INTRODUCTION: Males are disproportionately represented in dementia with Lewy bodies (DLB). Little is known regarding sex differences in cognitive, neuropsychiatric, and motor features of the prodromal stage of DLB. METHODS: We used National Alzheimer's Coordinating Center longitudinal data to examine cognitive, neuropsychiatric, and motor features in 120 males and 23 females 2 years prior to a clinical diagnosis of DLB. RESULTS: Males were more likely than females to present with two or more core DLB clinical features 2 years prior to obtaining a diagnosis of dementia. Rapid eye movement sleep behavior disorder, cognitive fluctuations, bradykinesia, and rigidity were more common in males than females. Neuropsychological test performance was similar between groups. DISCUSSION: In prodromal DLB, males exhibit a greater number of core features than females. Core DLB features may fall short in identifying females at risk. Additional work is needed to better understand the clinical profile of prodromal DLB in females. HIGHLIGHTS: There are sex differences in the presentation and course of neurodegenerative disease. Findings from the National Alzheimer's Coordinating Center Uniform Data Set suggest there are sex differences in prodromal DLB symptoms. Females were less likely to demonstrate core clinical features of DLB prior to dementia diagnosis. This information can help inform clinical diagnostic criteria for prodromal DLB.
