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      Sex and Gender Driven Modifiers of Alzheimer’s: The Role for Estrogenic Control Across Age, Race, Medical, and Lifestyle Risks

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          Abstract

          Research indicates that after advanced age, the major risk factor for late-onset Alzheimer’s disease (AD) is female sex. Out of every three AD patients, two are females with postmenopausal women contributing to over 60% of all those affected. Sex- and gender-related differences in AD have been widely researched and several emerging lines of evidence point to different vulnerabilities that contribute to dementia risk. Among those being considered, it is becoming widely accepted that gonadal steroids contribute to the gender disparity in AD, as evidenced by the “estrogen hypothesis.” This posits that sex hormones, 17β-estradiol in particular, exert a neuroprotective effect by shielding females’ brains from disease development. This theory is further supported by recent findings that the onset of menopause is associated with the emergence of AD-related brain changes in women in contrast to men of the same age. In this review, we discuss genetic, medical, societal, and lifestyle risk factors known to increase AD risk differently between the genders, with a focus on the role of hormonal changes, particularly declines in 17β-estradiol during the menopause transition (MT) as key underlying mechanisms.

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          Dementia prevention, intervention, and care

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            Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.

            The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
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              Neuroinflammation in Alzheimer's disease.

              Increasing evidence suggests that Alzheimer's disease pathogenesis is not restricted to the neuronal compartment, but includes strong interactions with immunological mechanisms in the brain. Misfolded and aggregated proteins bind to pattern recognition receptors on microglia and astroglia, and trigger an innate immune response characterised by release of inflammatory mediators, which contribute to disease progression and severity. Genome-wide analysis suggests that several genes that increase the risk for sporadic Alzheimer's disease encode factors that regulate glial clearance of misfolded proteins and the inflammatory reaction. External factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain and further promote disease progression. Modulation of risk factors and targeting of these immune mechanisms could lead to future therapeutic or preventive strategies for Alzheimer's disease. Copyright © 2015 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Front Aging Neurosci
                Front Aging Neurosci
                Front. Aging Neurosci.
                Frontiers in Aging Neuroscience
                Frontiers Media S.A.
                1663-4365
                15 November 2019
                2019
                : 11
                : 315
                Affiliations
                [1] 1Department of Neurology, Weill Cornell Medicine, Cornell University , New York, NY, United States
                [2] 2Concussion Clinic, Hospital for Special Surgery , New York, NY, United States
                [3] 3Department of Internal Medicine, Weill Cornell Medicine, Cornell University , New York, NY, United States
                [4] 4Department of Pharmacology, College of Medicine, The University of Arizona , Tucson, AZ, United States
                [5] 5Department of Neurology, College of Medicine, The University of Arizona , Tucson, AZ, United States
                [6] 6Department of Radiology, Weill Cornell Medicine, Cornell University , New York, NY, United States
                [7] 7Department of Psychiatry, New York University School of Medicine , New York, NY, United States
                Author notes

                Edited by: Patrizia Giannoni, University of Nîmes, France

                Reviewed by: Ana I. Duarte, University of Coimbra, Portugal; Praticò Domenico, Temple University, United States

                *Correspondence: Lisa Mosconi, lim2035@ 123456med.cornell.edu
                Article
                10.3389/fnagi.2019.00315
                6872493
                31803046
                dec1e2cc-4e53-4ef3-b58f-3f034840a5ac
                Copyright © 2019 Rahman, Jackson, Hristov, Isaacson, Saif, Shetty, Etingin, Henchcliffe, Brinton and Mosconi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 March 2019
                : 31 October 2019
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 309, Pages: 22, Words: 0
                Funding
                Funded by: National Institutes of Health 10.13039/100000002
                Award ID: P01AG026572
                Funded by: Cure Alzheimer's Fund 10.13039/100007625
                Categories
                Neuroscience
                Review

                Neurosciences
                alzheimer’s disease,estrogen hypothesis,sex differences,gender differences,menopause transition,risk factors

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