Sex and gender differences in Alzheimer's disease: current challenges and implications for clinical practice: Position paper of the Dementia and Cognitive Disorders Panel of the European Academy of Neurology

Alzheimer's disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual's sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.

Idiopathic intracranial hypertension: a retrospective clinical study

BACKGROUND

Idiopathic intracranial hypertension is a disorder characterized by an increased intracranial pressure, without deformity and obstruction of the ventricular system. There is a predilection of occurrence in obese women of childbearing age. The pathogenesis of idiopathic intracranial hypertension is likely related to abnormalities in the balance between production and drainage of cerebrospinal fluid. Diagnosis is made by excluding the known causes of elevated intracranial pressure.

OBJECTIVE

To evaluate the features, possible causes, treatment, and incidence of idiopathic intracranial hypertension as seen in patients attending our Department of Neurology.

METHODS

We retrospectively analysed a group of patients diagnosed with idiopathic intracranial hypertension in our Department of Neurology during a twenty-year period (1989 to 2008).

RESULTS

In six patients we confirmed the diagnosis of idiopathic intracranial hypertension during this period. Five of them were females and one was male, the average age of the patients was 32.30 years (22 to 52). The calculated incidence of idiopathic intracranial hypertension in our group was 0.15 per 100,000 persons. Out of these six persons there were four cases diagnosed in the last five years, changing the calculated incidence to 0.4 per 100,000 persons in this period. The average body mass index in our patients was 26.33 kg/m2 (20.1 to 31.38).

CONCLUSION

We suppose that the increased incidence of idiopathic intracranial hypertension in our patients in the last five years has been associated with an advance in diagnostics. With literary data, half of our patients were obese or overweighted, but all of them underwent also hormonal treatment, some had iron deficiency and one of them was pregnant (Tab. 3, Fig. 1, Ref. 17). Full Text in free PDF www.bmj.sk.