Sex and gender considerations in Alzheimer’s disease: The Women’s Brain Project contribution

The global population is expected to have about 131.5 million people living with Alzheimer’s disease (AD) and other dementias by 2050, posing a severe health crisis. Dementia is a progressive neurodegenerative condition that gradually impairs physical and cognitive functions. Dementia has a variety of causes, symptoms, and heterogeneity concerning the influence of sex on prevalence, risk factors, and outcomes. The proportion of male-to-female prevalence varies based on the type of dementia. Despite some types of dementia being more common in men, women have a greater lifetime risk of developing dementia. AD is the most common form of dementia in which approximately two-thirds of the affected persons are women. Profound sex and gender differences in physiology and pharmacokinetic and pharmacodynamic interactions have increasingly been identified. As a result, new approaches to dementia diagnosis, care, and patient journeys should be considered. In the heart of a rapidly aging worldwide population, the Women’s Brain Project (WBP) was born from the necessity to address the sex and gender gap in AD. WBP is now a well-established international non-profit organization with a global multidisciplinary team of experts studying sex and gender determinants in the brain and mental health. WBP works with different stakeholders worldwide to help change perceptions and reduce sex biases in clinical and preclinical research and policy frameworks. With its strong female leadership, WBP is an example of the importance of female professionals’ work in the field of dementia research. WBP-led peer-reviewed papers, articles, books, lectures, and various initiatives in the policy and advocacy space have profoundly impacted the community and driven global discussion. WBP is now in the initial phases of establishing the world’s first Sex and Gender Precision Medicine Institute. This review highlights the contributions of the WBP team to the field of AD. This review aims to increase awareness of potentially important aspects of basic science, clinical outcomes, digital health, policy framework and provide the research community with potential challenges and research suggestions to leverage sex and gender differences. Finally, at the end of the review, we briefly touch upon our progress and contribution toward sex and gender inclusion beyond Alzheimer’s disease

The association between extra-curricular sport participation and social anxiety symptoms in children

Social anxiety is a common psychological complaint that can have a significant and long-term negative impact on a child’s social and cognitive development. In the current study, the relationship between sport participation and social anxiety symptoms was investigated. Swiss primary school children (N = 201), parents, and teachers provided information about the children’s social anxiety symptoms, classroom behavior, and sport involvement. Gender differences were observed on social anxiety scores, where girls tended to report higher social anxiety symptoms, as well as on sport activity, where boys engaged in more sport involvement. MANCOVAs with gender as covariant showed no differences in social anxiety symptoms between children involved in an extracurricular sport and those not engaged in sport participation. Nevertheless, children engaged in team sports displayed fewer physical social anxiety symptoms than children involved in individual sports

Promoting gender equity in sport science

Gendered norms, stereotypes and biases implicitly influence our thoughts, attitudes and behaviours. These often lead to gender inequity, a phenomenon inherent in society and reflected in its various contexts. The increasing awareness of this inequity is leading to reflection and changes in society as a whole and its communities, organisations and institutions. In scientific disciplines, gender inequity has been, and still is, a point of discussion and consideration. In many cases, these discussions have led to positive and sustainable changes at both a structural as well as a policy level. This opinion piece discusses gender inequity in the context of sport science and, in particular, sport medicine in Switzerland. Specifically, academic position (professorships), first authorship of peer-reviewed publications in the SEMS-Journal as well as conference participation and scientific awards in two Swiss sport science organisations: Sportwissenschaftliche Gesellschaft der Schweiz (SGS) and Sport & Exercise Medicine Switzerland (SEMS) in terms of frequency are presented and discussed. An under-representation of women is observed in most categories. Finally, recommendations for promoting and supporting equity while maintaining an objective consideration of quality criteria and individual ability are put forward using examples of good practice.Geschlechtsspezifische Normen, Stereotypen und Vorurteile beeinflussen implizit unsere Gedanken, Einstellungen und Verhaltensweisen. Diese führen oft zu Geschlechterungleichheit, einem Phänomen, das der Gesellschaft inhärent ist und sich in ihren verschiedenen Kontexten widerspiegelt. Das zunehmende Bewusstsein für diese Ungleichheit führt zu Überlegungen und Veränderungen in der Gesellschaft als Ganzes und in ihren Gemeinschaften, Organisationen und Institutionen. In wissenschaftlichen Disziplinen war und ist die Ungleichheit der Geschlechter ein Punkt, der diskutiert und bedacht wird. In vielen Fällen haben diese Diskussionen zu positiven und nachhaltigen Veränderungen sowohl auf struktureller als auch auf politischer Ebene geführt. In diesem Opinion Paper wird die Ungleichheit der Geschlechter im Kontext der Sportwissenschaft und insbesondere der Sportmedizin in der Schweiz diskutiert. Konkret geht es um die akademische Position (Professuren), die Erstautorenschaft von «peer-reviewed» Publikationen in der Zeitschrift SEMS sowie um Konferenzteilnahmen und wissenschaftliche Auszeichnungen in zwei Schweizer Sportwissenschaftlichen Organisationen: Sportwissenschaftliche Gesellschaft der Schweiz (SGS) und Sport & Exercise Medicine Switzerland (SEMS) werden in Bezug auf die Geschlechtsverteilung vorgestellt und diskutiert. In den meisten Kategorien ist eine Unterrepräsentation von Frauen zu beobachten. Abschliessend werden Empfehlungen zur Förderung und Unterstützung der Chancengleichheit unter Beibehaltung einer objektiven Berücksichtigung von Qualitätskriterien und individuellen Fähigkeiten anhand von Good-Practice-Beispielen gegeben

No sports – no mental health? Analysis of longitudinal effects in SHP data.

Results from the Zurich study have shown lasting associations between sport practice and mental health. The effects are pronounced in people with pre-exising mental health problems. This analysis aims to replicate these results with the large Swiss Household Panel data set and to provide more differentiated results. The analysis covered the interviews 1999-2003 and included 3891 stayers, i.e., participants who were interviewed in all years. The outcome variables are depression / blues / anxiety, weakness / weariness, sleeping problems, energy / optimism. Confounding variables include sex, age, education level, citizenship. The analyses were carried out with mixed models (depression, optimism) and GEE models (weakness, sleep). About 60% of the SHP participants practise weekly or daily an individual or a team sport. A similar proportion enjoys a frequent physical activity (for half an hour minimum) which makes oneself slightly breathless. There are slight age-specific differences but also noteworthy regional differences. Practice of sport is clearly interrelated with self-reported depressive symptoms, optimism and weakness. This applies even though some relevant confounders – sex, educational level and citizenship – were introduced into the model. However, no relevant interaction effects with time could be shown. Moreover, direct interrelations commonly led to better fits than models with lagged variables, thus indicating that delayed effects of sport practice on the self-reported psychological complaints are less important. Model variants resulted for specific subgroups, for example, participants with a high vs. low initial activity level. Lack of sport practice is an interesting marker for serious psychological symptoms and mental disorders. The background of this association may differ in different subgroups, and should stimulate further investigations in this area

Sex differences in Alzheimer disease - the gateway to precision medicine

Alzheimer disease (AD) is characterized by wide heterogeneity in cognitive and behavioural syndromes, risk factors and pathophysiological mechanisms. Addressing this phenotypic variation will be crucial for the development of precise and effective therapeutics in AD. Sex-related differences in neural anatomy and function are starting to emerge, and sex might constitute an important factor for AD patient stratification and personalized treatment. Although the effects of sex on AD epidemiology are currently the subject of intense investigation, the notion of sex-specific clinicopathological AD phenotypes is largely unexplored. In this Review, we critically discuss the evidence for sex-related differences in AD symptomatology, progression, biomarkers, risk factor profiles and treatment. The cumulative evidence reviewed indicates sex-specific patterns of disease manifestation as well as sex differences in the rates of cognitive decline and brain atrophy, suggesting that sex is a crucial variable in disease heterogeneity. We discuss critical challenges and knowledge gaps in our current understanding. Elucidating sex differences in disease phenotypes will be instrumental in the development of a 'precision medicine' approach in AD, encompassing individual, multimodal, biomarker-driven and sex-sensitive strategies for prevention, detection, drug development and treatment