Sex and Gender Differences in Alzheimer's Disease

Sex and Gender Differences in Alzheimer's Disease

1st Edition - July 23, 2021

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  • Editors: Maria Teresa Ferretti, Annemarie Schumacher Dimech, Antonella Santuccione Chadha
  • eBook ISBN: 9780128193457
  • Hardcover ISBN: 9780128193440

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Description

Sex and Gender Differences in Alzheimer’s Disease: The Women’s Brain Project offers for the first time a critical overview of the evidence documenting sex and gender differences in Alzheimer’s disease neurobiology, biomarkers, clinical presentation, treatment, clinical trials and their outcomes, and socioeconomic impact on both patients and caregivers. This knowledge is crucial for clinical development, digital health solutions, as well as social and psychological support to Alzheimer’s disease families, in the frame of a precision medicine approach to Alzheimer’s disease.This book brings together up-to-date findings from a variety of experts, covering basic neuroscience, epidemiology, diagnosis, treatment, clinical trials development, socioeconomic factors, and psychosocial support. Alzheimer’s disease, the most common form of dementia, remains an unmet medical need for the planet. Wide interpersonal variability in disease onset, presentation, and biomarker profile make Alzheimer’s a clinical challenge to neuroscientists, clinicians, and drug developers alike, resulting in huge management costs for health systems and society. Not only do women represent the majority of Alzheimer’s disease patients, but they also represent two-thirds of caregivers. Understanding sex and gender differences in Alzheimer’s disease will lead to novel insights into disease mechanisms, and will be crucial for personalized disease management strategies and solutions, involving both the patient and their family. Endorsements/Reviews: "There is a clear sex and gender gap in outcomes for brain health disorders like Alzheimer’s disease, with strikingly negative outcomes for women. This understanding calls for a more systematic way of approaching this issue of inequality. This book effectively highlights and frames inequalities in all areas across the translational spectrum from bench-to-bedside and from boardroom-to-policy and economics. Closing the Brain Health Gap will help economies create recovery and prepare our systems for future global shocks." Harris A. Eyre MBBS, PhD, co-lead, Neuroscience-inspired Policy Initiative, OECD and PRODEO Institute. Instructor in Brain Health Diplomacy, Global Brain Health Institute, UCSF and TCD. "Sex and Gender Differences in Alzheimer's disease is the most important title to emerge on Alzheimer's disease in recent years.This comprehensive, multidisciplinary book is a must read for anyone with a serious interest in dementia prevention, diagnosis, treatment, care, cure and research. Precision medicine is the future of healthcare and this book represents an incredible and necessary resource to guide practice, policy and research in light of the fact that Alzheimer's disease disproportionately affects women. The combination of contributions from the most eminent experts and the most up-to-date research makes this an invaluable resource for clinicians, care providers, academics, researchers and policy makers. Given the complex nature of dementia and the multiple factors that influence risk and disease trajectory the scope of the book is both impressive and important covering sex differences in neurobiological processes, sex and gender differences in clinical aspects and gender differences linked to socioeconomic factors relevant to Alzheimer's disease. If you work in Alzheimer's disease, or indeed other dementias, then Sex and Gender Differences in Alzheimer's disease is a must have for your bookshelf." -- Sabina Brennan, PhD., C.Psychol.,PsSI., National representative for Ireland on Alzheimer Disease International's Medical and Scientific Advisory Panel

Key Features

  • Provides a comprehensive and critical review of sex differences in Alzheimer’s disease
  • Features discussion of sex and gender differences in disease biology, treatment, and socioeconomic factors, including impact on caregivers
  • Combines the knowledge and points-of-view of neuroscientists, medical doctors, psychologists, policymakers, health scientists, and clinical trial experts, for a 360-degree view on the topic and its possible implications
  • Edited by the Women’s Brain Project, the leading NGO in the field of sex and gender differences in brain and mental health as the gateway to precision medicine

Readership

Neurologists, neuroscientists, psychiatrists, psychologists, nurses, advanced practice practitioners and medical ethicists

Table of Contents

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • Dedication
  • Contributors
  • Acknowledgments
  • Introduction
  • Editors’ biography
  • Foreword
  • Section 1: Sex differences in fundamental neurobiological processes that are relevant to Alzheimer’s disease
  • Introduction
  • Chapter 1: Sex differences in Alzheimer’s disease animal models
  • Abstract
  • Overview of Alzheimer’s disease
  • AD animal models
  • Evidence for sex differences in AD animal models
  • Limitations
  • Conclusion
  • Chapter highlights
  • Chapter 2: Sex and sex hormone differences in hippocampal neurogenesis and their relevance to Alzheimer’s disease
  • Abstract
  • Introduction
  • Adult neurogenesis in the dentate gyrus
  • The function of adult neurogenesis in the hippocampus
  • Neurogenesis and aging
  • Sex differences in neurogenesis
  • Sex differences in neurogenesis in the context of cognitive training
  • Alzheimer’s disease
  • Sex differences in Alzheimer’s disease
  • Animal models for Alzheimer’s disease and sex differences
  • Neurogenesis in Alzheimer’s disease
  • Neurogenesis in models of Alzheimer’s disease
  • Estrogens and aging
  • Estrogens and neurogenesis
  • Estrogens and neurogenesis in the context of aging
  • Estrogens, aging, and cognition
  • Estrogens and neurogenesis in the context of Alzheimer’s disease
  • Parity and neurogenesis
  • Parity and Alzheimer’s disease
  • Testosterone and neurogenesis
  • Testosterone and neurogenesis in the context of aging and Alzheimer’s disease
  • Conclusion
  • Chapter highlights
  • Chapter 3: Sex differences in microglia as a risk factor for Alzheimer’s disease
  • Abstract
  • Introduction
  • Microglia: Protection and pathology in Alzheimer’s disease
  • Protective functions of microglia in Alzheimer’s disease
  • Detrimental roles of microglia in Alzheimer’s disease
  • Neuroinflammation
  • Sex differences in the immune system
  • Sex differences in microglia
  • Aging microglia
  • Interactions between AD, sex, and inflammation in the aged brain
  • Conclusion
  • Chapter highlights
  • Section 2: Sex and gender differences in clinical aspects of Alzheimer’s disease
  • Introduction
  • Chapter 4: Sex differences in CSF biomarkers of Alzheimer’s disease
  • Abstract
  • Introduction
  • Sex differences in brain structure and function
  • Sex differences in the core AD-related biomarkers
  • Sex differences in CSF biomarkers of other mechanisms related to the development and progression of AD pathology and clinical symptoms
  • Examples of sex-related factors that can influence the interpretation of AD-related biofluid biomarker results
  • Future potential of blood-based biomarkers
  • Conclusion
  • Chapter highlights
  • Chapter 5: Sex differences in neuroimaging biomarkers in healthy subjects and dementia
  • Abstract
  • Introduction
  • Structural MRI
  • Functional MRI
  • Perfusion SPECT
  • DAT SPECT
  • FDG-PET
  • Amyloid PET
  • Emerging PET modalities
  • Conclusion
  • Chapter highlights
  • Chapter 6: Sex and gender differences in neuropsychological symptoms for clinical diagnosis of Alzheimer’s disease
  • Abstract
  • Support
  • Introduction
  • Memory
  • Language
  • Executive function
  • Conclusion
  • Chapter highlights
  • Chapter 7: Sex differences in psychiatric disorders and their implication for dementia
  • Abstract
  • Psychiatric disorders matter as modifiable risk factors for dementia over the entire life span
  • Major depression: A relevant modifiable risk factor for dementia with sex- and gender-related implications
  • Pharmacotherapy in the elderly: A major challenge with the risk of detrimental polypharmacy
  • Behavioral and psychological symptoms of dementia
  • Conclusion
  • Chapter highlights
  • Chapter 8: Sleep disorders and dementia
  • Abstract
  • Why do we spend a third of life sleeping? An introduction to sleep and its main characteristics
  • Sleep disorders and physiological sleep changes during aging
  • Sex- and gender-related differences in sleep and sleep disorders
  • Sleep disorders in Alzheimer’s disease
  • Key points
  • Insomnia: An independent risk factor for cognitive impairment
  • Key points
  • Obstructive sleep apnea syndrome: A risk factor for cognitive impairment and Alzheimer’s disease
  • Key points
  • REM sleep behavior disorder: A relevant parasomnia and an early clinical biomarker for neurodegenerative diseases
  • Key points
  • Conclusion
  • Chapter highlights
  • Chapter 9: Hormones and dementia
  • Abstract
  • Sex differences are hormone differences
  • Hormones and cognition
  • Menopause and cognition
  • Observational studies of hormone therapy use
  • Interventional HT use
  • Hormone therapy in younger women
  • Hormones and cognition in men
  • Gaps in knowledge
  • Conclusion
  • Chapter highlights
  • Chapter 10: Sex and gender differences in genetic and lifestyle risk and protective factors for dementia
  • Abstract
  • Funding
  • Introduction
  • APOE allele
  • Hormones, menopause, and andropause
  • Andropause
  • Cardiometabolic risk factors
  • Smoking and alcohol consumption
  • Physical activity and exercise
  • Nutrition
  • Sleep disturbances
  • Neural reserve and resilience
  • The stress axes
  • Loneliness and social isolation
  • Depression
  • Response and adherence to multidomain lifestyle interventions
  • Discussion
  • Chapter highlights
  • Chapter 11: Sex and gender considerations in clinical trials for Alzheimer’s disease: Current state and recommendations
  • Abstract
  • Introduction
  • Sex considerations in preclinical stages of clinical trials
  • Sex and gender considerations in clinical trial stages involving human subjects
  • Sex and gender considerations in Alzheimer’s disease clinical trials
  • Conclusion
  • Recommendations for considering sex and gender in clinical trials
  • Chapter highlights
  • Section 3: Gender differences in the socio-economic factors linked to Alzheimer’s disease
  • Introduction
  • Chapter 12: Gender and socioeconomic differences in modifiable risk factors for Alzheimer’s disease and other types of dementia throughout the life course
  • Abstract
  • Inequality in early educational achievement
  • Inequality in behavioral risk factors: Obesity and physical activity
  • Inequality in clinical risk factors: Hypertension and diabetes
  • Social support, social isolation, and depression
  • Discussion
  • Chapter highlights
  • Chapter 13: Living with dementia and caregiving: Psychosocial considerations through the gender lens
  • Abstract
  • Introduction
  • Family dynamics in the context of caregiving in individuals living with dementia
  • Psychosocial interventions for individuals living with dementia and their caregivers
  • The influence of gender on psychosocial interventions for behavioral and psychological symptoms in dementia and Alzheimer’s disease
  • Conclusion
  • Chapter highlights
  • Chapter 14: Sex and gender differences in caregiving patterns and caregivers’ needs
  • Abstract
  • What are the patterns of care?
  • What are the implications of providing dementia care?
  • Why do we observe different outcomes for male and female caregivers?
  • Identified key support needs
  • Barriers to support
  • Is this likely to change in future?
  • Chapter highlights
  • Chapter 15: Gender barriers to communication in Alzheimer’s disease
  • Abstract
  • Introduction
  • Communication: Grounding concepts
  • Ethical implications of effective communication
  • Gender issues in IHC in general and implications for AD
  • General strategies for communication with dementia and Alzheimer’s patients
  • Communicating with caregivers of AD patients
  • A research agenda in AD, gender, and communication
  • Ten lessons learned about health communication avoiding gender biases in AD
  • Conclusion
  • Chapter highlights
  • Chapter 16: Women and dementia policy: Redressing imbalance through gender transformative policies
  • Abstract
  • Acknowledging the imbalance: Where we are now
  • Understanding the imbalance: How did we get here
  • Addressing the imbalance: How do we change and move forward?
  • Conclusion
  • Chapter highlights
  • Index

Product details

  • No. of pages: 512
  • Language: English
  • Copyright: © Academic Press 2021
  • Published: July 23, 2021
  • Imprint: Academic Press
  • eBook ISBN: 9780128193457
  • Hardcover ISBN: 9780128193440

About the Editors

Maria Teresa Ferretti

Dr. Maria Teresa Ferretti is a neuroscientist and neuroimmunologist, expert in Alzheimer’s disease and gender medicine. In 2016, together with Dr. Schumacher-Dimech, Dr. Santuccione Chadha and Gautam Maitra, she co-founded the nonprofit organization “Women’s Brain Project” (where she currently serves as Chief Scientific Officer), a world leader in the study of sex and gender characteristics in brain and mental health as the gateway to precision medicine. After graduating in Chemical and Pharmaceutical Technologies at University of Cagliari (Italy), she studied and worked in England, Canada (where she earned a PhD in Pharmacology and Pharmacological Therapy at McGill University in Montreal), Switzerland and Austria. Her studies have been published in numerous peer-reviewed journals, including Nature, and she is regularly invited by leading scientific conferences to lecture on Alzheimer’s disease, precision medicine and the differences between men and women in neurology and psychiatry. She has taught in numerous university courses and is currently ‘External Teacher’ at the Medical University of Vienna; in addition, Dr. Ferretti is responsible for continuous medical education courses in the field of gender and precision medicine. Passionate about scientific communication and motivated by the desire to break the stigma on mental and brain diseases, she was a TED-x speaker in 2019 and in 2021; in 2021, together with Antonella Santuccione Chadha, she wrote the book for the general public ‘Una bambina senza testa’ (Edizioni Mondo Nuovo).

Affiliations and Expertise

Co-founder and Chief Scientific Officer, Women’s Brain Project, Guntershausen, Switzerland

Annemarie Schumacher Dimech

Dr. Annemarie Schumacher Dimech obtained her first psychology degree with honors from the University of Malta, and holds an MSc in Health Psychology from the University of Surrey (UK) as a Chevening Scholar. In 2010, she obtained her PhD at the University of Bern. Her fascination with the interaction between body and mind motivates her to study physical and environmental factors affecting brain and mental health. The sex and gender differences in various socioeconomic and psychological factors affecting brain and mental health was Dr. Schumacher Dimech’s motivation to join forces with Antonella Santuccione Chadha, Maria Teresa Ferretti, and Gautam Maitra to found the Women’s Brain Project. In her pro bono work with the Women’s Brain Project, she contributes a psychosocial perspective to various WBP activities including educational events as well as publications, research, and other scientific events. Today, she is employed at the University of Lucerne where she developed and is heading its programme of further education in Palliative Care and is currently President of Women's Brain Project.

Affiliations and Expertise

Co-founder and President, Women’s Brain Project, Guntershausen, Switzerland; Program Manager, Palliative Care, University of Lucerne, Lucerne, Switzerland

Antonella Santuccione Chadha

Dr. Antonella Santuccione Chadha is a medical doctor with expertise in clinical pathology, neuroscience and psychiatric disorders. She is head of stakeholder engagement for Alzheimer’s disease at Biogen. She is co-founder and CEO of the non-profit organization “Women’s Brain Project” which is addressing the influence of sex and gender on mental and brain diseases. She is the Vice-president of Euresearch. As a medical doctor, Antonella has decades of experience in preclinical research, patient treatment, clinical development, medical affairs and setting up the international regulatory framework for Alzheimer’s disease. Always focused on solving the puzzles related to Alzheimer’s and other psychiatric diseases, she has worked with Swissmedic, the Bill and Melinda Gates Foundation, several European universities, the EU Commission Directorate for Health and Food Safety, the World Health Organization, the CEOi and several Alzheimer’s’ disease Organizations. Since 2018 she is listed among the top 100 Women in Business in Switzerland and in 2019 she has been elected Woman of the Year in Switzerland by the Magazine "Women in Business". In 2020, she received the World Sustainability Award for her involvement in advancing Precision Medicine. She also received the award “Premio Medicina Italia” for her contribution to the management of the pandemic. Dr. Santuccione Chadha is keenly interested in removing bias when developing solutions for mental and neurological diseases to achieve precision medicines.

Affiliations and Expertise

CEO pro Bono Women’s Brain Project, Guntershausen, Switzerland; Head of Stakeholder Engagement for Alzheimer’s Disease Biogen International. Vice-President at Euresearch, Switzerland

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