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Sex, Gender, and the Decline of Dementia

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Sex Steroids' Effects on Brain, Heart and Vessels

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Abstract

The incidence rate of dementia and Alzheimer’s disease (AD) has declined in high-income countries over the past 25 years. In this chapter, I provide a narrative review of new ideas and concepts related to the impact of sex and gender differences on the declining risk of dementia. In particular, I discuss three examples of risk factors related to sex and gender that have probably contributed to the trend. Apolipoprotein E genotype is equally common in men and women but has a stronger effect in women. Apolipoprotein E genotype is a biological factor that cannot be modified but interacts with sex- or gender-related factors that have changed over time. Low education is believed to have a similar harmful effect in men and women but has been historically more common in women. Therefore, education is a social factor related to gender that has contributed to the time trends. Bilateral oophorectomy is a surgical practice restricted to one sex that has changed over time. Consideration of risk and protective factors in men and women separately may accelerate etiologic research for neurological diseases in general, and for dementia and AD in particular, and may explain the observed differences in time trends across countries. Similarly, future preventive interventions for dementia should be tailored to men and women separately.

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Authors and Affiliations

  1. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Walter A. Rocca

  2. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Walter A. Rocca

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Correspondence to Walter A. Rocca .

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Editors and Affiliations

  1. Center for Innovation in Brain Sciencies-Department of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, USA

    Roberta Diaz Brinton

  2. International School for Gynecological and Reproductive Endocrinology, International Society of Gynecological Endocrinology, Locarno, Switzerland

    Andrea R. Genazzani

  3. Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy

    Tommaso Simoncini

  4. National Heart and Lung Institute, Imperial College London, London, UK

    John C. Stevenson

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Rocca, W.A. (2019). Sex, Gender, and the Decline of Dementia. In: Brinton, R., Genazzani, A., Simoncini, T., Stevenson, J. (eds) Sex Steroids' Effects on Brain, Heart and Vessels. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-030-11355-1_9

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