Why do more women than men suffer from Alzheimer’s disease? According to an article in the October 2018 issue of the AARP Bulletin, “nearly two-thirds of the 5.5 million people 65 or older with Alzheimer’s in the United States are female.” That number is a a little scary, so I think it’s important to understand why it’s so lopsided.
For a long time, dementia, Alzheimer’s, and memory loss were treated as issues that were almost inevitable as we aged. Add bad genes to the mix, and the odds of getting some form of dementia increased. Fortunately, more focus on Alzheimer’s disease in recent years has led to more research, especially as it relates to women.
What do we know to be true about women and Alzheimer’s? First, women live longer than men, on average, and the odds of exhibiting some form of dementia increase with age. In addition, research has shown that heart health could also play a role. One study suggests that men are more likely to die from heart disease in middle age; those men who live past the age of 65 likely have healthier hearts that may protect the brain from Alzheimer’s. This makes sense, since both heart disease and Alzheimer’s share some risk factors, including diabetes, obesity and high cholesterol.
Recent research also confirms that Alzheimer’s can start in the brain when people are in their 40s and 50s. That certainly differs from the notion that Alzheimer’s is an “old person’s disease” and that you don’t get it until you’re in your 70s or 80s.
An interesting study of the connection between menopause and Alzheimer’s was recently published by Dr. Lisa Mosconi, a neuroscientist. The study looked specifically at why women are more susceptible than men to Alzheimer’s. Dr. Mosconi noted an obvious difference between men and women, that as women get older, we “experience the decline in fertility and the beginning of menopause.”
What researchers are now finding of significance for women is that there may be a direct link between a drop in estrogen and the start of Alzheimer’s. We’ve known for years that beyond fertility, menopause can produce hot flashes, depression, and night sweats, all of which begin mostly in the brain and not in the ovaries. All of these symptoms are caused by a decline in estrogen. Dr. Mosconi’s research indicates that “estrogen serves to protect the female from aging” by increasing neural activity; it may also stop the build-up of plaques thought to cause Alzheimer’s. According to Dr. Mosconi, “when estrogen levels decline, the female brain becomes much more vulnerable.”
If we can detect early signs of Alzheimer’s while women are in their 40s and 50s, we can slow the progression of the disease until their later years, when it’s typically been diagnosed in the past. We may be able to look at estrogen levels and use brain imaging (as Dr. Mosconi did in her study) for premenopausal women, and then use hormone therapies (HT) early on to reduce the risk of Alzheimer’s.
Of course, we need much more research to determine who might benefit from things like HT and for whom the benefits outweigh the risks. It’s encouraging, though, to see research being done and discussion around the connection between menopause and Alzheimer’s. It gives hope that, in the near future, there may be early-diagnostic screening for Alzheimer’s disease—similar to pap smears and mammograms.
And then, as now, we also need continued research in treatment.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten. Read more about and from her here.