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788 X. Millet et al. / Archives of Clinical Neuropsychology 24 (2009) 783–789the increasing complexity of figures suggesting that they preferentially rely on holistic spatially oriented strategy allowing themrotating the figure as a whole in a unitary process. On the contrary, in women, the time to operate mental rotation increased withfigures complexity suggesting that they preferentially relied on a verbally mediated analytic strategy in which the figure isparsed into individual pieces rotated separately. In neuroimaging studies, this gender-related strategic differentiation hasbeen proposed to explain the results showing that men exhibit greater parietal areas activation, whereas women exhibitlower activation of the parietal lobe but additional activation of the frontal lobe while performing a mental rotation task(Schöning et al., 2007; Thomsen et al., 2000; Weiss et al., 2003b). Another hypothesis explaining gender effects on visuospatialperformances relies on the relationship between androgens and visuospatial memory. Indeed, studies with animal models haveshown that spatial memory is impaired after gonadectomy (Frye et al., 2001) and that it is restored with androgen adjunction(Edinger & Frye, 2004). Epidemiological studies also showed that lower testosterone levels in elderly men were associatedwith worse spatial memory (Moffat et al., 2002). On the other hand, testosterone adjunction increases spatial cognition inelderly men (Janowsky et al., 1994), female-to-male transsexuals (Van Goozen, Cohen-Kettenis, Gooren, Frijda, & Van dePoll, 1994), and hypogonadal men (Gray et al., 2005).Whether gender influences visuospatial deficits in AD may be interesting to consider in the context of the “cognitivereserve” hypothesis (Stern, 2006, for a review). Besides lifestyle factors, such as education, occupational attainment (e.g.,Stern et al., 1994), or stimulating leisure activities (e.g., Scarmeas, Levy, Tang, Manly, & Stern, 2001), sex was alsoshown to modulate the probability of developing AD, with women having higher risk than men (e.g., Letenneur et al.,1999). In addition to distinct probabilities of incidence, the clinical manifestation of the disease may not be exactly thesame in men in women, since as may be seen in the present study, at equivalent level of dementia severity, male andfemale AD patients exhibit different level of performances in specific dimensions of cognitive functioning. 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