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Sex-Specific Scoring Could Alter Mild Cognitive Impairment Diagnoses

Cognitive decline

Accounting for gender on memory tests may change the diagnosis for 20 percent of those currently diagnosed with mild cognitive impairment (MCI), with possibly more women and fewer men being diagnosed with MCI, according to a new study published online in the journal Neurology. Co-author Anat Biegon, PhD, Director of the Center on Gender, Hormones and Health, at the Renaissance School of Medicine at Stony Brook University, says if these results are confirmed, the process for testing men and women for dementia ultimately could change.

Cognitive decline
Women may be underdiagnosed with MCI.

MCI, considered a precursor to dementia, is when people have memory and thinking skill problems. Because women typically score higher than men on tests of verbal memory, they may not be diagnosed with MCI as early as men are when they have the same levels of Alzheimer’s disease-related brain changes, such as the amount of amyloid plaque deposits in the brain or amount of shrinkage in the hippocampus area of the brain.

In the study, researchers used memory test scores based on sex instead of averages for both men and women. Using the sex-specific scores, they found that 10 percent more women were diagnosed with MCI and 10 percent fewer men were diagnosed with MCI than when the averages were used.

“There are numerous implications to our findings if they are confirmed,” says Biegon, also a Professor of Radiology and Neurology, a co-author on the study.

These implications, she says, include:

  • If women are inaccurately identified as having no problems with memory and thinking skills when they actually have mild cognitive impairment, then treatments are not being started early enough, and they and their families are not planning ahead for their care or financial or legal situations.
  • If men are inaccurately diagnosed with mild cognitive impairment, they can be exposed to unneeded medications along with undue stress for them and their families,” she explains.

The study involved 985 people from the Alzheimer’s Disease Neuroimaging Initiative. All of the participants took a verbal memory test that involves learning a list of 15 unrelated words and recalling as many as possible in five immediate tests, where scores range from zero to 75, and also after learning another list and then a 30- minute delay, where scores range from zero to 15.

Overall, using typical scores bases on averages across men and women, 26 percent of women were diagnosed with MCI and 45 percent of men were diagnosed with MCI. With sex-specific scores, 36 percent of women, and 35 percent of men, respectively, were diagnosed with MCI.

The study was supported in part by the National Institutes of Health.

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