# Sex differences in cognitive decline and impairment: a scoping review in informatics literature

## TL;DR

This review explores how informatics research has studied differences in cognitive decline between men and women, finding that most studies identify differences but rarely explain why they occur.

## Contribution

The study identifies a gap in informatics research focusing on the root causes of sex-specific disparities in cognitive decline rather than just identifying them.

## Key findings

- Most studies use statistical modeling and machine learning to identify sex differences in cognitive decline.
- Research is predominantly single-site and lacks exploration of biological, social, and behavioral factors.
- There is a need for more comprehensive studies to understand the underlying causes of sex-specific disparities.

## Abstract

A scoping review was conducted to investigate knowledge gaps in the informatics research literature regarding sex differences in cognitive decline and impairment, identifying existing studies and areas requiring further exploration.

Our scoping review follows the Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA – ScR) guidelines. We searched Ovid and other databases (APA PsychInfo, EMB Reviews, and Embase) for studies on sex differences in cognitive decline and impairment, focusing on peer-reviewed informatics journals and conference proceedings from 2000 to 2025. The selected manuscripts were analyzed based on metadata statistics, study attributes, and thematic content.

A total of 17 full articles met the inclusion criteria. Most studies were conducted in North America (n = 7) and the European Union (n = 5). More than half of the studies were published after 2020 (n = 10). Our analyses highlight key aspects of selected studies, including bibliometric metadata, study attributes (e.g., study types, methods, and data sources), and thematic findings. Statistical modeling (n = 8) and machine learning (n = 4) are the most widely used study methods. Majority (n = 11) of the publications are single-site studies, while the other multi-site collaborations (n = 6) have emerged among hospitals, academic institutions, and research institutions.

Sex-specific disparities in cognitive decline and impairment remain a critical issue in healthcare. Most informatics research has primarily concentrated on identifying generic sex differences in cognitive decline and impairment progression, rather than exploring the complex underlying mechanisms such as observational studies with causal analysis. While these studies are valuable, they lack a holistic approach to understanding sex-specific disparities.

There is a significant gap in using informatics to understand how biological, social, and behavioral factors contribute to sex-specific disparities in cognitive decline and impairment. This limitation underscores the need for more comprehensive informatics research that goes beyond mere identification to find the root cause of these disparities in healthcare.

The online version contains supplementary material available at 10.1186/s13293-025-00804-6.

This study looked at what researchers have found—and what they haven’t—about how cognitive decline (like memory loss or dementia) affects men and women differently. We focused on research in the field of health informatics, which uses data and technology to study health. We followed a standard review process and searched major medical and psychology databases. Out of everything we found, 17 studies fit our criteria. More than half of the studies were published after 2020, with most originating from the U.S.A. and Europe. We analyzed key statistics from the selected studies and found that researchers often used statistical models and machine learning techniques to identify differences between men and women in how cognitive decline develops. To present our findings clearly, we organized the results into three parts: (a) an overview of how research in this area has evolved over time, (b) a summary of study designs and data sources, and (c) an analysis of common themes and focus areas across the studies. Our review found that most studies simply highlight that there are differences between men and women in how cognitive decline occurs, but they rarely explore why these differences exist. There is very little research that examines the biological, social, or behavioral factors that may explain these patterns. This points to a clear need for future studies to go beyond identifying differences and focus on understanding the root causes behind them.

The online version contains supplementary material available at 10.1186/s13293-025-00804-6.

Examine the existing informatics literature on sex-specific differences for cognitive decline and impairment.Reported the metadata analysis to examine the bibliographic landscape of the research field and its development over time.Discussed attributes (types, methods and data) of past studies for contextual understanding.Performed thematic analysis (clinical, biomedical, and psychological & behavioral) for sex differences.Recommended future research directions for healthcare informatics research on sex-specific differences in cognitive decline and impairment.

Examine the existing informatics literature on sex-specific differences for cognitive decline and impairment.

Reported the metadata analysis to examine the bibliographic landscape of the research field and its development over time.

Discussed attributes (types, methods and data) of past studies for contextual understanding.

Performed thematic analysis (clinical, biomedical, and psychological & behavioral) for sex differences.

Recommended future research directions for healthcare informatics research on sex-specific differences in cognitive decline and impairment.

The online version contains supplementary material available at 10.1186/s13293-025-00804-6.