Sex differences in the use of spatial strategies in humans: An updated systematic review of the last decade.

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: Not quantified — no meta-analytic pooling performed; results reported as study counts (13/21 showing male allocentric advantage; 7/21 showing no sex differences)

• Primary Outcome: Male advantages in allocentric (world-centred, map-based) spatial strategy use were observed in 13 of 21 included studies, spanning children, young adults, and older adults. Evidence for a female advantage in egocentric (body-centred, route-based) strategies was limited and inconsistent.

• Nnt Or Sensitivity: Not applicable to this review design; no diagnostic accuracy or therapeutic NNT data. Male advantages were also observed in navigation performance outcomes including target retrieval, route efficiency, and directional accuracy. Neurobiological correlates: men showed stronger hippocampal-parietal connectivity; women showed enhanced fronto-temporal connectivity.

• Confidence Interval: Not reported — narrative synthesis only

Clinical Application

The findings are primarily relevant to test selection and interpretation in neuropsychological practice rather than direct clinical intervention. Clinicians should be aware that sex-based normative data for spatial navigation tasks may need to account for strategy preference (egocentric vs. allocentric) rather than raw performance scores alone. Task design factors (complexity, immersion, familiarity) should be considered when interpreting sex-stratified spatial cognition results. In the Australian context, these findings are relevant to neuropsychologists and clinical psychologists practising under AHPRA registration who administer spatial cognition batteries (e.g., components of the WAIS-IV, CogState, or virtual navigation paradigms in research settings). The RACGP does not currently have specific guidelines on sex-stratified spatial cognition assessment, but the findings support the need for sex-specific normative data in cognitive screening tools used in Australian primary care and memory clinics. No PBS or TGA implications arise directly from this review. The findings may inform occupational therapy practice in aged care settings, given the documented age-sex interaction in allocentric strategy decline. Australian researchers should note that sociocultural factors influencing spatial experience (e.g., outdoor activity patterns, urban vs. rural environments) may modulate the sex differences reported in predominantly European and North American study samples. Broadly applicable to neuropsychological assessment contexts involving spatial cognition across the lifespan, including children with neurodevelopmental conditions, adults undergoing cognitive assessment, and older adults being evaluated for mild cognitive impairment or dementia. Relevant to rehabilitation medicine, occupational therapy, and sports/exercise science where spatial navigation is a functional outcome.

Abstract

Although sex differences in spatial cognition have been widely studied, the extent to which men and women differ in their use of egocentric and allocentric spatial strategies remains unclear. This systematic review summarizes findings from 21 studies published between 2014 and 2024 that examined sex differences in spatial strategy use throughout development, adulthood, and aging. Studies were identified through searches of Scopus, Web of Science, PubMed, and PsycINFO, in accordance with PRISMA guidelines. Eligible articles examined egocentric and allocentric spatial strategies in humans and reported results by sex. Results demonstrated male advantages in allocentric strategy, as observed in thirteen studies involving children, young adults, and older adults. Men also outperformed women in several navigation outcomes, including target retrieval, route efficiency, and directional accuracy. Evidence for a female advantage in egocentric strategies was limited and inconsistent. Seven studies reported no sex differences, particularly those using small-scale, familiar, or less immersive tasks. This suggests that methodological factors and task demands strongly influence the observed effects. Age also influenced outcomes. Male advantages in allocentric strategies emerged in early childhood. Older women showed relatively preserved egocentric abilities, but greater decline in allocentric tasks. Men showed stronger hippocampal-parietal connectivity supporting allocentric processing, while women exhibited enhanced fronto-temporal connectivity. Hormonal studies highlight the context-dependent effects of testosterone and estrogen. These findings indicate that sex differences in spatial strategies are highly sensitive to task complexity, environmental familiarity, cognitive load, and individual factors. These findings emphasize the necessity of integrative models that consider developmental, neurobiological, and sociocultural contributors.

References

1. 1.García-Navarra, S., Solares, L., & Mendez, M. (2026). Sex differences in the use of spatial strategies in humans: An updated systematic review of the last decade. Behavioural Brain Research, 116227. https://doi.org/10.1016/j.bbr.2026.116227