidence is nearly the sameincidence is nearly the same..

In our finding we reported that multi-In our finding we reported that multi-infarcts dementia is more common infarcts dementia is more common among male sex (66.7%) in our among male sex (66.7%) in our society this may be due to men are society this may be due to men are more liable to cerebrovascular insult more liable to cerebrovascular insult due to the higher incidence of due to the higher incidence of hypertension, diabetes, hypertension, diabetes, atheresclerosis, hypercholesterolemia atheresclerosis, hypercholesterolemia that are considered as important risk that are considered as important risk factors for brain vascular insult on factors for brain vascular insult on males more than females .males more than females .