Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis
Abstract Background Neuropsychiatric symptoms (NPS) are common in individuals with Alzheimer’s disease (AD) dementia, but substantial heterogeneity exists in the manifestation of NPS. Sex differences may explain this clinical variability. We aimed to investigate the sex differences in the prevalence...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Alzheimer’s Research & Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13195-022-00991-z |
| _version_ | 1828734176582434816 |
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| author | Willem S. Eikelboom Michel Pan Rik Ossenkoppele Michiel Coesmans Jennifer R. Gatchel Zahinoor Ismail Krista L. Lanctôt Corinne E. Fischer Moyra E. Mortby Esther van den Berg Janne M. Papma |
| author_facet | Willem S. Eikelboom Michel Pan Rik Ossenkoppele Michiel Coesmans Jennifer R. Gatchel Zahinoor Ismail Krista L. Lanctôt Corinne E. Fischer Moyra E. Mortby Esther van den Berg Janne M. Papma |
| author_sort | Willem S. Eikelboom |
| collection | DOAJ |
| description | Abstract Background Neuropsychiatric symptoms (NPS) are common in individuals with Alzheimer’s disease (AD) dementia, but substantial heterogeneity exists in the manifestation of NPS. Sex differences may explain this clinical variability. We aimed to investigate the sex differences in the prevalence and severity of NPS in AD dementia. Methods Literature searches were conducted in Embase, MEDLINE/PubMed, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar from inception to February 2021. Study selection, data extraction, and quality assessment were conducted in duplicate. Effect sizes were calculated as odds ratios (OR) for NPS prevalence and Hedges’ g for NPS severity. Data were pooled using random-effects models. Sources of heterogeneity were examined using meta-regression analyses. Results Sixty-two studies were eligible representing 21,554 patients (61.2% females). The majority of the included studies had an overall rating of fair quality (71.0%), with ten studies of good quality (16.1%) and eight studies of poor quality (12.9%). There was no sex difference in the presence of any NPS (k = 4, OR = 1.35 [95% confidence interval 0.78, 2.35]) and overall NPS severity (k = 13, g = 0.04 [− 0.04, 0.12]). Regarding specific symptoms, female sex was associated with more prevalent depressive symptoms (k = 20, OR = 1.60 [1.28, 1.98]), psychotic symptoms (general psychosis k = 4, OR = 1.62 [1.12, 2.33]; delusions k = 12, OR = 1.56 [1.28, 1.89]), and aberrant motor behavior (k = 6, OR = 1.47 [1.09, 1.98]). In addition, female sex was related to more severe depressive symptoms (k = 16, g = 0.24 [0.14, 0.34]), delusions (k = 10, g = 0.19 [0.04, 0.34]), and aberrant motor behavior (k = 9, g = 0.17 [0.08, 0.26]), while apathy was more severe among males compared to females (k = 11, g = − 0.10 [− 0.18, − 0.01]). There was no association between sex and the prevalence and severity of agitation, anxiety, disinhibition, eating behavior, euphoria, hallucinations, irritability, and sleep disturbances. Meta-regression analyses revealed no consistent association between the effect sizes across studies and method of NPS assessment and demographic and clinical characteristics. Discussion Female sex was associated with a higher prevalence and greater severity of several specific NPS, while male sex was associated with more severe apathy. While more research is needed into factors underlying these sex differences, our findings may guide tailored treatment approaches of NPS in AD dementia. |
| first_indexed | 2024-04-12T22:43:41Z |
| format | Article |
| id | doaj.art-5a800028bc714bf7a31e97c2c258c089 |
| institution | Directory Open Access Journal |
| issn | 1758-9193 |
| language | English |
| last_indexed | 2024-04-12T22:43:41Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj.art-5a800028bc714bf7a31e97c2c258c0892022-12-22T03:13:38ZengBMCAlzheimer’s Research & Therapy1758-91932022-04-0114111310.1186/s13195-022-00991-zSex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysisWillem S. Eikelboom0Michel Pan1Rik Ossenkoppele2Michiel Coesmans3Jennifer R. Gatchel4Zahinoor Ismail5Krista L. Lanctôt6Corinne E. Fischer7Moyra E. Mortby8Esther van den Berg9Janne M. Papma10Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical CenterDepartment of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical CenterDepartment of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical CentersDepartment of Psychiatry, Erasmus MC University Medical CenterDivision of Geriatric Psychiatry, McLean Hospital, Harvard Medical SchoolDepartments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute, University of CalgaryDepartment of Psychiatry, University of TorontoDepartment of Psychiatry, University of TorontoSchool of Psychology, University of New South WalesDepartment of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical CenterDepartment of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical CenterAbstract Background Neuropsychiatric symptoms (NPS) are common in individuals with Alzheimer’s disease (AD) dementia, but substantial heterogeneity exists in the manifestation of NPS. Sex differences may explain this clinical variability. We aimed to investigate the sex differences in the prevalence and severity of NPS in AD dementia. Methods Literature searches were conducted in Embase, MEDLINE/PubMed, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar from inception to February 2021. Study selection, data extraction, and quality assessment were conducted in duplicate. Effect sizes were calculated as odds ratios (OR) for NPS prevalence and Hedges’ g for NPS severity. Data were pooled using random-effects models. Sources of heterogeneity were examined using meta-regression analyses. Results Sixty-two studies were eligible representing 21,554 patients (61.2% females). The majority of the included studies had an overall rating of fair quality (71.0%), with ten studies of good quality (16.1%) and eight studies of poor quality (12.9%). There was no sex difference in the presence of any NPS (k = 4, OR = 1.35 [95% confidence interval 0.78, 2.35]) and overall NPS severity (k = 13, g = 0.04 [− 0.04, 0.12]). Regarding specific symptoms, female sex was associated with more prevalent depressive symptoms (k = 20, OR = 1.60 [1.28, 1.98]), psychotic symptoms (general psychosis k = 4, OR = 1.62 [1.12, 2.33]; delusions k = 12, OR = 1.56 [1.28, 1.89]), and aberrant motor behavior (k = 6, OR = 1.47 [1.09, 1.98]). In addition, female sex was related to more severe depressive symptoms (k = 16, g = 0.24 [0.14, 0.34]), delusions (k = 10, g = 0.19 [0.04, 0.34]), and aberrant motor behavior (k = 9, g = 0.17 [0.08, 0.26]), while apathy was more severe among males compared to females (k = 11, g = − 0.10 [− 0.18, − 0.01]). There was no association between sex and the prevalence and severity of agitation, anxiety, disinhibition, eating behavior, euphoria, hallucinations, irritability, and sleep disturbances. Meta-regression analyses revealed no consistent association between the effect sizes across studies and method of NPS assessment and demographic and clinical characteristics. Discussion Female sex was associated with a higher prevalence and greater severity of several specific NPS, while male sex was associated with more severe apathy. While more research is needed into factors underlying these sex differences, our findings may guide tailored treatment approaches of NPS in AD dementia.https://doi.org/10.1186/s13195-022-00991-zAlzheimer’s diseaseBehavioral and psychological symptoms of dementiaBehavioral symptomsMeta-analysisNeuropsychiatrySex |
| spellingShingle | Willem S. Eikelboom Michel Pan Rik Ossenkoppele Michiel Coesmans Jennifer R. Gatchel Zahinoor Ismail Krista L. Lanctôt Corinne E. Fischer Moyra E. Mortby Esther van den Berg Janne M. Papma Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis Alzheimer’s Research & Therapy Alzheimer’s disease Behavioral and psychological symptoms of dementia Behavioral symptoms Meta-analysis Neuropsychiatry Sex |
| title | Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis |
| title_full | Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis |
| title_fullStr | Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis |
| title_full_unstemmed | Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis |
| title_short | Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis |
| title_sort | sex differences in neuropsychiatric symptoms in alzheimer s disease dementia a meta analysis |
| topic | Alzheimer’s disease Behavioral and psychological symptoms of dementia Behavioral symptoms Meta-analysis Neuropsychiatry Sex |
| url | https://doi.org/10.1186/s13195-022-00991-z |
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