Sex Differences in the Clinical Presentation of Prodromal Dementia with Lewy Bodies

Abstract

AbstractBackgroundSex is an important biological variable which can influence the prevalence, clinical presentation, and progression of neurodegenerative diseases. Little is known regarding possible sex differences in prodromal dementia with Lewy bodies (DLB).MethodWe analyzed data from the National Alzheimer’s Coordinating Center’s Uniform Data Set (NACC database is funded by NIH U01‐AG016976). Annual visits occurred across 39 past/present Alzheimer’s Disease Research Centers (ADRC) between September 2005 and September 2021. We included non‐demented participants at baseline who were clinically diagnosed with DLB by ADRC staff at a subsequent visit. The presence of motor symptoms, visual hallucinations, REM sleep behavior disorder (RBD), cognitive fluctuations, and neuropsychiatric symptoms were assessed through clinical exam and informant responses 1–2 years prior to DLB diagnosis.ResultWe identified 160 participants with DLB (82.5% male). Male and female groups differed in age and ethnicity (Table 1).There were no differences in education, cognition, functional status, severity of neuropsychiatric symptoms, or number of visits prior to phenoconversion to DLB.RBD was more prevalent in men (58‐62% vs. 25–36% women). Cognitive fluctuations were also more common among men (33‐40% vs. 6–18% women). Men reported a higher prevalence of visual hallucinations 2‐years prior to dementia diagnosis (23% vs. 6% women), but visual hallucinations were more prevalent in women than men at the first visit with dementia diagnosis (54% women vs. 43% men). Motor slowing and parkinsonian gait were prevalent among both groups; however, tremor and rigidity were more common in men, while postural instability and falls were more frequent in women. Apathy was common in both groups; however, anxiety was more frequent in men, and women had a higher prevalence of depression. (Table 2). The groups did not differ in rates of 1 vs. 2+ core clinical features 1‐year prior to diagnosis (Table 3).ConclusionThis descriptive analysis appears to indicate there are sex differences in the prodromal presentation of DLB. Men may present with established core features earlier than women. Limitations include lack of pathological confirmation and the number of female and ethno‐racially diverse participants. Understanding differences in clinical presentations may inform diagnostic criteria and therefore improve clinical sensitivity.