Sex differences in psychiatric disorders and their implication for dementia

Abstract

Abstract In this chapter we focus on sex- and gender-related aspects of psychiatric disorders as risk factors for dementia and outline major depression as a potentially modifiable risk factor of dementia. We pinpoint the twofold higher prevalence of depression in females over the entire adult life span and the current evidence of a different psychopathology in depressive disorders in males and females. A major concern in Alzheimer’s disease is behavioral and psychological symptoms of dementia (BPSD) that hamper the patient’s and caregiver’s wellbeing and often require hospitalization. The clinical presentation of BPSD seems to be sex- and gender-related, with males showing predominantly agitated and aggressive behaviors and with females suffering more from affective and psychotic symptoms. Nonpharmacologic management is the first-line recommendation to treat BPSD, although patients of both sexes often receive harmful polypharmacy. Antipsychotics need to be carefully prescribed with respect to their beneficial and detrimental effects, as they increase the mortality of patients with dementia and may result in a variety of harmful adverse side effects. Irrespective of disease status, females receive antipsychotics more frequently than males and, therefore, are at greater risk of pharmaceutical harm. Hence, prescribing antipsychotics in females needs our special focus to help improving the personalized treatment of psychiatric disorders. In addition, there is a need to reduce the stigma of mental disorders to help with diagnosing and treating major depression early on, thereby slowing down conversion to Alzheimer’s disease or dementia progression.