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Sex Differences in Alzheimer's Disease Blood Biomarkers in a Caribbean Population of African Ancestry: The Tobago Health Study

INTRODUCTION: Alzheimer’s disease is increasing in the Caribbean, especially for persons of African ancestry and women. However, studies have mostly utilized surveys without AD biomarkers.

METHODS: In the Tobago Health Study (n = 309; 109 women, mean age 70.3 ± 6.6),we assessed sex differences and risk factors for serum levels of phosphorylated tau-181 (p-tau181), amyloid-beta (Aβ)42/40 ratio, glial fibrillary acidic protein, and neurofilament light chain. Blood samples were from 2010 to 2013 for men and from 2019 to 2023 for women.

RESULTS: Women were more obese, hypertensive, and sedentary but reported less smoking and alcohol use than men (age-adjusted p < 0.04). Compared to men, women had worse levels of Alzheimer’s disease biomarkers, with higher p-tau181 and lower Aβ42/40, inde-pendent of covariates (p < 0.001). In sex-stratified analyses, higher p-tau181 was associated with older age in women and with hypertension in men. Glial fibrillary acidic protein and neurofilament light chain did not differ by sex.

DISCUSSION: Women had worse AD biomarkers than men, unexplained by age, cardiometabolic diseases, or lifestyle. Studying risk factors for Alzheimer’s disease in persons of African ancestry is warranted, especially for women earlier in life.

Rosano C, Karikari TK, Cvejkus R, Bellaver B, Ferreira PCL, Zmuda J, Wheeler V, Pascoal TA, Miljkovic I.
Rosano C and Karikari TK are co-first authors.
Alzheimer’s Dement. 2024;10:e12460.https://doi.org/10.1002/trc2.12460