Introduction Sex differences in dementia with Lewy bodies (DLB) have been reported in clinically defined cohorts; however, clinical diagnostic accuracy in DLB is suboptimal and phenotypic differences have not been assessed in pathologically confirmed participants.
Methods Core DLB features were compared across 55 women and 156 men with pathologically defined DLB in the National Alzheimer’s Coordinating Center. These analyses were repeated for 55 women and 55 men matched for age, education and tau burden.
Results In the total sample, women died older, had fewer years of education, had higher tau burden but were less likely to be diagnosed with dementia and clinical DLB. In the matched sample, visual hallucinations continued to be less common in women, and fewer women met clinical DLB criteria.
Discussion Sex impacts clinical manifestations of underlying pathologies in DLB. Despite similar underlying Lewy body pathology, women are less likely to manifest core DLB features and may be clinically underdiagnosed.
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Contributors EB conceptualised the study, acquired, analysed and interpreted the data, drafted and revised the manuscript. DGC contributed to design of the analysis, interpretation of data and revising the work. SJB contributed to conceptualisation of the study, interpretation of data and revising the work. IL contributed to design of the analysis, interpretation of data and revising the work. All authors have seen and approved the final version. All authors have confidence in the integrity of the work and of the contributions of their coauthors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DGC: supported by the American Academy of Neurology, American Brain Foundation, and the Parkinson’s Foundation Clinical Research Training Scholarship in Parkinson’s disease (2059) and by NIA P30AG 062429.
SJB: consulting relationship with Boston University on the DIAGNOSE CTE project (U01NS093334); and research funding from the NIA/NIH (R01AG066088), Alzheimer’s Association and California Department of Public Health.
IL: supported by the National Institutes of Health grants: 2R01AG038791-06A, U01NS090259, U01NS100610, U01NS80818, R25NS098999, P20GM109025; U19 AG063911-1; 1R21NS114764-01A1; Michael J Fox Foundation, Lewy Body Association, Abbvie, Biogen, Centogene, Roche, EIP-Pharma and Biohaven Pharmaceuticals. She was member of a Lundbeck Advisory Board. She receives her salary from the University of California San Diego and is the Chief Editor of Frontiers in Neurology.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The data were made available to the authors by the NACC database and may be obtained following the approval of a data request to the NACC database.
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