Table 2. Association of Cognition Decline With Sex Adjusted for Patient Factors^a.

Coefficient	Dependent variables
	Global cognition (n = 26 088)		Executive function (n = 24 392)		Memory (n = 20 191)
	Estimateb (95% CI)	P value	Estimateb (95% CI)	P value	Estimateb (95% CI)	P value
At first cognitive assessment
Difference in intercept between women and men	2.20 (2.04 to 2.35)	<.001	2.13 (1.98 to 2.29)	<.001	1.89 (1.72 to 2.06)	<.001
Change in intercept per 10-y increase in age	−2.09 (−2.20 to −1.98)	<.001	−2.40 (−2.52 to −2.28)	<.001	−1.73 (−1.86 to −1.59)	<.001
Slope in White men at median age, per y	−0.21 (−0.22 to −0.20)	<.001	−0.33 (−0.34 to −0.32)	<.001	−0.23 (−0.25 to −0.21)	<.001
Difference in slope between White women and White men, per y	−0.07 (−0.08 to −0.05)	<.001	−0.06 (−0.07 to −0.05)	<.001	−0.004 (−0.023 to 0.014)	.61
Change in slope per 10-y increase in age at first cognitive assessment, per y	−0.12 (−0.13 to −0.11)	<.001	−0.028 (−0.034 to 0.022)	<.001	−0.16 (−0.18 to −0.15)	<.001

^aLinear mixed-effects models included time since first cognitive assessment and baseline values (measured before or at time of first cognitive assessment) of sex, race, age, cohort study, years of school, alcohol use, cigarette smoking, body mass index, waist circumference, physical activity, time-varying cumulative mean systolic blood pressure (BP), hypertension treatment, fasting glucose, low-density lipoprotein (LDL) cholesterol, history of atrial fibrillation, age × follow-up time, sex × follow-up time, race × follow-up time, time-varying cumulative mean systolic BP × follow-up time, and hypertension treatment × follow-up time. To take into account correlation between longitudinal cognitive measures, we included random intercept and slope effects associated with participants. All continuous covariates were centered at the overall median, except cumulative mean systolic BP, which was centered at 120 mm Hg. Glucose, LDL cholesterol, and systolic BP values were divided by 10 so that the parameter estimates refer to a 10-unit change in the variables. Systolic BP was the time-dependent mean of all systolic BPs before the measurement of cognition. To estimate sex differences in cognitive decline, models included a sex × follow-up time interaction term.

^bGlobal cognition measures global cognitive performance. All cognitive measures are set to a t score metric (mean 50, SD 10) at a participant’s first cognitive assessment; a 1-point difference represents a 0.1-SD difference in the distribution of cognition across the 5 cohorts. Higher cognitive scores indicate better performance.