Are There Sex Differences in sociodemographic background and cognitive Functions Among Patients With dementia,a comparative study among an Egyptian sample. Ashour A. MD, Abd-Elrazek Gh. MD, Mahmoud A. MD, Hewedi D. MD.

Introduction

Sex difference in the degenerative dementias not well established until now and the prevalence of dementia still is the same in males and females except for dementia of Alzheimer ’ s type, which is reported to be higher in females.

But, several studies based on prevalent cases of dementia report a higher frequency of dementia in women compared with men. However, these finding may reflect differences between men and women in survival after dementia is detected.

Material and method

p. 22 males and 26 females patient selected from memory clinic which is a special outpatient psychogeriatric clinic diagnosed to have dementia with its different subtypes according to ICD10 symptoms check list, the total sample was screened with brief cognitive tests, and screen positives were investigated in a follow-up diagnostic assessment for assessment of different cognitive function, laboratory and radiological investigation were done if indicated.

Subjects

Subjects include those attending the memory clinic at the Ain Shams institute of psychiatry complaining of cognitive impairment, from march 2003 to march 2005, with the following Inclusion criteria : Age : above the age of 50 years. Nationality : of Egyption nationality. The individuals must be coming mainly with memory impairment as their primary presenting symptom.

Exclusion criteria: Difficult uncooperative patient due to –Late stage of dementia –Patient with aphasia. –Other causes.

Procedures

Study proper An information consent had obtained from each individual or their care givers. Full psychiatric assessment using symptoms chick list of ICD10 in order to obtain diagnosis according to ICD10 criteria for research. Full Neurological examination had done according to Ain-Shams university hospital neurological sheet. Full medical examination.

Mini-Mental State Examination was administered ( the Arabic version ) (MMSE): The MMSE is found to be valid and reliable in assessing a limited range of cognitive functions in a global way. This was followed by assessment of cognitive function using CAMCOG scale (Arabic version of cognitive section of CAMDEX scale).

which measures the following cognitive functions: Memory (learning, recent & remote memory ). Language (expression & comprehension Attension.Praxis.Calculation. Abstraction ( perception & thinking). Orientation. Neuropsychological assessment using Wchseler memory scale revised battery (WMS- R) which comprises eleven subtests measuring the following cognitive function: Attention & concentration. Verbal memory. Visual memory (performance ). General or total memory. Recall. Neuroimaging if indicated (CT brain, MRI ….ect). Laboratory investigation if indicated.

Statistical analysis

Statistical analysis was carried out by using means and SDs, analysis of variance by one way (ANOVA) test with repeated measures. Frequency distributions were calculated with chi- square tests `

Results

Table ( 1 ):shows the number & percent of patient diagnosed as dementia with its subtype attending the memory clinic through the period of research %NoDiagnoses Dementia of alz type 23.6%*13* Dementia of alz type with early onset 40%**22** Dementia of alz type with late onset 16.4%9 Multi-infarcts dementia 12.7%7 Pick ’ s disease 3.6%2 Lewy bodies dementia 3.6%2 Subcortical dementia

Table ( 1 ) : shows that Dementia of alz type with late onset was the commonest cognitive disorder presented to our clinic during this peroid

Table ( 2 ) : shows the distribution of dementia subtypes through defferent age groups Total % 80 < % 70 – 79 % 60 – 69 % 50 – 59 % 40 – 49 % 13 (23.6%) -5 (9.1%) -6 (10.9%)** 2 (3.6%) Dementia of alz type with early onset 22 (40%) 10 (18.2%)11 (20%)**-- Dementia of alz type with late onset 9 (16.4%) -6 (10.9%)** 2 (3.6%) - Multi- infarcts dementia 7 (12.7%) -1 (1.8%)6 (10.9%)**- Pick’s disease 2 (3.6%) ---2 (3.6%) - Lewy bodies dementia 2 (3.6%) ---1 (1.8%) 1 (1.8%) Subcortica l dementia.

Table ( 2 ) shows that: Dementia of alz type with early onset more common at the age from 50 – 59. Dementia of alz type with late onset was more common at the age from 70 – 79 Multi-infarcts dementia was more common at the age from 70 – 79

Figure (1): Gender percentage distribution of the studied group.

Figure (2): education percentage distribution of the female studied group

Figure (3): education percentage distribution of the male studied group

Table ( 3 ): the relation between dementia subtypes and gender. FemaleMale Diagnosis 5 (9.1%)8 (14.5%*) Dementia of alz type with early onset 15 (27.3%)*7 (12.7%) Dementia of alz type with late onset 3 (5.5%)6 (10.9%*) Multi-infarcts dementia 2 (3.6%)5 (9.1%) Pick’s disease 2 (3.6%)- Lewy bodies dementia. -2 (3.6%) Subcortical dementia.

This table shows the number of each gender group in each dementia subtype: The number of female patient diagnosed as Dementia of alz type with late onset were more than males while it was less than males in Dementia of alz type with early onset & Multi-infarcts dementia.

The data obtained from cognitive assessment and follow up clinically revealed that : Symptoms profiles and cognitive decline were to some extend similar in both males and females, but by follow up the course and rate of deterioration was slowly in women than in men and the response to medication, symptoms improvement, prognosis and mortality rate were better in females.

Discussion &Conclusion

We examined gender differences in a sample of demented patient attending the memory clinic through 2 years. Our analyses suggest that dementia of Alzheimer type with late onset appears to be more in females, this difference is due to a higher risk in women for AD. In addition to that by follow up of these patients we found that the course of progression, prognosis and outcome were better in females than in males. However the number of males attending memory clinic diagnosed as dementia with its different subtypes were more than females which may attributed to the following factors: The males considered as the caring of their families in Arab countries. So, the social & occupational deterioration rapidly noticed in males than females. Higher level of education in males than females in our countries increase the level of their awareness and early detection of their cognitive changes, however the low level of education is known to influence performance on cognitive screening tests resulting in higher proportion of screen positives among women. However, diagnosis was based on subsequent clinical examination, informant interviews, and more detailed neuropsychological testing these procedures would reduce the chance of diagnostic bias.

Many studies reported gender effects on cerebral glucose metabolic patterns, and that there was a strong correlation between brain adrenal axis activity and cognitive impairment in women but not in men. However, the more credited explanation for the gender difference relates to hormonal influences effects on cerebral glucose metabolic patterns.

Estrogen stimulates the action and viability of cholinergic neurons; it modulates axonal elongation and promotes the formation of dendritic spines and synapses, it promotes the breakdown of the amyloid precursor protein. In addition, estrogen has antioxidant properties and modifies some aspects of the inflammatory response mechanisms that have been implicated in the pathology of AD, Finally, estrogen increases cerebral glucose utilization and cerebral blood flow.

so from these studies we can revealed that before menopause, estrogen delay the incidence of AD, while after that the incidence is nearly the same.

In our finding we reported that multi- infarcts dementia is more common among male sex (66.7%) in our society this may be due to men are more liable to cerebrovascular insult due to the higher incidence of hypertension, diabetes, atheresclerosis, hypercholesterolemia that are considered as important risk factors for brain vascular insult on males more than females.