EEG recordings during visuo‐attentive task reduce sex bias in Alzheimer's disease diagnosis

INTRODUCTION: Pathological cognitive decline affects roughly 15% of older adults, presenting relevant sex differences, being a stronger predictor of Alzheimer's disease in females. Yet, sex-specific neural markers that support a balanced early diagnosis remain limited. Event-related potentials (ERPs) derived from task-based electroencephalograph (EEG) offer a non-invasive window into cognitive processing, but their sex-specific diagnostic value in subjective cognitive decline (SCD) has not been explored. METHODS: = 19) to extract ERP components reflecting stimulus encoding and decision processes. We investigated sex-specific associations between ERP features and task performance and trained separate machine learning models for SCD diagnosis in males and females. Diagnostic models were constructed using either clinical features alone or a combination of clinical and ERP features to quantify the added value of ERPs over standard assessments. RESULTS: = 0.31). ERP features consistently demonstrated higher sensitivity to subtle cognitive alterations, particularly in females. DISCUSSION: Task-related ERPs provide complementary, sex-specific neural information that mitigates diagnostic disparity arising from clinical assessments alone. Incorporating ERP features supports a more equitable early identification of cognitive decline and may improve screening strategies for populations usually under-recognized in preclinical Alzheimer's disease pathways. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05569083. Highlights: Task-based electroencephalograph (EEG) reveals sex-specific neural mechanisms in early Alzheimer's disease (AD) stages.Event-related potentials (ERP) features improve subjective cognitive decline (SCD) diagnosis and eliminate sex bias in classification.Combining cognitive data with task-EEG enhances overall diagnostic accuracy.Visuo-attentive EEG offers a non-invasive, unbiased tool for early AD detection.