Sarah J. Banks

University of California, San Diego | UCSD · Department of Neurosciences

Introduction: We investigated how the associations between tau and cognitive measures differ by sex in the preclinical Alzheimer's disease (AD) stage. Methods: A total of 343 cognitively unimpaired, amyloid-positive individuals (205 women, 138 men) who self-identified as non-Hispanic White from the Anti-Amyloid Treatment in Asymptomatic Alzheime...

Background: The association between obesity and Alzheimer's disease (AD) is complex. Recent studies indicated the relationships between obesity and AD may differ by sex, and women may benefit from being overweight in terms of AD risk. Objective: We investigated whether sex modifies the associations of obesity with tau positron emission tomograph...

The field of life course epidemiology has seen extraordinary developments since this book was first published. While recent advances in evidence allow for more comprehensive and clearer understanding of the factors at work, the core questions remain. How far is the health of women shaped by biological, social, and psychological processes that begin...

Background: Race/ethnicity is associated with differences in reproductive history and cognition individually, yet it remains an understudied factor in the relationship between parity and later-life cognition. Objective: To evaluate if the association between parity and cognition differs between racial/ethnic groups. Methods: Participants inclu...

Introduction: There is a pressing need for non-invasive, cost-effective tools for early detection of Alzheimer's disease (AD). Methods: Using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), Cox proportional models were conducted to develop a multimodal hazard score (MHS) combining age, a polygenic hazard score (PHS), brain atro...

Introduction: Remote screening for cognitive impairment associated with Alzheimer's disease (AD) has grown in importance with the expected rise in prevalence of AD in an aging population and with new potential treatment options. Methods: The Telephone Interview for Cognitive Status (TICS) and new telephone adaptation of the Montreal Cognitive As...

Although poor sleep quality and extreme sleep durations have been associated with brain atrophy and dementia, it is unclear whether sleep disturbances contribute to neural injury in the absence of neurodegeneration and cognitive impairment. In 146 dementia-free older adults of the Rancho Bernardo Study of Healthy Aging (76.7 ± 7.8 years at MRI), we...

Introduction: Identifying individuals who are most likely to accumulate tau and exhibit cognitive decline is critical for Alzheimer's disease (AD) clinical trials. Methods: Participants (N = 235) who were cognitively normal or with mild cognitive impairment from the Alzheimer's Disease Neuroimaging Initiative were stratified by a cutoff on the p...

Male sex is suggested as a risk factor for mild cognitive impairment (MCI), but this association may be influenced by the female verbal memory advantage, and the use of verbal memory tests has been shown to delay MCI diagnosis in women. Moreover, this association may vary by apolipoprotein E (APOE) genotype. The National Alzheimer’s Coordinating Ce...

Lifetime risk for Alzheimer’s disease is higher among women than men, and reproductive health factors may contribute to differential risk. Reproductive health and cognitive aging among Hispanic women/Latinas is understudied, so we examined such relationships in the Hispanic Community Healthy Study/Study of Latinos (HCHS/SOL) and the SOL‐Investigati...

Overall risk of Alzheimer’s disease (AD) and APOE‐ε4‐related risk for AD is higher among women than men, but the sex‐specific biological underpinnings of these sex differences are unknown. Earlier age at menopause has been associated with higher risk of AD and related dementias (ADRD); however, it is unclear whether this relationship holds among na...

Background Modifiable risk factors (MRF) for Alzheimer’s disease (AD) include sedentary behavior, sleep apnea, and loneliness; however, how these MRFs influence one another is unclear. We examined correlations among loneliness, physical activity and sleep apnea among older women at higher risk for AD. Methods Data were collected as part of the Wom...

Vascular dysfunction frequently accompanies Alzheimer’s disease (AD), and its suspected contributions to AD pathogenesis may be partly mediated by disrupted blood‐brain barrier (BBB) function. Despite consistent evidence for increased BBB permeability in AD, it remains unclear whether BBB damage occurs in preclinical stages, when therapeutic interv...

Abnormal tau deposition is an important pathological feature of AD. Important sex differences exist, with women showing greater tau deposition along the AD continuum compared to men. Our group has previously shown sex differences in the genetic risk associated with AD. However, whether specific genetic variants are associated with sex differences i...

Background and Objectives Important sex differences exist in tau pathology along the Alzheimer disease (AD) continuum, with women showing enhanced tau deposition compared with men, especially during the mild cognitive impairment (MCI) phase. This study aims to identify specific genetic variants associated with sex differences in regional tau aggreg...

Matrix metalloproteinase‐9 (MMP‐9) is a proinflammatory, proteolytic enzyme that is dysregulated in Apolipoprotein (APOE) ε4 carriers, patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) and has been shown to accelerate tau oligomerization, blood‐brain barrier breakdown and amyloid‐β (Aβ) accumulation. Evidence suggests that...

Obstructive sleep apnea (OSA) is characterized by recurrent pharyngeal airway collapse and drops in blood oxygen levels that lead to intermittent hypoxemia. OSA has been associated with Alzheimer’s disease (AD) pathology, including tau. AD is more prevalent in women, and women tend to have higher levels of tau compared to men. OSA is underdiagnosed...

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is characterized by perivascular foci of phosphorylated tau (p‐tau) notably in the depths of sulci, with varying patterns in the cerebral cortex. Prior studies show elevated flortaucipir (FTP) PET binding in former American professional football players(PRO). However, the as...

The number of Americans with Alzheimer’s disease (AD) is expected to rise to nearly 14 million by 2060. This alarming number shows a critical need for brief mental status tests that can be administered remotely (e.g., by telephone or videoconferencing) to large numbers of individuals while maintaining the ability to reliably detect cognitive impair...

The accumulation of pathological tau in the medial temporal lobe is a hallmark of early Alzheimer’s disease (AD) that leads to memory decline. The majority of studies in AD use exclusively verbal memory tests to detect this memory loss, which is problematic because women have a lifelong advantage in verbal memory such that these tests may be less r...

Background Studies have reported higher plasma matrix metalloproteinase-9 (MMP-9) levels in mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Despite evidence that MMP-9 activity and its influence on AD pathophysiology may be modulated by sex hormones, sex differences in the association between MMP-9 and AD biomarkers and cognition have...

Objective: The association of pregnancy with later-life cognition is not well understood. We examined whether full-term and incomplete pregnancies were associated with cognition in a sample of postmenopausal women, and whether socioeconomic status (SES) factors mediated these relationships. Methods: A total of 1016 cognitively normal women from...

Introduction: SuperAgers are individuals over age 80 with superior episodic memory, at a level consistent with individuals 20 to 30 years their junior and who seem to show resistance to age-related neurofibrillary degeneration. Here we examine whether low genetic risk for Alzheimer's disease (AD) contributes to SuperAgers' unusually high episodic...

Introduction: The presentation, risk factors, and etiologies of white matter hyperintensities (WMH) in people exposed to repetitive head impacts are unknown. We examined the burden and distribution of WMH, and their association with years of play, age of first exposure, and clinical function in former American football players. Methods: A total...

Studies have shown that women on the Alzheimer’s disease (AD) continuum have more pathological tau in the brain and cerebrospinal fluid (CSF), than men. Some studies have found that higher levels of tau biomarkers are more strongly associated with clinical AD, cognitive decline and neurodegeneration in women than in men. Despite major developments...

Objective: To assess the initial features and evolution of neurologic Postacute Sequelae of SARS-CoV-2 infection (neuro-PASC) in patients with and without prior neurologic disease. Methods: Participants with neurologic symptoms following acute SARS-CoV-2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a...

Introduction: Despite women showing greater Alzheimer's disease (AD) prevalence, tau burden, and immune/neuroinflammatory response, whether neuroinflammation impacts cognition differently in women versus men and the biological basis of this impact remain unknown. We examined sex differences in how cerebrospinal fluid (CSF) neuroinflammation relate...

Brain plasticity is essential for experts to acquire the abilities they need. Sommeliers are olfaction experts who display differences in olfactory regions in the brain that correlate with greater olfactory abilities. While most studies on this topic are cross‐sectional, we used a longitudinal design and invited 17 sommelier students at the start a...

The interaction between APOE ε4 and vascular risk factors on cognitive function is stronger in women than in men. These effects may be mediated by the amount of tau pathology in the brain. Therefore, we examined whether APOE ε4 and sex modify cross-sectional associations between cardiovascular risk and tau deposition in cognitively normal older adu...

Higher insulin resistance (IR) is a key mediator of prediabetes and diabetes that relates to abnormal insulin functioning and ineffective glucose metabolism. Furthermore, higher IR relates to increased risk of Alzheimer’s disease and to poorer cognitive function. Several of these studies were conducted in women-only samples; however, sex difference...

The COVID-19 pandemic generated large amounts of stress across the globe. While acute stress negatively impacts health, defining exact consequences and behavioral interventions can be difficult. We hypothesized that a generalized increase in stress and anxiety caused by continuation of the global pandemic would negatively impact sleep quality and t...

Background Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurologi...

Background There are important sex differences in Alzheimer’s disease (AD) including two‐fold higher prevalence and stronger association of the apolipoprotien‐ε e4 allele ( APOE4 ) with AD risk in women versus men. Given the central role of sex hormones in brain structure/function, examining factors influencing lifetime exposure to sex hormones is...

Background Mounting evidence from cerebrospinal fluid (CSF) studies suggests that women on the AD spectrum have higher levels of pathological tau in the CSF than men. Several studies suggest that plasma tau phosphorylated at threonine 181 (p‐tau181) is strongly associated with CSF biomarkers of tau and may constitute an accessible and informative b...

Background High‐density lipoprotein (HDL) is protective against cardiovascular disease (Di Angelantonio et al., 2009), a risk factor for AD pathogenesis (Brickman et al., 2015). Aerobic exercise can increase HDL concentration (Hsu et al., 2019), and evidence suggests this HDL benefit occurs more so in women than in men (Werner et al., 1995). Both H...

Background Little is known about sleep in those with a history of contact sports, who are at increased risk for neurodegenerative disease(s). Sleep disruption and disorders are increasingly recognized as having a bidirectional relationship with Alzheimer’s disease neuropathology. Here, we investigated self‐reported sleep disruption and disorders in...

Background Repetitive head impacts from American football have been associated with long‐term cognitive symptoms. The late neuropsychological profiles of this population is not well‐characterized. Research has relied on retrospective informant reports and/or has been small samples of former professional players. We describe objective neuropsycholog...

Background Tau propagation from medial temporal regions to neocortex correlates with cognitive decline and neurodegeneration. Microstructural damage to medial temporal gray matter and associated white matter predicts Alzheimer’s disease (AD)‐related cognitive impairment. However, whether brain cytoarchitectural injury mediates effects of tau on cog...

Objective: The association of pregnancy with later life cognition is not well understood. Few studies address the potential confounding role of socioeconomic factors on this relationship. We examined whether pregnancy was associated with cognitive function in a large, population-based sample of post-menopausal women and the potential mediating effe...

Professional athletes exposed to repetitive head impacts are at increased risk for developing a progressive neurological syndrome known as traumatic encephalopathy syndrome and neuropathology seen on autopsy called chronic traumatic encephalopathy (CTE). The early identification of individuals at increased risk for CTE is important and the search f...

Objective Story memory tasks are among the most commonly used memory tests; however, research suggests they may be less sensitive to memory decline and have a weaker association with hippocampal volumes than list learning tasks. To examine its utility, we compared story memory to other memory tests on impairment rates and association with hippocamp...

To determine if sex differences in verbal memory in AD are related to differences in extent or distribution of pathological tau, we studied 275 participants who were amyloid PET positive and carried clinical classifications of normal cognition, mild cognitive impairment (MCI) or dementia, and had tau (AV1451) PET. We compared tau distribution betwe...

Introduction: Participants from a longitudinal cohort study were surveyed to evaluate the practical feasibility of remote cognitive assessment. Methods: All active participants/informants at the University of California San Diego Alzheimer's Disease Research Center were invited to complete a nine-question survey assessing technology access/use a...

Objective To develop evidence-informed, expert consensus research diagnostic criteria for Traumatic Encephalopathy Syndrome (TES), the clinical disorder associated with neuropathologically diagnosed Chronic Traumatic Encephalopathy (CTE). Methods A panel of 20 expert clinician-scientists in neurology, neuropsychology, psychiatry, neurosurgery, and...

Background: Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer's disease (AD), although their interactive effects have yet to be fully examined. Objective: The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and...

Introduction Sex differences in dementia with Lewy bodies (DLB) have been reported in clinically defined cohorts; however, clinical diagnostic accuracy in DLB is suboptimal and phenotypic differences have not been assessed in pathologically confirmed participants. Methods Core DLB features were compared across 55 women and 156 men with pathologica...

Background: The increasing prevalence of Alzheimer's disease (AD) and lack of effective medications has led to a need to identify modifiable risk factors as targets for interventions. Objective: In this cross-sectional study, we sought to determine whether worse sleep quality is associated with increased pathological tau, and whether this relati...

Abstract Women show greater pathological Tau biomarkers than men along the Alzheimer’s disease (AD) continuum, particularly among apolipoprotein ε-E4 (APOE4) carriers; however, the reason for this sex difference in unknown. Sex differences often indicate an underlying role of sex hormones. We examined whether testosterone levels might influence thi...

Background Unusually successful cognitive aging (e.g. SuperAging) may reflect underlying resistance to age‐associated cognitive decline and the neuropathologic markers of Alzheimer’s disease (AD). However, it is unknown whether these individuals vary in their genetic protection from AD relative to other clinically normal elderly individuals. Metho...

Background Recent evidence suggests that tau accumulates differently in the brains of men and women with Alzheimer’s disease (AD), with greater neurofibrillary tangles in women especially in the MCI stage. Women show a reserve in verbal memory but then more rapid decline in this domain once they are symptomatic. Since regional tau deposition is clo...

Objective: Incidence of concussions and report of symptoms are greater among women across sports. While structural brain changes and cognitive declines are associated with repetitive head impact (RHI), the role of sex is not well-understood. This study aimed to determine if there is a moderating effect of sex on the relationship the number of profe...

Introduction: Selecting individuals at high risk of Alzheimer's disease (AD) dementia and using the most sensitive outcome measures are important aspects of trial design. Methods: We divided participants from Alzheimer's Disease Neuroimaging Initiative at the 50th percentile of the predicted absolute risk of the polygenic hazard score (PHS). Out...

Sex differences in the manifestations of Alzheimer's disease are under intense investigation. Despite the emerging importance of polygenic predictions for Alzheimer's disease, sex-dependent polygenic effects have not been demonstrated. Here, using a sex crossover analysis, we show that sex-dependent autosomal genetic effects on Alzheimer's disease...

Objective: Incidence of concussions and report of symptoms are greater amongst women across sports. While structural brain changes and cognitive declines are associated with repetitive head impact (RHI), the role of sex is not well understood. This study aimed to determine if there is a moderating effect of sex on the relationship number of profess...

The COVID-19 pandemic caused by the highly contagious SARS-CoV-2 virus has had devastating consequences across the globe. However, multiple clinics and hospitals have experienced a decrease in rates of acute myocardial infarction and corresponding cardiac catheterization lab activations, raising the question: Has the risk of myocardial infarction d...

Using resting state fMRI from the ADNI dataset, we observed that sex moderates the effect of APOE4 status and amyloid on resting state default mode network functional connectivity. Left prefrontal areas that may relate to education-based cognitive reserve did not show a relationship to DMN that differed by sex, A+, and E4+. Amyloid positive, E4+,...

Background The increasing prevalence of Alzheimer’s Disease (AD) and lack of effective medications has led to a need to identify modifiable risk factors as targets for interventions. In this cross-sectional study, we sought to determine whether worse sleep quality is associated with increased pathological tau, and whether this relationship is affec...

Women show greater pathological Tau biomarkers than men along the Alzheimer’s disease (AD) continuum, particularly among apolipoprotein ε-E4 (APOE4) carriers; however, the reason for this sex difference in unknown. Sex differences often indicate an underlying role of sex hormones. We examined whether testosterone levels might influence this sex dif...

Women show greater pathological Tau biomarkers than men along the Alzheimer’s disease (AD) continuum, particularly among apolipoprotein ε-E4 (APOE4) carriers; however, the reason for this sex difference in unknown. Sex differences often indicate an underlying role of sex hormones. We examined whether testosterone levels might influence this sex dif...

In this study, we aimed to assess whether women are able to withstand more tau before exhibiting verbal memory impairment. Using data from 121 amyloid-β-positive Alzheimer’s Disease Neuroimaging Initiative participants, we fit a linear model with Rey Auditory Verbal Learning Test score as the response variable and tau-PET standard uptake value rati...

Soccer is perhaps the most popular sport on the planet, with the Fédération Internationale de Football Association (FIFA) estimating that 4% of the world’s population plays the game.¹ Although most ball contacts are made with the lower limbs, headers, when the ball is intentionally hit with the head instead of the foot, are frequent plays. When the...

Background: We examined interactive effects of sex, diagnosis, and cerebrospinal fluid (CSF) amyloid beta/phosphorylated tau ratio (Aβ/P-tau) on verbal memory and hippocampal volumes. Methods: We assessed 682 participants (350 women) from BioFINDER (250 cognitively normal [CN]; and 432 symptomatic: 186 subjective cognitive decline [SCD], 246 mil...

Objective To evaluate the sex differences in cognitive course over 4 years in Parkinson’s disease (PD) patients with and without mild cognitive impairment (MCI) compared to controls. Methods Four-year longitudinal cognitive scores of 257 cognitively intact PD, 167 PD-MCI, and 140 controls from the Parkinson’s Progression Markers Initiative were in...

Objective: This study tests the hypothesis that certain MRI-based regional brain volumes will show reductions over time in a cohort exposed to repetitive head impacts (RHI). Methods: Participants were drawn from the Professional Fighters Brain Health Study, a longitudinal observational study of professional fighters and controls. Participants un...

Background: Although amyloid-β (Aβ) and microstructural brain changes are both effective biomarkers of Alzheimer's disease, their independent or synergistic effects on cognitive decline are unclear. Objective: To examine associations of Aβ and brain microstructure with cognitive decline in amnestic mild cognitive impairment and dementia. Method...

Objective: Repetitive head impacts (RHIs) in combat sports are associated with cognitive decline and brain volume reduction. While fighting style differences between boxers, mixed martial artists (MMAs), and martial artists (MAs) have resulted in a broader spectrum of injury, the effects of RHIs on MAs relative to other fighters have not yet been...

The Boston Naming Test–Second edition (BNT-2) and the Neuropsychological Assessment Battery–Naming (NAB-N) subtest are two commonly used confrontation naming tests used to evaluate word-finding ability in individuals suspected of neurodegenerative disease. The BNT-2 and NAB-N are designed to measure the same construct; however, observations in prac...

Importance Many studies have investigated the imaging findings showing sequelae of repetitive head trauma, with mixed results. Objective To determine whether fighters (boxers and mixed martial arts fighters) with cavum septum pellucidum (CSP) and cavum vergae (CV) have reduced volumes in various brain structures or worse clinical outcomes on cogni...

Women are more likely to have Alzheimer's disease (AD) and decline more rapidly once diagnosed despite greater verbal memory early in the disease compared to men—an advantage that has been termed “memory reserve.” Resting state functional MRI (fMRI) investigations demonstrate interactions between sex and AD risk factors in default mode network (DMN...

This study measured outcomes of a novel pilot program designed to teach improvisation skills to caregivers of family members with dementia. Fifteen caregivers completed questionnaires measuring changes in their perception of burden (Zarit Burden Interview), depression (Beck Depression Inventory), their cared-for person’s neuropsychiatric symptoms (...

Long-term traumatic brain injury due to repeated head impacts (RHI) has been shown to be a risk factor for neurodegenerative disorders, characterized by a loss in cognitive performance. Establishing the correlation between changes in the white matter (WM) structural connectivity measures and neuropsychological test scores might help to identify the...

Objective This study examined the neuropsychological correlates and impact on caregiver distress of reduced awareness of mood symptoms in patients with suspected neurodegenerative disease. Method Records from a clinical sample of older adults were examined (N = 940). Results More than one-third of patient and caregiver ratings of mood symptoms di...

Background: Late-onset Alzheimer's d