Most Alzheimer Patients Are Women: Study Probes Reasons
More than five million Americans live with Alzheimer’s dementia. Nearly two-thirds are women. And scientists have spent years trying to figure out why. Turns out – women develop brain changes associated with Alzheimer’s disease earlier than men, according to a study published in Neurology.
Researchers from Weill Cornell Medicine recruited 121 participants (85 women and 36 men), between the ages 40 and 65 with normal brain function. Participants underwent an extensive intake process plus clinical and neuropsychological examinations, laboratory tests and various brain scans.
After collecting data, researchers assessed specific risk factors -- age, education level, APOE status, family history, depression, diabetes, high cholesterol, thyroid disease, post-menopause, smoking, diet, exercise and intellectual activity -- and used them to compare Alzheimer’s disease biomarkers between men and women and to identify risk factors associated with gender-related differences.
Results suggested that middle aged women had 30 percent more Alzheimer’s-related brain plaque compared to middle aged men. Women also had 22 percent less energy in the brain, but 11 percent more brain shrinkage. Researchers attributed the differences to waning estrogen and progesterone levels associated with menopause.
“This is a small study, but its results echo other studies,” says Bernard Kaminetsky, MD, medical director, MDVIP.
At the 2019 Alzheimer’s Association International Conference in Los Angeles, researchers from Vanderbilt University, University of California, San Diego (UCSD) and University of Miami (UM) presented related studies.
Vanderbilt’s study looked at the differences in how tau, a protein that forms tangles that destroy nerve cells, spreads in the brain. They found women with mild impairment had wider spread networks of tau compared to men, suggesting more areas of the brain were affected.
The UCSD study questioned why women tend to have better verbal memory skills (i.e., recalling words and lists) than men, even while showing signs of early to moderate Alzheimer’s disease. After scanning more than 1,000 brains of elderly adults, they found that women’s brains were more efficient at using sugar -- its main energy source – compared to men. Researchers think this efficiency helps women compensate for, as well as mask, the toll dementia takes on their brains. The results also suggest that women are less likely to be diagnosed with Alzheimer’s disease based on verbal skills tests.
And a UM study analyzed genes of 30,000 people — half with Alzheimer’s, half without. Researchers identified four genes that appear to have a gender-related disease risk. One gene seems to raise the risk in women, the other three in men. At this point, researchers don’t understand a lot about these genes, other than some appear connected to the immune system. The National Institute on Aging has awarded UM with grant money to expand the study to worldwide and include 100,000 people.
“Although more research is necessary, it would not surprise me if diagnostic testing for dementia became gender specific and if scientists began studying safer hormonal replacement therapies for women,” says Kaminetsky. “Some experts are already suggesting that physicians should begin conversing with women about reducing their risk for dementia as soon as they hit middle-age, as opposed to waiting until they are elderly. But regardless of your age and gender, you can always talk to your doctor about making lifestyle changes that can help lower your risk of dementia such as eating healthier, quitting smoking, limiting alcohol consumption, getting adequate sleep, adding exercise into your routine and controlling chronic conditions.”
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