“Women are marginalized when it comes to dementia. They are more likely to die from the condition than anything else and they bear a disproportionate burden when it comes to caring for people with dementia.” - Alzheimer’s Research UK - Women and Dementia: A Marginalized Majority
Emerging research is asking why Alzheimer’s affects more women than men. In the past, higher rates of diagnosis in women had been explained away by women’s longevity. A closer look shows this is not true. While 66 percent of people diagnosed with Alzheimer’s are women, at no age are women more than 66 percent of the population. Scientists are therefore looking into other explanations that we’ll explore more below.
The Latest Research on Alzheimer’s and Women
More Periods, Less Dementia Risk
Recent studies looked at how a women’s reproductive story shapes her dementia risk. A longer time between puberty and menopause correlated with a lower risk of dementia.
“Compared to women with reproductive periods of 38-44 years, women with reproductive periods of 21-30 years were at 33% elevated dementia risk adjusting for demographics,” according to Paola Gilsanz, ScD, and Rachel Whitmer, PhD, This data was collected from 14,595 women who were between the ages of 40-55 in 1964-1973.
More Months Pregnant, Less Dementia Risk
“We are intrigued by the possibility that pregnancy may reorganize the mother’s body in ways that could protect her against developing Alzheimer’s later in life,” said Molly Fox, PhD. Past research has shown pregnancy to be a protective factor.
Fox is taking a deeper look into this correlation. The protective effect may be from estrogen exposure, changes to the immune system or some other factor. Fox’s study shows how the many months of life a woman is pregnant correlates with a lower risk of dementia.
As reported at the 2018 Alzheimer’s Association International Conference (AAIC), "a woman who spent 12.5 percent more months pregnant than another otherwise identical woman had approximately 20 percent lower Alzheimer’s risk."
Earlier Hormone Therapy, Less Dementia Risk
Previous studies linked hormone therapy with a higher risk of dementia.
Carey E. Gleason’s, PhD, recent study exposes a crucial complexity. Starting hormone therapy between 50 to 54 made no increase in risk for dementia when compared to a control group that did not take hormones. However, starting therapy between 65 to 79 increased dementia risk.
Gleason reported that “These findings add to our understanding of the complex effects of hormones on the brain. These data are sorely needed to guide women’s healthcare during and after the menopausal transition and to help women make personalized and informed decisions regarding the management of their menopausal symptoms and the prevention of future adverse health outcomes.”
Sex-Specific Diagnostics for Earlier Diagnosis
Women, with and without dementia, are better at retaining words and verbal communication skills as they age. During the early stages of dementia, women are better at hiding the changes.
This may be helpful in the day-to-day but means women get diagnosed later. “These findings may help to explain why women show a more rapid decline across a wide range of cognitive abilities after being diagnosed with Alzheimer’s,” said Pauline Maki, PhD, who sought to explore this.
“While the female advantage may be functionally beneficial, it could mask early stages of Alzheimer’s, resulting in a more severe burden of disease at the time of diagnosis, with more rapid deterioration thereafter.”
The study went on to report that “When a gender-based diagnostic approach was applied, it resulted in improved diagnostic accuracy in both sexes. This suggests the need for, and value of, alternative approaches — such as sex-specific “cut points” in diagnostic tests — to improve early detection in women.”
Women and Tau
Deposits of tau proteins correlate with a diagnosis of Alzheimer’s disease. A recent study by Rachel Buckley, PhD, et al. found, “Early tau deposition was elevated in women compared with men in individuals on the Alzheimer disease trajectory.”
This adds to a growing body of research looking at the role gender plays on the trajectory of Alzheimer’s disease. This further highlights the need for sex-specific diagnostic, research and treatment approaches.
Further compounding this is the difficulty of diagnosing Alzheimer’s, as well as the vast amounts of mystery still surrounding it.
What To Do Now?
Alzheimer’s affects women more by the rate of diagnosis and also across the life-span, by providing the majority of care. By ‘Alzheimer’s’ I mean the diagnosis and the cultural reaction to it. Alzheimer’s carries a huge stigma, akin to cancer and AIDS in years past.
Professor Kimberlé Crenshaw’s coined the term “intersectionality”, which is “a lens through which you can see where power comes and collides, where it interlocks and intersects.” In the case of Alzheimer's, ageism, ableism, and sexism, to name a few, are colliding and interlocking.
We cannot change genetics. While we wait for science to find a cure, there is a lot we can do to help make women with Alzheimer’s and their loved ones feel more supported.
- Be a care ally. Do you know a woman who is caring for someone living with dementia? Reach out and see how you can support her. Can you bring by food? Can you be with her loved one while she goes out? Can you stop by and help the social isolation that all too often accompanies Alzheimer’s?
- Advocate for updated testing. Spread awareness about the differences based on sex. If you or a loved one is experiencing changes in memory, advocate for sex-specific testing.
- Reduce stigma. Join initiatives like Dementia Friendly America. Help reduce stigma and raise understanding in your area. Intersectionality works both ways. Fighting any of the -isms compounded here will help weaken them all. Ageism is a good place to start. Reductions in ageism have also shown a reduction in dementia risk.
- Self-care. Diet and exercise are protective factors, especially for women. For all women, especially those providing care, this is crucial. Where in your day can you add in more physical activity? Can you bike or walk versus drive? Can you build a community by joining a fitness class?
Yes, Alzheimer's affects more women than men and in deeper ways. The first step to changing this is becoming aware of it and all the complexities playing into it. There is more to this story that needs to be uncovered. Missing from the research is gender spectrum inclusion, as well as ethnic variants and other marginalized groups. In the quest for change and cure, we all need to do our part to make sure the complexities of our human family are taken into account and researched.