The impact of sex on the progression of AD atrophy‐based subtypes

Abstract

AbstractBackgroundRecently, longitudinal subtypes in AD have been identified based on their different brain atrophy trajectories (Poulakis et al. 2022 Nat Commun), which follow either mediotemporal or cortical pathways. The mediotemporal pathway, which is the most prevalent, includes three longitudinal subtypes: the limbic predominant plus (LPA+), the limbic predominant (LPA), and the minimal atrophy (MA) subtypes. While the LPA+ is characterised by the fastest rate of atrophy starting in the entorhinal cortex and later spreading to the temporal lobe and the rest of the cortex, the LPA is restrained to atrophy in temporal regions. The MA subtype, on the other side, is characterised by minimal atrophy in mediotemporal areas. Although the discovery of brain atrophy trajectories in AD represents a significant contribution towards precision medicine, the impact of sex – a major risk factor for AD – on these trajectories has yet to be explored.MethodWe used longitudinal magnetic resonance imaging data as well as clinical data (up to 5 timepoints) from 3 international AD cohorts (ADNI, J‐ADNI and AIBL). AD individuals had previously been identified, as one of the following longitudinal subtypes: LPA+ (N = 23, 61% females), LPA (N = 93, 48% females), and MA subtype (N = 189, 48% females). We applied linear mixed effect models (LMMs) on 34 cortical and 7 subcortical regions to assess differences in sex within each AD longitudinal subtype. Results were adjusted for ageing effects, cohort, disease duration and intracranial volume.ResultLPA+ females showed greater atrophy over time compared to LPA+ males in frontal regions as well as in the lingual and the parahippocampal gyri. LPA females tended to show greater atrophy in the medial orbitofrontal cortex compared to LPA males. Finally, within the MA subtype, females showed greater atrophy than males in the hippocampus over time.ConclusionThis study demonstrates that sex‐specific regional vulnerabilities are crucial to consider in the study of AD heterogeneity, particularly within the mediotemporal pathway. Our results reveal that females exhibit distinct atrophy patterns over time compared to males in different AD subtypes, emphasizing the importance of investigating sex‐related differences to develop more targeted and effective interventions for AD.