A new study shows standard cognitive screening tools used to monitor Alzheimer’s disease may not reflect underlying brain changes in the same way for women and men—and these differences could matter in clinical care. It also suggests doctors may need to interpret common tests differently for each sex.
The problem starts with standard screening tools like the 30-point Mini-Mental State Examination, or MMSE. Mild cognitive impairment (MCI) is an intermediate stage between normal aging and Alzheimer’s disease—and this research suggests that, for women, a good MMSE score during that stage may not fully reflect underlying brain changes.
To understand why, researchers at Georgie State University analyzed brain scans from 332 people at different stages of the disease. In men, the brain showed more shrinkage earlier in the disease’s progression, from normal cognitive health to MCI. In women, the brain showed steeper and more widespread decline from MCI to Alzheimer’s disease.
The findings suggest, in woman, the brain may be compensating in ways that help maintain cognitive performance earlier in the disease. Their cognitive scores were tied to a broader range of brain regions than men’s, suggesting the brain may be recruiting additional areas to support performance. That may help explain why structural brain changes and cognitive scores may not align in the same way for women and men.
The work lays a foundation for the next phase of research, including tracking patients over time and examining how hormones and genetics influence these differences.
“If this line of research succeeds, the larger impact would be a move away from a one-size-fits-all framework for Alzheimer’s disease,” said Mukesh Dhamala, the study’s senior author and a professor of physics and neuroscience at Georgia State University. “Diagnosis could become more sex-informed, biomarkers could be interpreted differently in men and women, and treatment trials could be designed with the understanding that disease timing and brain vulnerability may not be the same across sexes.”
Data from Georgia State University