Gender differences in cognitive reserve: implication for subjective cognitive decline in women

Giulia Giacomucci, Salvatore Mazzeo, Sonia Padiglioni, Silvia Bagnoli, Laura Belloni, Camilla Ferrari, Laura Bracco, Benedetta Nacmias, Sandro Sorbi, Valentina Bessi, Giulia Giacomucci, Salvatore Mazzeo, Sonia Padiglioni, Silvia Bagnoli, Laura Belloni, Camilla Ferrari, Laura Bracco, Benedetta Nacmias, Sandro Sorbi, Valentina Bessi

Abstract

Background: Subjective Cognitive Decline (SCD) is a self-experienced decline in cognitive capacity with normal performance on standardized cognitive tests, showing to increase risk of Alzheimer's Disease (AD). Cognitive reserve seems to influence the progression from SCD to Mild Cognitive Impairment (MCI) and to AD. The aim of our study was to investigate gender differences in cognitive reserve evaluating how sex might modulate the role of cognitive reserve on SCD.

Methods: We included 381 SCD patients who underwent clinical evaluation, neuropsychological assessment, evaluation of premorbid intelligence by the Test di Intelligenza Breve (TIB), cognitive complaints by the Memory Assessment Clinics Questionnaire (MAC-Q), and apolipoprotein E (APOE) genotyping.

Results: The proportion between women and men was significantly different (68.7% [95% CI 63.9-73.4 vs 31.4%, 95% CI 26.6-36.0]). Women were younger than men at onset of SCD and at the baseline visit (p = 0.021), had lower years of education (p = 0.007), lower TIB scores (p < 0.001), and higher MAC-Q scores (p = 0.012). TIB was directly associated with age at onset of SCD in both women and men, while years of education was inversely associated with age at onset only in women. Multivariate analysis showed that sex influences TIB independently from years of education. TIB was directly associated with MAC-Q in men.

Conclusions: Sex interacts with premorbid intelligence and education level in influencing the age at onset and the severity of SCD. As the effect of education was different between men and women, we speculated that education might act as a minor contributor of cognitive reserve in women.

Keywords: Cognitive reserve; Gender differences; Sex; Subjective cognitive decline.

Conflict of interest statement

No authors report any conflicts of interest for this study.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Sex difference of the correlation between premorbid intelligence and years of education. Scatter plots with lines of best fit (95% CI) show the relationship between TIB and years of education. The correlation between TIB and years of education was significant both in men (Spearman’s rho 0.753, p < 0.001) and in women (Spearman’s rho 0.754, p < 0.001)
Fig. 2
Fig. 2
Interaction between gender and cognitive reserve proxies on age at onset of SCD and cognitive complaints. (A) Age at onset: opposite effect of premorbid intelligence and education in women. Scatter plots with lines of best fit (95% CI) show the relationship between age at onset and years of education (a) and TIB (b). The correlation between age at onset of SCD and years of education was significant in women (Spearman’s rho − 0.259, p < 0.001). The correlation between age at onset of SCD and TIB was significant in men (Spearman’s rho 0.292, p = 0.005). (B) MAC-Q: effect of premorbid intelligence in men. Scatter plots with lines of best fit (95% CI) show the relationship between MAC-Q and years of education (a) and TIB (b)

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