Review Article|Articles in Press

Sex-Specific Neurocognitive Impairment

Published:February 20, 2023DOI:


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Neurologic Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Attarian H.
        • Brandes J.
        • Dafer R.
        • et al.
        Sex Differences in the Study of Neurological Illnesses.
        Behav Neurol. 2015; 2015: 1-2
        • Levine D.A.
        • Gross A.L.
        • Briceño E.M.
        • et al.
        Sex differences in cognitive decline among US adults.
        JAMA Netw Open. 2021; 4: e210169
        • Mendrek A.
        Is It Important to Consider Sex and Gender in Neurocognitive Studies? Opinion.
        Front Psychiatr. 2015; 6
        • Gelman S.A.
        • Taylor M.G.
        Gender essentialism in cognitive development. Toward a feminist developmental.
        psychology. Taylor & Frances/Routledge, New York, NY2000: 169-190
        • Arnegard M.E.
        • Whitten L.A.
        • Hunter C.
        • et al.
        Sex as a Biological Variable: A 5-Year Progress Report and Call to Action.
        J Womens Health (Larchmt). 2020; 29: 858-864
        • National Academies of Sciences E, Medicine, Health
        • et al.
        The National Academies Collection: Reports funded by National Institutes of Health.
        in: Stroud C. Norris S.M.P. Bain L. Sex differences in brain disorders: emerging transcriptomic evidence: proceedings of a workshop. National Academies Press, US2021 (Copyright 2021 by the National Academy of Sciences. All rights reserved.)
        • Eggers S.
        • Sinclair A.
        Mammalian sex determination—insights from humans and mice.
        Chromosome Res. 2012; 20: 215-238
        • Fleming P.J.
        • Agnew-Brune C.
        Current trends in the study of gender norms and health behaviors.
        Current Opinion in Psychology. 2015; 5: 72-77
        • Roselli C.E.
        Neurobiology of gender identity and sexual orientation.
        J Neuroendocrinol. 2018; 30: e12562
        • Ainsworth C.
        Sex redefined.
        Nature. 2015; 518: 288-291
        • Mielke M.M.
        • Aggarwal N.T.
        • Vila-Castelar C.
        • et al.
        Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective.
        Alzheimer's Dementia. 2022;
      1. Farhadi-Langroudi K, Sargent K, Masuda A. Doubly Disenfranchised: An Acceptance-and Compassion-Based Approach to Being a Minority Within GSM Communities. Mindfulness and Acceptance for Gender and Sexual Minorities: A Clinician's Guide to Fostering Compassion, Connection, and Equality Using Contextual Strategies. 2016:247.

        • Stites S.D.
        • Cao H.
        • Harkins K.
        • et al.
        Measuring Sex and Gender in Aging and Alzheimer’s Research: Results of a National Survey.
        J Gerontol: Series B. 2022; 77: 1005-1016
        • Mauvais-Jarvis F.
        • Bairey Merz N.
        • Barnes P.J.
        • et al.
        Sex and gender: modifiers of health, disease, and medicine.
        Lancet. 2020/08/22/2020; 396: 565-582
        • Stites S.D.
        • Midgett S.
        • Mechanic-Hamilton D.
        • et al.
        Establishing a Framework for Gathering Structural and Social Determinants of Health in Alzheimer’s Disease Research Centers.
        Gerontol. 2022; 62: 694-703
        • Madsen T.E.
        • Hamilton R.
        Racial- and Gender-Based Disparities in IV-Alteplase Declination.
        Looking for Barriers and Biases When Patients Say No. 2022; 98: 647-648
        • Mendelson S.J.
        • Zhang S.
        • Matsouaka R.
        • et al.
        Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke.
        Neurology. 2022; 98: e1596-e1604
        • Pertl M.M.
        • Lawlor B.A.
        • Robertson I.H.
        • et al.
        Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study.
        J Geriatr Psychiatry Neurol. 2015; 28: 260-271
        • Norton M.C.
        • Smith K.R.
        • Østbye T.
        • et al.
        Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study.
        J Am Geriatr Soc. 2010; 58: 895-900
        • Vitaliano P.P.
        An Ironic Tragedy: Are Spouses of Persons with Dementia at Higher Risk for Dementia than Spouses of Persons without Dementia?.
        J Am Geriatr Soc. 2010; 58: 976-978
        • Hidalgo V.
        • Pulopulos M.M.
        • Salvador A.
        Acute psychosocial stress effects on memory performance: Relevance of age and sex.
        Neurobiol Learn Mem. 2019; 157: 48-60
        • Wu-Chung E.L.
        • Leal S.L.
        • Denny B.T.
        • et al.
        Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood.
        Neurosci Biobehav Rev. 2022; 134: 104487
        • Phelan J.C.
        • Link B.G.
        • Tehranifar P.
        Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications.
        J Health Soc Behav. 2010; 51: S28-S40
      2. Bronfenbrenner U. Ecological systems theory (1992). Making human beings human: Bioecological perspectives on human development, 2005, Sage Publications Ltd, Thousand Oaks, CA, 106–173.

        • Bronfenbrenner U.
        Ecological systems theory. Six theories of child development: revised formulations and current issues. Jessica Kingsley Publishers, London, England1992: 187-249
        • Wolfova K.
        • Csajbok Z.
        • Kagstrom A.
        • et al.
        Role of sex in the association between childhood socioeconomic position and cognitive ageing in later life.
        Sci Rep. 2021; 11
        • Hyde J.S.
        Gender Similarities and Differences.
        Annu Rev Psychol. 2014; 65: 373-398
        • Sundermann E.E.
        • Barnes L.L.
        • Bondi M.W.
        • et al.
        Improving Detection of Amnestic Mild Cognitive Impairment with Sex-Specific Cognitive Norms.
        J Alzheimers Dis. 2021; 84: 1763-1770
        • McCarrey A.C.
        • An Y.
        • Kitner-Triolo M.H.
        • et al.
        Sex differences in cognitive trajectories in clinically normal older adults.
        Psychol Aging. 2016; 31: 166-175
        • Kramer J.H.
        • Delis D.C.
        • Daniel M.
        Sex differences in verbal learning.
        J Clin Psychol. 1988; 44: 907-915
        • Aartsen M.J.
        • Martin M.
        • Zimprich D.
        Gender Differences in Level and Change in Cognitive Functioning.
        Gerontology. 2004; 50: 35-38
        • Pauls F.
        • Petermann F.
        • Lepach A.C.
        Gender differences in episodic memory and visual working memory including the effects of age.
        Memory. 2013; 21: 857-874
        • Sundermann E.E.
        • Maki P.M.
        • Rubin L.H.
        • et al.
        Female advantage in verbal memory: Evidence of sex-specific cognitive reserve.
        Neurology. 2016; 87: 1916-1924
        • Sundermann E.E.
        • Biegon A.
        • Rubin L.H.
        • et al.
        Does the Female Advantage in Verbal Memory Contribute to Underestimating Alzheimer's Disease Pathology in Women versus Men?.
        J Alzheimers Dis. 2017; 56: 947-957
        • Sundermann E.E.
        • Maki P.
        • Biegon A.
        • et al.
        Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI.
        Neurology. 2019; 93: e1881-e1889
        • Sano M.
        • Gandy S.
        Sex differences in cognition. Does the “fairer sex” need a fairer test?.
        Neurology. 2016; 86: 1364-1365
        • Biegon A.
        • Sundermann E.
        Considering Biological Sex in Neurological Research.
        Front Neurol. 2021; 12: 1139
        • Şahin Ö.
        • Soylu Yalcinkaya N.
        The Gendered Brain: Implications of Exposure to Neuroscience Research for Gender Essentialist Beliefs.
        Sex Roles. 2021; 84: 522-535
        • Anstey K.J.
        • Peters R.
        • Mortby M.E.
        • et al.
        Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20–76 years.
        Sci Rep. 2021; 11
        • Lipnicki D.M.
        • Crawford J.D.
        • Dutta R.
        • et al.
        Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study.
        PLoS Med. 2017; 14: e1002261
        • Pa J.
        • Aslanyan V.
        • Casaletto K.B.
        • et al.
        Effects of Sex, APOE4, and Lifestyle Activities on Cognitive Reserve in Older Adults.
        Neurology. 2022;
        • Lohner V.
        • Pehlivan G.
        • Sanroma G.
        • et al.
        The Relation Between Sex, Menopause, and White Matter Hyperintensities: The Rhineland Study.
        Neurology. 2022;
        • Utian W.H.
        Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: A comprehensive review.
        Health Qual Life Outcome. 2005; 3: 47
        • Curtis A.F.
        • Masellis M.
        • Camicioli R.
        • et al.
        Cognitive profile of non-demented Parkinson's disease: Meta-analysis of domain and sex-specific deficits.
        Parkinsonism Relat Disord. 2019; 60: 32-42
        • Cholerton B.
        • Johnson C.O.
        • Fish B.
        • et al.
        Sex differences in progression to mild cognitive impairment and dementia in Parkinson's disease.
        Park Relat Disord. 2018; 50: 29-36
        • Tipton P.W.
        • Bülbül N.
        • Crook J.
        • et al.
        Effects of sex and APOE on Parkinson’s Disease-related cognitive decline.
        Neurol Neurochir Pol. 2021; 55: 559-566
        • Hentosh S.
        • Zhu L.
        • Patino J.
        • et al.
        Sex Differences in Huntington's Disease: Evaluating the <scp>Enroll-HD</scp> Database.
        Movement Disorders Clinical Practice. 2021; 8: 420-426
        • Illán-Gala I.
        • Casaletto K.B.
        • Borrego-Écija S.
        • et al.
        Sex differences in the behavioral variant of frontotemporal dementia: A new window to executive and behavioral reserve.
        Alzheimer's Dementia. 2021; 17: 1329-1341
        • Gupte R.
        • Brooks W.
        • Vukas R.
        • et al.
        Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know.
        J Neurotrauma. 2019; 36: 3063-3091
        • Sundermann E.E.
        • Heaton R.K.
        • Pasipanodya E.
        • et al.
        Sex differences in HIV-associated cognitive impairment.
        Aids. 2018; 32: 2719-2726
        • Putatunda R.
        • Zhang Y.
        • Li F.
        • et al.
        Sex-specific neurogenic deficits and neurocognitive disorders in middle-aged HIV-1 Tg26 transgenic mice.
        Brain Behav Immun. 2019; 80: 488-499
        • Malorni W.
        The Long COVID: a new challenge for gender-specific medicine?.
        Italian Journal of Gender-Specific Medicine. 2021; 7: 59-60
        • Jensen A.
        • Castro A.W.
        • Ferretti M.T.
        • et al.
        Sex and gender differences in the neurological and neuropsychiatric symptoms of long COVID: a narrative review.
        Italian Journal of Gender-Specific Medicine. 2022; 8: 18-28
        • Sykes D.L.
        • Holdsworth L.
        • Jawad N.
        • et al.
        Post-COVID-19 Symptom Burden: What is Long-COVID and How Should We Manage It?.
        Lung. 2021; 199: 113-119
        • Matta J.
        • Wiernik E.
        • Robineau O.
        • et al.
        Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic.
        JAMA Intern Med. 2022; 182: 19
        • Bölte S.
        • Duketis E.
        • Poustka F.
        • et al.
        Sex differences in cognitive domains and their clinical correlates in higher-functioning autism spectrum disorders.
        Autism. 2011; 15: 497-511
        • Howlin P.
        • Goode S.
        • Hutton J.
        • et al.
        Adult outcome for children with autism.
        JCPP (J Child Psychol Psychiatry). 2004; 45: 212-229
        • Holtmann M.
        • Bölte S.
        • Poustka F.
        Autism spectrum disorders: Sex differences in autistic behaviour domains and coexisting psychopathology.
        Dev Med Child Neurol. 2007; 49: 361-366
        • van Schalkwyk G.I.
        • Klingensmith K.
        • Volkmar F.R.
        Gender identity and autism spectrum disorders.
        Yale J Biol Med. 2015; 88: 81-83
        • Loyer Carbonneau M.
        • Demers M.
        • Bigras M.
        • et al.
        Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits.
        J Atten Disord. 2021; 25: 1640-1656
        • Williamson D.
        • Johnston C.
        Gender differences in adults with attention-deficit/hyperactivity disorder: A narrative review.
        Clin Psychol Rev. 2015; 40: 15-27
        • Ayesa-Arriola R.
        • Setién-Suero E.
        • Neergaard K.D.
        • et al.
        Premorbid IQ subgroups in first episode non affective psychosis patients: Long-term sex differences in function and neurocognition.
        Schizophr Res. 2018; 197: 370-377
        • Navarra-Ventura G.
        • Fernandez-Gonzalo S.
        • Turon M.
        • et al.
        Gender Differences in Social Cognition: A Cross-Sectional Pilot Study of Recently Diagnosed Patients with Schizophrenia and Healthy Subjects.
        Can J Psychiatr. 2018; 63: 538-546
        • Roberts A.L.
        • Liu J.
        • Lawn R.B.
        • et al.
        Association of Posttraumatic Stress Disorder With Accelerated Cognitive Decline in Middle-aged Women.
        JAMA Netw Open. 2022; 5: e2217698
        • Sargent K.
        Intersecting and Multiple Identities in Behavioral Health.
        in: Benuto L. Duckworth M. Masuda A. O’Donohue W. Prejudice, Stigma, Privilege, and Oppression. Springer, Cham2020
        • Singer M.
        • Bulled N.
        • Ostrach B.
        • et al.
        Syndemics and the biosocial conception of health.
        Lancet. 2017/03/04/2017; 389: 941-950
        • Singer M.
        • Singer M.
        Brain Syndemics: Cognitive Deficit, Pathways of Interaction, and the Biology of Inequality.
        Neurol Neurobiol. 2021; : 1-12
        • Duchesne A.
        • Kaiser Trujillo A.
        Reflections on Neurofeminism and Intersectionality Using Insights From Psychology. Review.
        Front Hum Neurosci. 2021; 2021: 15