Sex / gender bias on the Face-Name Associative Memory Exam in clinically-normal older adults

Kirsty Lu1*, Jennifer Nicholas2, Rebecca Street1, Sarah-Naomi James3, Nick C. Fox1, Marcus Richards3, Sebastian J. Crutch1, Jonathan M. Schott1
1. Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, UK
2. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
3. MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
* Corresponding author: kirsty.lu@ucl.ac.uk

Background Methods Learning and recall 1 Participants

• The Face-Name Associative Memory Exam p
• Participants (n=500) in ‘Insight 46’, a sub-study of the MRC National Survey of males females
value
(FNAME) [1] is designed to detect subtle Health and Development (British 1946 birth cohort), attended a baseline Learning and recall 2 N at baseline 256 244
Alzheimer’s disease-related memory assessment at age ~70 years and a follow-up at age ~73. N at follow-up 227 205
impairment. An advantage for female • At both time-points they completed the 12-item Face-Name test (FNAME-12A).
participants has been reported on this test in
10-min delayed recall Age at baseline (years): 70.6, 0.7, 70.7, 0.7,
0.80
Stimuli comprise six male and six female faces (presented in alternating Mean, SD, (range) (69.2, 71.7) (69.2, 71.8)
samples from the US [2], UK [3] and Spain [4]. order), with names and occupations. Recall of the names and occupations is Interval between baseline and
This is consistent with many other studies of 2.5, 0.3, 2.5, 0.3,
tested four times, cued by presentation of the face (Fig 1). 30-min delayed recall follow-up (years): mean, SD, 0.94
(2.1, 3.6) (2.0, 4.1)
memory which report female participants • The following four total scores (each out of 24) were calculated across all (range)
performing slightly better than males. Fig 1. Procedure for the Face-Name Childhood cognitive ability (z- 0.36, 0.75 0.42, 0.73,
recall trials: female names; female occupations; male names; male 0.36
Associative Memory Exam (FNAME-12), and score): mean, SD, (range) (-1.60, 2.50) (-1.59, 2.47)
• One recent study found sex differences in occupations. We also calculated a proportional ‘bias score’ (range -1 to +1) by
an example stimulus. Highest educational
opposite directions on two different memory subtracting the total points for female items from the total points for male qualification: %
tests, with males performing better at recalling items, then dividing by the total number of points for all items. None 15.2 16.0
a story with a male protagonist, and females • We fitted multivariable regression models at each time-point using Generalised Below O-levels (vocational) 4.3 6.2
performing better at recalling a story with a Estimating Equations to investigate effects of item type (name/occupation),
O-levels or equivalent 21.1 28.7 0.008
female protagonist [5]. The authors item gender (male/female) and participant sex (male/female), and interactions
A-levels or equivalent 32.4 39.3
suggested that sex differences may depend between these variables, controlling for age, education, socioeconomic
on the content of the tests, with some content position and prospectively-collected childhood cognitive ability. Degree or equivalent 27.0 9.8
being more memorable to males or females. • We also investigated the correlation between the ‘bias scores’ at the two time- Socioeconomic position: %

• We investigated whether male and female points. Unskilled 0.8 1.2

older adults show differences on the Face- • N.B. We have used the term ‘sex’ when referring to male/female participants, Partly skilled 2.3 7.4
Name test at two time-points. Specifically, do as is our standard practice. We have used the term ‘gender’ when referring to Skilled (manual) 14.1 4.5 <0.001
they show a bias towards remembering the the FNAME items as the male/female item classification is based on the visual
Fig 3. Performance of male and female Skilled (non-manual) 10.2 32.8
stimuli that match their own sex? appearance, name (and, to some extent, the occupation) of each stimulus.
participants on the FNAME-12 test at follow- Intermediate 52.7 51.6
up, for male and female items. Markers show raw Professional 19.9 2.5
scores. Solid lines show line of best fit, with shaded 95% % amyloid positive at
Results confidence intervals. For female participants the line of best
is close to y=x (y = 0.9x + 0.2), whereas for male
baseline
25.6 24.7 0.81

% APOE-ε4 carriers 32.7 26.6 0.14

• We previously reported that women outperformed men on this test at baseline [3]. The same result was observed at follow-up participants it is shifted downwards (y = 0.9x – 4.2)
(coefficient averaged across the four conditions = 2.2 points [95% CIs 1.3, 3.1], p<0.001). indicating a bias towards poorer recall of female items.

• This difference was exaggerated for female stimuli (follow-up interaction coefficient=2.0 [1.4, 2.6], p<0.001) (Fig 2, Fig 3), and female Conclusions
stimuli occupations (follow-up 3-way interaction coefficient=0.8 [-0.0, 1.6] p=0.050) (Fig 2). In other words, women scored better than (mean = 0.04)

men even on male names, whereas men were particularly disadvantaged at recalling information associated with female stimuli, • We found evidence of a gender bias on FNAME-12
especially their occupations. The only condition on which men performed equally to women was male occupations. (mean = 0.13) among cognitively-normal male participants in their
• These effects were seen on all recall trials (i.e. immediately after learning, and after 10-minute and 30-minute delays) (results not early 70s, where their recall was worse for female
shown). items compared to male items, which may partially
explain their poorer performance on this test.
• Men had higher ‘gender bias’ scores than women at both baseline (Fig 4) and follow-up. The correlation between ‘gender bias’ scores
• This bias was present on both immediate and
at the two time-points was 0.40 (p<0.0001) for female participants and 0.41 for male participants (p<0.0001).
delayed recall and was consistent after a ~3 year
Baseline Follow-up interval. Therefore, it appears to be a stable
phenomenon which may reflect a tendency among
Fig 4. Distribution of ‘gender bias’ scores for males to have a gender bias in attention and/or
male and female participants on the FNAME- encoding in the context of this fairly challenging test.
12 test baseline. A score of +1 would indicate that only • Such biases should be considered when interpreting
male items were correctly recalled. A score of -1 would
indicate that only female items were correctly recalled.
sex differences on memory tests in general.
Fig 2. Mean score (and 95% confidence
intervals) of male and female participants on
each condition of the FNAME-12 test at References 1) Papp et al. (2014) Clin Neuropsychol 28(5): 771–785. 2) Rentz et al. (2017) Menopause 24:4. 3) Lu et al. (2019) Neurology
baseline and follow-up. 93:e2144-e2156. 4) Alegret et al. (2015) Arch Clin Neuropsychol 30;7:712-720. 5) Nester et al. (2022) Arch Clin Neuropsychol acac102.

Acknowledgements: We would like to thank all study participants and the radiographers
at the Institute of Nuclear Medicine, University College London Hospitals. We acknowledge
contributions from AVID Pharmaceutical, a wholly owned subsidiary of Eli Lilly.