Influence of sex on tau distribution across Braak stages in the Alzheimer's disease spectrum

Abstract

Sex differences in Alzheimer's disease (AD) phenotypes are well documented. Wang et al. examined sex-specific tau propagation across Braak neurofibrillary tangle stages in an Alzheimer's Disease Neuroimaging Initiative cohort, while considering cognitive and amyloid status, using longitudinal tau-PET imaging. They found that females exhibit faster tau spread and accelerated clinical decline in advanced stages. While the study offers valuable insights, factors such as neuroimaging-pathology discordance, coexisting conditions, and limited cohort diversity warrant caution before making broad generalizations. Nonetheless, these findings highlight sex-dependent AD trajectories and reinforce the need for precision medicine and timely, individualized interventions to improve outcomes and address biological variability in disease progression.