Sex Differences in Longitudinal Trajectories of Cognitive Aging in Zaragoza, Spain

Objectives: The objective of this study was to document the longitudinal trajec-tories of cognitive aging in a sample of cognitively healthy subjects of 55 years or older. The following differences between men and women were hypothesized: 1) in the cognitive loss through aging, 2) in the distinct trajectories identified; and 3) in the predictors associated with the identified trajectories. Design and setting: A 4-wave, population-based study in Zaragoza, Spain (1994-2006).Participants: A total of 2,403 individuals aged 55+ years, cognitively healthy at baseline.Measurements: All participants had at least three measurements with the Mini-Mental State Examination (MMSE). Validated Spanish versions of international instruments were used for assessment. Random effects linear panel regression model for analyzing differences by sex in MMSE scores through aging were performed, and growth mixture models (GMM) applied indepen-dently for each sex for modeling the longitudinal cognitive trajectories.Results: Women showed lower mean MMSE scores in all phases and signifi-cantly higher loss in the MMSE from phases 2 to 3 and 3 to 4. The best fitting age-adjusted model of the cognitive trajectories was a 4-class GMM in men and a 3-class in women. Education was a predictor of cognitive trajectories in both men and women. Dependence on iADLs and alcohol status were predictors only for men, and depression and diabetes only for women.Conclusions: The identified differences by sex in cognitive trajectories and their associated factors suggest that men and women may require a different strategy when addressing cognitive aging. (Am J Geriatr Psychiatry 2023; 31:796-807)