Do males and females show distinct symptoms in Alzheimer's disease and behavioral variant frontotemporal dementia?
Bibliographic record
Abstract
BACKGROUND: An imbalanced sex ratio has been reported in sporadic behavioral variant frontotemporal dementia (bvFTD), along with differences in clinical symptoms between sporadic and genetic cases, particularly in females. We hypothesize that some females without genetic mutations may be misdiagnosed with Alzheimer's disease (AD) due to atypical bvFTD symptom presentation. METHOD: We examined participants with probable or possible AD from the National Alzheimer's Coordinating Center (NACC) dataset (N = 11,286, 5,923 females and 5,363 males). Sex differences in neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q), and cognitive function was evaluated across major domains using standardized cognitive tests. Subgroup analyses were conducted for early-onset AD (age < 65 years, n = 1,465) and late-onset AD (n = 9,821). Analyses were corrected for age, disease severity, and education years. RESULT: Females exhibited more severe executive deficits (F (4, 11281) = 932.8, |β| = 0.084, p < 0.001) and depression (F (4, 11281) = 112.4, |β| = 0.080, p < 0.001) compared to males (Figure 1); while males exhibited more severe irritability (F (4, 11281) = 134.9, |β| = 0.15, p < 0.001), apathy (F (4, 11281) = 474.4, |β| = 0.14, p < 0.001), disinhibition (F (4, 11281) = 174.4, |β| = 0.062, p < 0.001), agitation (F (4, 11281) = 199, |β| = 0.067, p < 0.001) and nighttime behavioral disturbances (F (4, 11281) = 92.28, |β| = 0.072, p < 0.001). Males with early-onset AD were particularly more severe in symptoms of motor behavior disturbances, disinhibition and delusions. CONCLUSION: These findings reveal sex-related differences in the presentation of behavioral and cognitive symptoms in AD, with females displaying more executive deficits, and males exhibiting more behavioral disturbances. These differences may contribute to diagnostic misclassification, particularly in females with atypical bvFTD-like symptoms. Improved recognition of sex-related symptom variability is crucial for enhancing diagnostic accuracy and ensuring appropriate clinical management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".