Consider the following statements:

  • Women over the age of 60 are twice as likely to develop Alzheimer’s disease as they are to develop breast cancer. There are survivors of cancer but there are not yet survivors of Alzheimer’s disease.
  • Two thirds of the population living with Alzheimer’s disease are female.

What makes women more susceptible to Alzheimer’s disease than men?  The previous thinking was that women simply lived longer than men. However, recent research suggests some interesting alternative explanations.  

Advances in science and technology have allowed investigators to discover important biological differences between women and men that are changing our fundamental understanding of Alzheimer’s disease. According to recent studies, women appear to have increased genetic risk for Alzheimer’s disease compared with men. In addition, women may be more susceptible to some aspects of disease progression. But at the same time, they may also be more resistant to experiencing the symptoms of the disease.

The explanation is complex, and may include a variety of factors – biological, genetic and social.

Biological Factors

Regarding biological factors, brain imaging has shown that toxic tau protein, a hallmark sign of the disease found in the brain, spreads faster and more easily in a woman’s brain and is dispersed more widely. A recent study from the Center for Cognitive Medicine at Vanderbilt University Medical Center identified that the structure of tau networks is different in men and women, with women having more “bridging regions” that connect various regions of the brain. These “bridging regions” may be what is allowing tau to spread faster and easier in women, accelerating the development of Alzheimer’s disease.   

Additionally, brain imaging by researchers at the University of California, San Diego, shows that women’s brains metabolize sugar more effectively than men. Sugar is the brain’s main energy source. While this would appear to be an advantage, it is possible that women are being diagnosed with memory loss later in the disease process, because their brains are better able to mask the symptoms of the disease. Women’s higher verbal skills also result in better performance on the verbal portion of cognitive tests, which may delay the diagnosis until Alzheimer’s disease is further along in its course.

Genetic Factors

Genetically, University of Miami researchers have determined that there appear to be specific genes that are related to disease risk by sex. This means certain genes may present a risk for Alzheimer’s only to men, while others only to women.  Researchers at Stanford University studying individuals with the Alzheimer’s risk gene known as ApoE-4 found that women who carry a copy of the gene are nearly twice as likely to develop Alzheimer’s as women without the risk gene. Men who carry the gene are at only slightly higher risk than men without it.  Seven other sex-related genes are being studied in relation to Alzheimer’s disease.  More studies are underway to determine how these risk genes influence the disease process.

Social Factors

Finally, social factors may play a role in women’s risk for Alzheimer’s disease. There has been discussion about the traditional role of women in past generations and how that may have contributed to the disproportion in Alzheimer’s between the sexes.  Previous generations of females were not given the same access to education, employment and athletics as men.  

Education is an important factor in terms of Alzheimer’s disease risk. More education is well known to reduce one’s risk for Alzheimer’s disease (a concept called “cognitive reserve”), and lower education has more recently been identified as an early-life risk factor for later-life Alzheimer’s disease.

One additional thought is that it is traditionally the women’s role to act as caregivers to both children and the elderly.  The level of stress that they may experience as a result could possibly influence their risk level.

Reduce your risk

Taken in total, these factors may be impacting the prevalence of Alzheimer’s disease in women.  To reduce your risk, live a heart- and brain-healthy lifestyle.  Diet, exercise and management of physical and mental health concerns, along with restful sleep, social engagement, and a habit of lifelong learning can all help you live your best life.  

If you are concerned about your memory or thinking abilities, please share these concerns with your health provider.  You can learn more about Alzheimer’s disease on our website.

Jonathan Drake, MD

Dr. Jonathan Drake is associate director of the Alzheimer’s Disease and Memory Disorders Center at Rhode Island Hospital, and specializes in aging and dementia. His clinical and research interests are in the early detection and prevention of Alzheimer’s disease and other forms of dementia.