Gender Differences on a Brief Measure of Cognitive Functioning in Alzheimer's Disease

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Abstract
• Objective. —We evaluated scores on a brief psychometric screening instrument—the Mini-Mental State Examination (MMSE)—for possible effects of gender, hypothesizing that women with Alzheimer's disease (AD) would perform more poorly than men. A significant gender difference was to be explored with post hoc item analyses. Design. —Case-study design. A hierarchical regression procedure controlled for the possible influence on MMSE performance of demographic variables (eg, age, duration of dementia symptoms, education, and family history of dementia) before the effect of gender was analyzed. Setting. —Data were gathered by trained neuropsychological examiners from subjects enrolled in the Alzheimer's Disease Research Center at the University of Southern California, Los Angeles. Subjects. —One hundred forty-two subjects who met strict criteria for probable AD and 121 nondemented elderly subjects were included in the study. All subjects underwent periodic neuropsychological testing. We extracted MMSE scores and demographic data to test the hypothesis that women would perform more poorly than men on the MMSE. Criterion Measure. —The MMSE was chosen because of its wide use in clinical and research settings to screen for the presence or severity of dementia. Results. —After controlling for the demographic variables for subjects with AD, we observed a significant difference in the predicted direction for total MMSE score, but there was no significant gender effect on the MMSE for the nondemented elderly sample. Among subjects with AD, gender-associated differences were limited to only a subset of MMSE items. Conclusions. —Results imply that MMSE performance may differ between men and women with AD and that differences might pertain only to discrete areas of cognitive functioning. Although gender effects were relatively small, findings indicate the relevance of gender to studies of AD.