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Sex differences in the behavioral variant of frontotemporal dementia: A new window to executive and behavioral reserve. 2021
Ignacio Illán-Gala, and
Kaitlin B Casaletto, and
Sergi Borrego-Écija, and
Eider M Arenaza-Urquijo, and
Amy Wolf, and
Yann Cobigo, and
Sheng Yang M Goh, and
Adam M Staffaroni, and
Daniel Alcolea, and
Juan Fortea, and
Rafael Blesa, and
Jordi Clarimon, and
Maria Florencia Iulita, and
Anna Brugulat-Serrat, and
Albert Lladó, and
Lea T Grinberg, and
Katherine Possin, and
Katherine P Rankin, and
Joel H Kramer, and
Gil D Rabinovici, and
Adam Boxer, and
William W Seeley, and
Virginia E Sturm, and
Maria Luisa Gorno-Tempini, and
Bruce L Miller, and
Raquel Sánchez-Valle, and
David C Perry, and
Alberto Lleó, and
Howard J Rosen
Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Biological sex is an increasingly recognized factor driving clinical and structural heterogeneity in Alzheimer's disease, but its role in the behavioral variant of frontotemporal dementia (bvFTD) is unknown. We included 216 patients with bvFTD and 235 controls with magnetic resonance imaging (MRI) from a large multicenter cohort. We compared the clinical characteristics and cortical thickness between men and women with bvFTD and controls. We followed the residuals approach to study behavioral and cognitive reserve. At diagnosis, women with bvFTD showed greater atrophy burden in the frontotemporal regions compared to men despite similar clinical characteristics. For a similar amount of atrophy, women demonstrated better-than-expected scores on executive function and fewer changes in apathy, sleep, and appetite than men. Our findings suggest that women might have greater behavioral and executive reserve than men, and neurodegeneration must be more severe in women to produce symptoms similar in severity to those in men.
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