Why is Dementia Different for Women Than it is for Men?

Diagnosed with Alzheimer’s in 2017, 72-year-old Anne still enjoys puzzles, sewing, and watercolor painting. New activities are less appealing to her and she is becoming a lot more forgetful lately and in need of assistance with everyday activities.

Jeffrey has also had Alzheimer’s since 2017. He still enjoys the same activities he did then, yet the severity of his Alzheimer’s seems a lot less than Anne’s at this point. How can this be?

Anne and Jeffrey are among more than 50 million people worldwide living with dementia – a degenerative disease affecting memory and brain processing. Alzheimer’s is one of several forms of dementia. The number of people with dementia is rising quickly. Globally, experts estimate that 75 million people will live with dementia by 2030 and 131.5 million by 2050. Two-thirds of people living with Alzheimer’s are women.

Alzheimer’s Affects Women More Than Men — Scientists are Trying to Figure Out Why!

Alzheimer’s and other forms of dementia disproportionately affect women more than men in both prevalence and severity. However, the scientific reasons underlying these sex differences are not fully understood.

Dr. Christian Pike, a professor at the University of California (USC)’s Leonard Davis School of Gerontology, studies the disparity of incidence of dementia (focusing mostly on Alzheimer’s) in women and men. He examines key genes involved in the disease and how their effects differ in males and females.

Dr. Pike explains, “Men and women are affected by Alzheimer’s disease differently, both in terms of disease development and progression. Understanding the underlying bases of these differences should be useful in determining whether we need to view prevention and treatment differently depending upon gender.”

Dr. Pike’s study examines the specific gene that is a primary genetic risk factor for Alzheimer’s disease. The presence of this gene disproportionately increases the risk for the disease in women versus men. He explains, “(e)ven in the absence of dementia, this gene, the APOE4, is associated with significantly increased atrophy and dysfunction of the brain and that affects women much more strongly than men.” The gene increases inflammation in the brain and other genetic risk factors that also affect the functioning of the immune system.

Dr. Pike’s study is supported by a $250,000 Sex and Gender in Alzheimer’s (SAGA) research grant from the Alzheimer’s Association, one of the first-ever grants which aim to accelerate research on sex differences in Alzheimer’s disease.

Another Recent Study Offers Additional Findings

Another researcher at the University of Michigan Medical School, Dr. Deborah Levine, recently published findings from research involving 34,000 men and women who participated in one of five studies from 1971 to 2017 and who were followed for a median of eight years. Findings explained how Alzheimer’s may strike later in women than men, but once it takes hold women tend to deteriorate far faster than men.

The study found that “(s)omething known as cognitive reserve helps the aging brain function better for longer, and researchers report that women appear to have more of it than men. But once the reserve runs out, mental decline in women speeds up.”

According to the research, because women may have more cognitive reserve than men, they often perform better on cognitive tests early in the disease than men do. A diagnosis of Alzheimer’s disease involves tests of verbal memory, a function that women on average have an advantage for over men, according to research. The downside is women can perform well on these tests even in the presence of pathology, so diagnosis for mild cognitive impairment and Alzheimer’s disease may be delayed. By the time many women are diagnosed with these conditions, they already have a more severe disease burden and decline more rapidly compared to men. According to Rebecca Edelmyer, director of scientific engagement at the Alzheimer’s Association, “(f)or now, we need to factor these differences into how we test women and men for Alzheimer’s in both the clinic and in research settings. For example, there may be a need for more sensitive testing tools or different testing thresholds that correlate to unimpaired versus impaired cognition for women and men, so we can detect changes as early as possible.”

More Ways Alzheimer’s Differs for Men and Women

Here are some more ways that Alzheimer’s differs in men and women, from the two studies described above and additional research:

• Age is the major risk factor for Alzheimer’s disease, and women on average live longer than men. However, longevity alone does not fully explain why two-thirds of Alzheimer’s patients are women. Even after taking into account the difference in longevity, some studies have suggested that women are still at a higher risk.
• Depression is linked to higher dementia risk and women are two-fold more likely to have depression than men. Additionally, depression is associated with a smaller hippocampus, a brain region important for memory formation, in women, but this association was not observed in men. A history of depression is also associated with faster shrinkage of the hippocampus in women but not in men. The reasons for these gender differences, however, are currently unknown.
• Women have a higher caregiver burden than men: Women make up about 60% of all family caregivers for Alzheimer’s patients. Women caregivers typically have a two-fold higher caregiver burden than male caregivers and are more likely to leave their job to care for a family member. Some studies suggest that spousal caregivers may be at a higher risk of cognitive impairment or dementia than non-caregivers.
• APOE4 Affects women and men differently: Apolipoprotein E, known as APOE, is a gene associated with varying risk of Alzheimer’s. Of the three different APOE types (APOE2, APOE3, and APOE4), the APOE4 type is associated with an increased risk for Alzheimer’s disease. Women with APOE4 are more likely to develop mild cognitive impairment or Alzheimer’s disease than men with APOE4. They are also more likely than men to have worse memory performance, greater brain atrophy, and lower brain metabolism. In APOE4 carriers with mild cognitive impairment, women have higher levels of biological markers associated with Alzheimer’s than men.

You Can’t Control Your Genetics—But You Can Control Your Environment

Whether you are a man or a woman, you can’t control your genetics. At least you can’t yet. But what you can control is your environment and your lifestyle. There are steps we can all take to keep our brains and bodies healthy, such as eating a Mediterranean-style diet, doing cognitively challenging activities, and getting enough sleep. Be sure to take advantage of your annual preventative doctor’s visits and continue to maintain your cardiac health. It still holds true that exercise is good; smoking is bad; and developing diabetes or obesity increases the risk. These recommendations, as most people know, are true for any disease. Check out our article for more tips of keeping your brain healthy!

Planning for a Loved One with Alzheimer’s

Do you have a loved one who suffers from Alzheimer’s or another form of dementia? Persons with Alzheimer’s disease and their families face special legal and financial needs. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s and their loved ones. As Life Care Planning and Medicaid Planning Attorneys in Fairfax, Fredericksburg, Rockville, and DC, we help protect a family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If your family is facing a diagnosis of Alzheimer’s disease or any other type of dementia, please call us as soon as possible to make an appointment for an initial consultation:

Medicaid Planning Attorney Fairfax, VA: 703-691-1888

Medicaid Planning Attorney Fredericksburg, VA: 540-479-1435

Medicaid Planning Attorney Rockville, MD: 301-519-8041

Medicaid Planning Attorney Washington, DC: 202-587-2797