Abstract
Background Sex differences in cognitive performance have been extensively documented. Understanding the underlying factors contributing to sex differences in older adults is imperative to promote healthy cognitive ageing. Sex hormones, estrogens, and testosterone have been suggested to be associated with cognition. Nevertheless, there is a scarcity of studies investigating the sex difference in cognitive performance and the contribution of gonadal hormones in older adults. Hence, the current study aimed to investigate sex differences in cognitive performance and elucidate the association between gonadal hormones and cognitive performance in 80+-year-olds.Methods Using confirmatory factor analysis in a sample of 131 older adults (aged 80 to 92 years), 17 cognitive performance measures were divided into two cognitive components: executive functioning and memory. Subsequently, mediation analyses were conducted to determine the direct effect of sex and the indirect effect mediated by gonadal hormones on executive functioning and memory.Results Females outperformed males in executive functioning and memory. However, gonadal hormones did not mediate the sex effect on cognitive performance. Interestingly, estrogen significantly predicted executive functioning but not memory. Testosterone was not found to predict either executive functioning or memory.Conclusion Our study confirms enduring sex differences in memory and executive function, even among individuals aged 80 and above. Current gonadal hormone levels do not mediate these differences. While estrogen may predict executive function, its influence does not explain the sex differences. These findings underscore the complex nature of cognitive disparities between sexes in older age, warranting further investigation into underlying mechanisms.