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• W2898075969 abstract "Organizational and activational effects of sex steroid hormones (i.e., estradiol and progesterone) contribute to sex differences in cognition, including verbal episodic memory. For example, prospective cohort studies have demonstrated decreases in verbal memory as women transition from premenopausal to perimenopausal stages of the menopausal transition, even after controlling for age and menopausal symptoms. Neuroimaging studies suggest that estrogen-induced alterations in the hippocampus and prefrontal cortex may contribute to these effects. Recent works shows that these sex differences in cognition and brain aging contribute to sex differences in the presentation and clinical course of Alzheimer's disease (AD). In a series of studies, we examined the implications of these sex differences in the diagnosis of amnestic mild cognitive impairment (aMCI) and AD. First, sex differences in cognition and neuroimaging outcomes (hippocampal volume, brain hypometabolism, and cortical amyloid-β (Aβ) plaque burden) were examined in a series of studies drawing on the Alzheimer's Disease Neuroimaging Initiative (ADNI). Second, we applied sex-adjusted cut-scores for verbal memory impairment to determine if they improved the accuracy of aMCI and AD diagnosis when compared to conventional cut-scores. There, diagnostic accuracy was assessed using positivity rates for the cerebrospinal fluid (CSF) phosphorylated tau (p-tau)/Amyloid-β (Aβ) ratio. For each of three neuroimaging biomarkers, women and men showed similarly moderate levels of disease burden despite better verbal memory performance in women. At high levels of disease burden, the female advantage was eliminated. The application of sex-adjusted cut-scores resulted in improved diagnostic accuracy; positivity rates for the p-tau/Aβ ratio levels were appropriately high for newly classified impaired individuals and appropriately low for newly classified unimpaired individuals. This enhanced diagnostic accuracy in both sexes (i.e., more “true positive” women and fewer “false positive” men). These findings suggest that the female advantage in verbal memory serves as a form of cognitive reserve that can mask underlying AD pathology in the aMCI stage. The application of sex-adjusted cut-scores for verbal memory may result in earlier detection of memory impairment in women and improved diagnostic accuracy in women and men." @default.
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• W2898075969 date "2018-07-01" @default.
• W2898075969 modified "2023-10-16" @default.
• W2898075969 title "F2‐01‐04: INTERSECTION BETWEEN REPRODUCTIVE AGING AND BRAIN AGING" @default.
• W2898075969 doi "https://doi.org/10.1016/j.jalz.2018.06.2614" @default.
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