Sex, gender, and the brain

Abstract

Background: Invited lecture.Objective: To discuss new concepts related to differences between men and women in their experience of neurological diseases. As an example, I use dementia or Alzheimer’s disease (AD), and I focus on risk and protective factors.Material and methods: This is a narrative review of the literature; therefore, Institutional Review Board (IRB) approval was not necessary. First, I introduce the concept of dimorphic neurology and the distinction between sex (biological) and gender (social-cultural). Second, I provide three examples of risk factors related to sex and gender from the literature.Results: Apolipoprotein E genotype is equally common in men and women but increases the risk of AD more strongly in women than in men. Apolipoprotein E genotype is a biological factor that may not be modified directly, but it interacts with sex or gender related factors that may be modified. Low education increases the risk of dementia in both men and women; however, women historically have had less access to education. Education is a social-cultural factor related to gender that may be modified. Finally, bilateral oophorectomy is a factor restricted to women. Bilateral oophorectomy is a surgical practice related to sex that may be modified.Conclusions: Consideration of risk and protective factors in men and women separately may accelerate etiologic research for neurological diseases in general, and for dementia in particular. In addition, future preventive interventions for dementia should consider both sex and gender factors (Mielke et al., Clin Epidemiol 2014; Rocca et al., Maturitas 2014). Background: Invited lecture. Objective: To discuss new concepts related to differences between men and women in their experience of neurological diseases. As an example, I use dementia or Alzheimer’s disease (AD), and I focus on risk and protective factors. Material and methods: This is a narrative review of the literature; therefore, Institutional Review Board (IRB) approval was not necessary. First, I introduce the concept of dimorphic neurology and the distinction between sex (biological) and gender (social-cultural). Second, I provide three examples of risk factors related to sex and gender from the literature. Results: Apolipoprotein E genotype is equally common in men and women but increases the risk of AD more strongly in women than in men. Apolipoprotein E genotype is a biological factor that may not be modified directly, but it interacts with sex or gender related factors that may be modified. Low education increases the risk of dementia in both men and women; however, women historically have had less access to education. Education is a social-cultural factor related to gender that may be modified. Finally, bilateral oophorectomy is a factor restricted to women. Bilateral oophorectomy is a surgical practice related to sex that may be modified. Conclusions: Consideration of risk and protective factors in men and women separately may accelerate etiologic research for neurological diseases in general, and for dementia in particular. In addition, future preventive interventions for dementia should consider both sex and gender factors (Mielke et al., Clin Epidemiol 2014; Rocca et al., Maturitas 2014).