Unlucky Ladies: Why Dementia is Rougher for Women

By Kathleen Murphy

Females are far more prone to cognitive impairment than men.

But new research shows that with the right approaches, many risks can be averted.

Picture a person with a condition such as Alzheimer’s Disease or dementia. Who do you see?

If you imagined an elderly woman, you’re correct. Nearly two-thirds of people living with Alzheimer’s are female, and 74% are age 75 or older. (Alzheimer’s is the most common form of dementia.)

But why the disparity – what makes women more vulnerable to health conditions like these, which can lead to cognitive decline? 

For many years, researchers assumed longevity was the culprit. Since the average lifespan of a woman is several years longer than that of a man, the thinking went, women are more prone.

But new research is questioning that logic. Researchers at the University of California, San Diego (UCSD) School of Medicine have discovered that when it comes to Alzheimer’s and other forms of dementia, women not only face higher rates but may also be more strongly affected by several common risks related to cognitive decline. 

The differences “highlight the importance of considering sex as a key variable in dementia research,” Judy Pa, a neurosciences professor and the study’s corresponding author, said in a statement. “Sex differences are profoundly overlooked among many leading causes of death like Alzheimer’s, heart disease, and cancer.”

Despite this clinical oversight, the new study offers a note of optimism for people of both genders: If a person’s unique risk factors could be identified as early as possible– ideally by midlife – they could, through medical care or lifestyle modifications, be adjusted, treated, or avoided. Seen in this way, the specter of dementia could be left in the dust – welcome news for both men and women. 

Women take the brunt

For the new study, UCSD researchers used information from the Health and Retirement Study –  a nationally representative group of more than 17,000 US adults in mid- to late life. 

Scientists examined more than a dozen risk factors for dementia, including depression, obesity, physical inactivity, smoking, hearing loss, diabetes, hypertension, alcohol use, cholesterol levels, poor vision, social isolation, sleep problems, and low levels of education. Evidence suggests that nearly half of all dementia cases worldwide could be prevented or delayed by addressing risk factors across a person’s lifespan. 

Study results found that depression is nearly twice as common in women (17%) as in men (9%). Additionally, women were more likely to be physically inactive (48%) and to have sleep problems (45%) than men (42% and 40%, respectively).

Obesity and high blood pressure were found to be equally prevalent between the sexes. But even when prevalence was the same, women with these conditions showed steeper drops in cognition than men. And when factors such as hearing loss or diabetes were examined (which males experience more commonly than women)– poorer cognitive scores were still shown among the females. 

What this means

The study’s implications are clear: Dementia risks don’t carry equal weight between the sexes. What’s not so straightforward: Why do women suffer stronger negative effects?

Biology itself may be a factor. Some researchers point to the fact that women’s stronger immune systems produce more amyloid plaque, one component of Alzheimer’s Disease pathology. Additionally, a woman’s menopausal symptoms, which often include insomnia, mood changes, and brain fog, could set the stage for later cognitive decline. 

UCSD researchers point out that even the type of work a person performs can matter. They pointed to the fact that the exhausting and stressful job of caregiving for young children and elderly parents overwhelmingly falls to women. And older women are less likely to have attended college, which sets the stage for lifelong curiosity and brain health.

Individualized medical treatment

Fortunately, UCSD researchers say, many of the risk factors identified in the study are modifiable – meaning there may be opportunities to reduce them through targeted clinical interventions. A key opportunity is improving women’s cardiovascular health by addressing untreated hypertension.

Placing a greater focus on sex-based differences aligns with the growing field of precision medicine. Under this type of care, patients are treated based on their individual characteristics and factors such as biology, environment, and lifestyle, rather than a “one size fits all” treatment.

Preventing and reducing your risks

Even if you’re a woman in middle age or older, there are many things you can do to reduce your risk of dementia and Alzheimer’s. Because there is no cure for Alzheimer’s or most causes of cognitive decline, prevention and risk reduction are essential. 

Majid Fotuhi, a neurologist and author of the new book “The Invincible Brain: The Clinically Proven Plan to Age-Proof Your Brain and Stay Sharp for Life,” suggests the following: 

• Exercise. No surprise here: Your brain benefits when you engage in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.  
• Eat a Mediterranean diet. Fill your plate with foods such as fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry – all containing nutrients that promote cognitive health. 
• Keep your brain active. Take up a new hobby, socialize with friends, and continuously learn new skills. Remember that the brain is like a muscle: The more you use it, the bigger and stronger it gets. 
• Get enough Zzz’s. Sleeping well at night does more than set you up for the next day. Inside your brain, it clears those amyloid Alzheimer’s plaques. 
• Meditate. Studies have shown that meditation increases blood flow to the brain and strengthens connections between the neurons. The practice also decreases cortisol, a stress hormone that, when chronically elevated, can harm your brain.

Looking to the future, “a more nuanced understanding of (sex-related) differences could help us design smarter, more targeted interventions,” the study’s lead author, Megan Fitzhugh, an assistant professor of neurosciences in the UC San Diego School of Medicine, concluded. “That’s an essential step toward reducing the burden of dementia for everyone, but especially for women, who are disproportionately affected.”

Kathleen Murphy has always been a writer – for newspapers, magazines, companies, and nonprofit organizations. Today, as an independent journalist, she writes about physical health, emotional wellness, and successful aging.  She’s living her dream through her creative projects and her adventures in the great outdoors. We are thrilled to welcome Kathleen as a new feature writer for agebuzz!