Sex differences in brain atrophy in dementia with Lewy bodies

Alzheimers Dement. 2024 Mar;20(3):1815-1826. doi: 10.1002/alz.13571. Epub 2023 Dec 22.


Introduction: Sex influences neurodegeneration, but it has been poorly investigated in dementia with Lewy bodies (DLB). We investigated sex differences in brain atrophy in DLB using magnetic resonance imaging (MRI).

Methods: We included 436 patients from the European-DLB consortium and the Mayo Clinic. Sex differences and sex-by-age interactions were assessed through visual atrophy rating scales (n = 327; 73 ± 8 years, 62% males) and automated estimations of regional gray matter volume and cortical thickness (n = 165; 69 ± 9 years, 72% males).

Results: We found a higher likelihood of frontal atrophy and smaller volumes in six cortical regions in males and thinner olfactory cortices in females. There were significant sex-by-age interactions in volume (six regions) and cortical thickness (seven regions) across the entire cortex.

Discussion: We demonstrate that males have more widespread cortical atrophy at younger ages, but differences tend to disappear with increasing age, with males and females converging around the age of 75.

Highlights: Male DLB patients had higher odds for frontal atrophy on radiological visual rating scales. Male DLB patients displayed a widespread pattern of cortical gray matter alterations on automated methods. Sex differences in gray matter measures in DLB tended to disappear with increasing age.

Keywords: atrophy; dementia with Lewy bodies; magnetic resonance imaging; sex differences.

MeSH terms

  • Alzheimer Disease* / pathology
  • Atrophy / pathology
  • Cerebral Cortex / pathology
  • Female
  • Humans
  • Lewy Body Disease* / diagnostic imaging
  • Lewy Body Disease* / pathology
  • Magnetic Resonance Imaging
  • Male
  • Sex Characteristics