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Why Are Women More Likely To Develop Alzheimer's?


For years, doctors and researchers have known women are more likely to develop Alzheimer’s disease than men. This has largely been attributed to the longevity of women; however, science has some new, startling evidence. 

Today, 5 million Americans have Alzheimer’s disease. And the majority of those people -- about 3.2 million -- are women (about 64 percent). By the age of 65, women have a 1 in 5 chance of developing Alzheimer’s, compared to a 1 in 11 chance in men

Why the disparity? 

For years, it’s been mostly attributed to the fact that women live longer than men, and older age is the greatest risk for Alzheimer’s. However, researchers are now questioning whether the risk of Alzheimer’s could actually be higher for women at any given age due to biological or genetic variations or differences in life experiences.

What is Alzheimer’s? 

First, let’s discuss the basics of what Alzheimer’s disease is and what it does to a person:  

  • Alzheimer’s disease is an irreversible brain disease that slowly destroys memory skills, thinking skills and, eventually, the ability to carry out daily activities, leading to the need for full-time care. 

  • Dementia is the general term for a group of brain disorders that cause problems with thinking, memory and behavior. Alzheimer’s disease is the most common type. 

  • People with Alzheimer's disease have problems with memory loss, disorientation and thinking ability. Those afflicted with the disease may have trouble with vocabulary, recognizing everyday objects, and recognizing family and friends. They may become frustrated, irritable, and agitated.

  • As the disease gets worse over time, physical problems may include loss of strength and balance, and diminishing bladder and bowel control. As more and more of the brain is affected, areas that control basic life functions, like swallowing and breathing, become irreversibly damaged, resulting eventually in death.

  • It’s a disease that can occur in people as early as their 30s and 40s, but the vast majority of people diagnosed with Alzheimer’s are older than 65. 

Not Just About Longevity 

At the 2019 Alzheimer’s Association International Conference in Los Angeles, scientists presented new evidence that the disease may in fact spread differently in the brains of men and women. Additionally, other researchers showed that several newly identified genes seem related to Alzheimer’s by sex. 

The majority of people living with Alzheimer’s are women and it’s imperative we understand why,” said Maria C. Carrillo, PhD, Alzheimer’s Association chief science officer.“The research reported today at AAIC gets us one step closer to answering that question by identifying specific biological and social reasons why Alzheimer’s is different in men and women.”

Carrillo says there’s “a biological underpinning” for sex differences in the disease. “Understanding these sex-specific differences may help us identify and apply customized prevention strategies for different populations against cognitive decline, Alzheimer’s disease and other dementias.” 

Stanford University researchers studied over 8,000 people in the search for a form of the gene ApoE-4, a gene that increases the risk of Alzheimer’s. In their research, they found that women who carry a copy of ApoE-4 variant were twice as likely to eventually develop Alzheimer’s as women without the gene. Men who had the gene were only at a slightly increased risk than men who did not have the gene. While it’s unclear exactly why the gene poses such a drastic increase in risk, Roberta Diaz Brinton, a University of Southern California professor who studies gender differences, believes it may be how the gene interacts with estrogen. 

Other research suggests heart health may be the key difference in men and women developing Alzheimer’s. A study from Framingham, Massachusetts suggests that because men are more likely to die from heart disease in middle age, those men who live beyond 65 may have healthier hearts. And since heart disease and Alzheimer’s share many of the same risk factors -- high cholesterol, diabetes, obesity -- that could explain the connection. 

At Vanderbilt University, researchers looked at the function of tau (tau are proteins that bind to and stabilize microtubules in healthy brains).

Using scans on 301 people with normal thinking skills and 161 others with mild impairment, they mapped where tau was deposited and correlated it with nerve networks — highways that brain signals follow.

They found that tau networks in women with mild impairment were more diffused and spread out than in men, which suggests that more areas of the brain were affected.

One final factor to consider is the work-family demands that women experience. Over the last 100 years, women have experienced drastic changes to employment patterns and family circumstances. 

Elizabeth Rose Mayeda, PhD, MPH, assistant professor of epidemiology at UCLA Fielding School of Public Health, and team studied women born between 1935 and 1956 in the Health and Retirement Study to better understand how women’s work-family demands may play a role in late-life memory decline. 

The researchers found that women who participated in the paid labor force between early adulthood and middle age, including mothers and non-mothers, experienced slower memory decline in late-life. They found the rate of memory decline was fastest among women who did not engage in waged employment. 

Compared with married mothers who participated in the paid labor force:

  • The average memory performance between ages 60-70 declined 61% faster for married women with children who never participated in the paid labor force. 

  • The average memory performance between ages 60-70 declined 83% faster for women who experienced a prolonged period of single motherhood without waged employment.

This suggests that participation in the paid labor force may play an important role in late-life cognitive health for women in the United States, and lends further credibility to previous research in this field. 

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