Do sex differences in dementia with Lewy bodies arise from Alzheimer's disease biological profile?

Sex differences in dementia with Lewy bodies (DLB) remain understudied despite growing evidence in neurodegenerative diseases. In this retrospective multicentric study of 310 patients with probable DLB, we assessed whether sex-related clinical differences could be explained by Alzheimer's disease (AD) cerebrospinal fluid biomarkers. While, in univariate analysis, females had lower Mini-Mental State Examination (MMSE) scores and more frequent AD profiles, males presented more REM sleep disorders. Adjusting for AD biomarkers attenuated some differences (REM sleep disorder, MMSE), but not all like parkinsonism. These findings suggest that AD co-pathology partly contributes to sex differences in DLB, but additional mechanisms likely underlie the observed clinical variability.