Objective: Assess sex differences for documented primary psychiatric diagnoses in people with dementia with Lewy bodies (DLB) and their associations with care outcomes (hospitalization, specialty access, medication use).

Background: Given reported sex differences in core clinical features [1], women with DLB may have a higher risk of being labeled with primary psychiatric diagnoses than men, negatively affecting care and outcomes (e.g., use of contraindicated antipsychotics).

Method: Data from Epic Cosmos, a collaborative HIPAA-compliant database of electronic health record data from organizations using Epic Systems, for unique patients with DLB diagnoses (G31.83) and ≥1 healthcare encounter between 1/1/2021-12/31/2025 were evaluated (n=100,862; 42% women, 58% men). Demographics, DLB core clinical features, primary psychiatric diagnoses, and care outcomes were compared between sexes with z-tests. Odds ratios (ORs) for care outcomes were estimated for people with and without psychiatric diagnoses within sexes; sex differences for these ORs were computed with z-tests for logORs.

Results: A higher percentage of women with DLB had documented primary psychiatric diagnoses [Table1]. Lower percentages of women with DLB had documented parkinsonism or REM sleep behavior disorder; a higher percentage had visual hallucinations. Lower percentages of women with DLB were hospitalized, accessed neurology or rehab, or used cognitive medication; higher percentages accessed geriatrics and used antipsychotics. Primary psychiatric diagnoses were associated with higher rates of hospitalization, specialty access (except neurology), and antipsychotic and cognitive medication use for both sexes [Table2]. Primary psychiatric diagnosis was associated with greater odds of antipsychotic use in women with DLB, namely contraindicated haloperidol [Figure1].

Conclusion: Core clinical features of parkinsonism and REM sleep behavior disorder were less frequently documented in women with DLB than men, in line with previous literature. Visual hallucinations and primary psychiatric diagnoses were more commonly documented in women with DLB. Women with DLB were less likely to receive cognitive medications or safer antipsychotic medications, an effect compounded by coexisting psychiatric diagnoses. More prominent neuropsychiatric syndromes in women with DLB may lead to misdiagnoses and inappropriate care.

Table 1

Table 2

Figure 1

References: [1] Chiu SY, Wyman-Chick KA, Ferman TJ, Bayram E, Holden SK, Choudhury P, Armstrong MJ. Sex differences in dementia with Lewy bodies: Focused review of available evidence and future directions. Parkinsonism Relat Disord. 2023 Feb;107:105285. doi: 10.1016/j.parkreldis.2023.105285. Epub 2023 Jan 16. PMID: 36682958; PMCID: PMC10024862.

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