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We investigated sex differences in cognition, neuroimaging, and fluid biomarkers in dominantly inherited AD (DIAD).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Three hundred twenty\u2010five mutation carriers (55% female) and one hundred eighty\u2010six non\u2010carriers (58% female) of the Dominantly Inherited Alzheimer Network Observational Study were analyzed. Linear mixed models and Spearman's correlation explored cross\u2010sectional sex differences in cognition, cerebrospinal fluid (CSF) biomarkers, Pittsburgh compound B positron emission tomography (<jats:sup>11<\/jats:sup>C\u2010PiB PET) and structural magnetic resonance imaging (MRI).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Female carriers performed better than males on delayed recall and processing speed despite similar hippocampal volumes. As the disease progressed, symptomatic females revealed higher increases in MRI markers of neurodegeneration and memory impairment. PiB PET and established CSF AD markers revealed no sex differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>Our findings suggest an initial cognitive reserve in female carriers followed by a pronounced increase in neurodegeneration coupled with worse performance on delayed recall at later stages of DIAD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.13460","type":"journal-article","created":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T13:09:09Z","timestamp":1695474549000},"page":"47-62","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Investigation of sex differences in mutation carriers of the Dominantly Inherited Alzheimer Network"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-9105","authenticated-orcid":false,"given":"Olivia","family":"Wagemann","sequence":"first","affiliation":[{"name":"Department of Neurology Washington University St. Louis  St. Louis Missouri USA"},{"name":"Department of Neurology Ludwig\u2010Maximilians\u2010Universit\u00e4t M\u00fcnchen Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Washington University St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Hassenstab","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Aschenbrenner","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole S.","family":"McKay","sequence":"additional","affiliation":[{"name":"Department of Radiology Washington University St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian A.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Radiology Washington University St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tammie L. 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