Structural volume and cortical thickness differences between males and females in cognitively normal, cognitively impaired and Alzheimer's dementia population

Age- and Sex-Specific Patterns in Adult Brain Network Segregation

The human brain is organized into several segregated associative and sensory functional networks, each responsible for various aspects of cognitive and sensory processing. These functional networks become less segregated over the adult lifespan, possibly contributing to cognitive decline that is observed during advanced age. To date, a comprehensive understanding of decreasing network segregation with age has been hampered by (1) small sample sizes, (2) lack of investigation at different spatial scales, (3) the limited age range of participants, and more importantly (4) an inadequate consideration of sex (biological females and males) differences. This study aimed to address these shortcomings. Resting-state functional magnetic resonance imaging data were collected from 357 cognitively intact participants (18.2-91.8 years; 49.9 ± 17.1 years; 27.70 ± 1.72 MoCA score, 203 [56.8%] females), and the segregation index (defined as one minus the ratio of between-network connectivity to within-network connectivity) was calculated at three spatial scales of brain networks: whole-brain network, intermediate sensory and associative networks, as well as core visual (VIS), sensorimotor (SMN), frontoparietal (FPN), ventral attention (VAN), dorsal attention (DAN), and default mode networks (DMN). Where applicable, secondary within-, between-, and pairwise connectivity analyses were also conducted to investigate the origin of any observed age and sex effects on network segregation. For any given functional metric, linear and quadratic age effects, sex effects, and respective age by sex interaction effects were assessed using backwards iterative linear regression modeling. Replicating previous work, brain networks were found to become less segregated across adulthood. Specifically, negative quadratic decreases in whole-brain network, intermediate associative network, VAN, and DMN segregation index were observed. Intermediate sensory networks, VIS, and SMN exhibited negative linear decreases in segregation index. Secondary analysis revealed that this process of age-related functional reorganization was preferential as functional connectivity was observed to increase either between anatomically adjacent associative networks (DMN-DAN, FPN-DAN) or between anterior associative and posterior sensory networks (VIS-DAN, VIS-DMN, VIS-FPN, SMN-DMN, and SMN-FPN). Inherent sex differences in network segregation index were also observed. Specifically, whole-brain, associative, DMN, VAN, and FPN segregation index was greater in females compared to males, irrespective of age. Secondary analysis found that females have reduced functional connectivity between associative networks (DAN-VAN, VAN-FPN) compared to males and independent of age. A notable linear age-related decrease in FPN SI was also only observed for females and not males. The observed findings support the notion that functional networks reorganize across the adult lifespan, becoming less segregated. This decline may reflect underlying neurocognitive aging mechanisms like neural dedifferentiation, inefficiency, and compensation. The aging trajectories and rates of decreasing network segregation, however, vary across associative and sensory networks. This study also provides preliminary evidence of inherent sex differences in network organization, where associative networks are more segregated in females than males. These inherent sex differences suggest that female functional networks may be more efficient and functionally specialized compared to males across adulthood. Given these findings, future studies should take a more focused approach to examining sex differences across the lifespan, incorporating multimodal methodologies.

Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status

PURPOSE

Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density.

METHOD

Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables.

RESULTS

The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally.

CONCLUSIONS

The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels.

WHAT IS ALREADY KNOWN ON THIS SUBJECT

Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels.

WHAT THIS STUDY ADDS

The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education.

CLINICAL IMPLICATIONS OF THIS STUDY

This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24905046.

Impact of sex and APOE-ε4 genotype on patterns of regional brain atrophy in Alzheimer's disease and healthy aging

Alzheimer's Disease (AD) is a heterogeneous disease that disproportionately affects women and people with the APOE-ε4 susceptibility gene. We aim to describe the not-well-understood influence of both risk factors on the dynamics of brain atrophy in AD and healthy aging. Regional cortical thinning and brain atrophy were modeled over time using non-linear mixed-effect models and the FreeSurfer software with t1-MRI scans from the Alzheimer's Disease Neuroimaging Initiative (N = 1,502 subjects, 6,728 images in total). Covariance analysis was used to disentangle the effect of sex and APOE genotype on the regional onset age and pace of atrophy, while correcting for educational level. A map of the regions mostly affected by neurodegeneration is provided. Results were confirmed on gray matter density data from the SPM software. Women experience faster atrophic rates in the temporal, frontal, parietal lobes and limbic system and earlier onset in the amygdalas, but slightly later onset in the postcentral and cingulate gyri as well as all regions of the basal ganglia and thalamus. APOE-ε4 genotypes leads to earlier and faster atrophy in the temporal, frontal, parietal lobes, and limbic system in AD patients, but not in healthy patients. Higher education was found to slightly delay atrophy in healthy patients, but not for AD patients. A cohort of amyloid positive patients with MCI showed a similar impact of sex as in the healthy cohort, while APOE-ε4 showed similar associations as in the AD cohort. Female sex is as strong a risk factor for AD as APOE-ε4 genotype regarding neurodegeneration. Women experience a sharper atrophy in the later stages of the disease, although not a significantly earlier onset. These findings may have important implications for the development of targeted intervention.

Relationship of sex differences in cortical thickness and memory among cognitively healthy subjects and individuals with mild cognitive impairment and Alzheimer disease

BACKGROUND

An aging society has increased rates of late onset Alzheimer disease dementia (ADD), the most common form of age-related dementia. This neurodegenerative disease disproportionately affects women.

METHODS

We use data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to examine sex differences in cortical thickness (CT) and memory performance. Analyses of covariance (ANCOVA) models were used to examine effects of sex and diagnosis (DX) on CT and verbal memory. For regions demonstrating significant interaction effects of sex and DX, we tested whether sex moderated cognition-thickness relationships. We used machine learning as a complementary method to explore multivariate CT differences between women and men.

RESULTS

Women demonstrated greater CT in many brain regions. More specifically, men showed relatively consistent CT declines in all stages, from normal control (NC) to ADD in the bilateral cingulate cortex, bilateral temporal regions, and left precuneus; women had more stable CT in these regions between NC and mild cognitive impairment (MCI) stages, but sharper declines from MCI to ADD. Similarly, for the Rey Auditory Verbal Learning Test (RAVLT), ANCOVA analyses showed that women had significantly better immediate and delayed recall scores than men, at NC and MCI stages, but greater differences, cross-sectionally, from MCI to ADD than men. We found significant sex moderation effects between RAVLT-immediate scores and CT of right isthmus-cingulate for all subjects across DX. Partial correlation analyses revealed that increased CT of right isthmus-cingulate was associated with better verbal learning in women, driven by positron emission tomography defined amyloid positive (Aβ+) subjects. Significant sex-moderation effects in cognition-thickness relationships were further found in the right middle-temporal, left precuneus, and left superior temporal regions in Aβ+ subjects. Using a machine learning approach, we investigated multivariate CT differences between women and men, showing an accuracy in classification of 75% for Aβ+ cognitively NC participants.

CONCLUSIONS

Sex differences in memory and CT can play a key role in the different vulnerability and progression of ADD in women compared to men. Machine learning indicates sex differences in CT are most relevant early in the ADD neurodegeneration.