On Thursday, May 21 AARP presented an in-depth virtual conversation to release the report “It’s Time to Act: The Challenges of Alzheimer’s and Dementia for Women.” The report is a collaborative effort between AARP and the Women’s Alzheimer’s Movement, along with leading brain health researchers and policy advocates from around the world, with support from AARP Foundation’s A. Barry Rand Fund for Brain Health Research. Listen to a replay of the event here.
En español | Roughly 5.8 million people in the U.S. have Alzheimer's disease, and two-thirds of them are women. By 2050, the number of Americans living with Alzheimer's is expected to skyrocket to 13.8 million, according to a new report from the AARP-founded Global Council on Brain Health (GCBH). And more than 9 million of them will be women.
If you're surprised by the disease's gender discrepancy, you're hardly alone. “People just don't think about the fact that women are disproportionately affected by dementia,” says Kristine Yaffe, M.D., professor of psychiatry, neurology and epidemiology at the University of California, San Francisco.
Dementia isn't a specific disease but rather a group of symptoms related to a decline in memory, thinking and social abilities to the extent that it interferes with someone's ability to function on a daily basis. Alzheimer's disease is the most common cause of dementia, but there are others, and “women shoulder a wildly disproportionate burden in every single one of these diseases, robbing them of independence, memories, and in many cases, their self-identity,” the GCBH report states.
How women can reduce risks
- Exercise regularly.
- Stimulate your brain with puzzles, books and games.
- Stay socially connected.
- Relieve your stress.
- Get plenty of good-quality sleep.
- Consume a balanced diet; Mediterranean-style is optimal.
- Protect your head from injury with a helmet when biking or skiing.
- Control chronic health conditions such as high blood pressure and diabetes.
This burden comes in two forms. First, women are more likely than men to develop dementia. Currently, a woman's lifetime risk of developing Alzheimer's disease (after age 45) is approximately 1 in 5; for men, it's 1 in 10.
Women are also more likely to fill the role of caregiver for loved ones with dementia, which can take a toll on their financial, physical and mental well-being. According to the GCBH report, women make up more than 60 percent of dementia caregivers — and many more will take on that role as the population of dementia patients increases in the next few decades.
Not just a matter of age
Why are women at greater risk for dementia? It's a simple question with complex answers — and many unknowns.
For decades, experts assumed the increased prevalence of Alzheimer's disease among women was a consequence of their living longer than men. And while that may be partially true — given that advancing age is the primary risk factor — it's not the only reason.
"The social and environmental influences on health play a huge role in brain health for women,” notes Sarah Lenz Lock, senior vice president for policy and brain health at AARP and executive director of the GCBH. “Women face more challenges due to lower educational levels, they have fewer economic resources, they provide more caregiving for their families and they experience more stress — and these factors can have an effect on the risk of cognitive decline.”
A woman's reproductive history — including the age at which she got her first menstrual period, how many successful pregnancies she had, and the age at which she reached menopause — may play a role in her risk of developing dementia. While the GCBH report acknowledges that more research needs to be done to investigate the effects of pregnancy and childbearing on a woman's risk of developing dementia, some research already suggests that women who have three or more children have a 12 percent lower risk of dementia compared to women who have one child.
Another factor: The precipitous decline in estrogen that occurs around menopause may increase the risk of dementia. “The loss of estrogen may have an effect on mitochondrial function in cells in the brain,” says Ronald Petersen, M.D., professor of neurology and director of the Mayo Clinic's Alzheimer's Disease Research Center in Rochester, Minnesota. This is significant because mitochondria are the powerhouses of the cells.
Genetic factors are at play, too. Women with a certain gene called APOE4, which helps transport fat into the bloodstream, have a higher risk for developing dementia than do men with the same gene. Depression and anxiety are also risk factors for developing dementia, and these mental health conditions are more common among women. “With depression, there's a little bit of a chicken-and-egg phenomenon: Could depression be one of the earliest symptoms of dementia, or is it a cause, or both?” Petersen says.
Another gender discrepancy: Once dementia is diagnosed, it may be more advanced in women than it is in men, according to the GCBH report. One possible reason is that women tend to perform better than men on verbal memory tests at earlier stages of dementia — a difference that can mask memory problems and delay the diagnosis of mild cognitive impairment and dementia.
"We're now appreciating that we shouldn't be using the same normative measures, based on age and education, for women and men,” Petersen says. “The bar may be set too low for women; we need to adjust the norms for sex.” Because women are diagnosed with dementia later in the process, “more pathology has built up in the brain by the time the diagnosis is made,” Petersen says.
It's important to note, too, that some women face a greater risk for dementia than others due to racial and ethnic disparities, the GCBH report points out. Older African Americans are twice as likely to have Alzheimer's as older whites, and older Hispanics have a 1.5 times higher risk than non-Hispanic whites do. “Little if any research has been done to explain these differences. But access to health care stands out as a possible cause,” the GCBH report states. Conditions such as heart disease, stress, hypertension, diabetes and obesity, many of which disproportionately affect racial and ethnic minorities, are also believed to increase dementia risk.
What can women do to reduce their risk for dementia?
While “many women accept that cognitive decline is a normal part of aging,” as Lock notes, it doesn't have to be. “We want more women to prioritize their own health, including their brain health,” she says.
The good news: A mounting body of research suggests that maintaining a healthy lifestyle can reduce the risk of dementia by more than 33 percent.
Here are the key components of a brain-protective lifestyle:
Exercise regularly. Cardio or aerobic exercise, in particular, increases blood flow, reduces inflammation and stimulates the release of growth factors, all of which are protective of brain health, Yaffe notes.
Stimulate your brain. Engage in cognitive activities regularly, such as puzzles, word games and challenging reading material. Using your “mental muscles” supports cognitive reserve and creates a buffer against dementia, Yaffe says.
Stay socially connected. Besides helping to prevent isolation and loneliness, staying connected to people you care about provides a sense of purpose and support for when you need it.
Relieve your stress. Life in the modern world is stressful enough, and most women must juggle careers and family obligations. That's a problem for brain health because, as the GCBH report notes, “ongoing stress and anxiety can depress the immune system, cause depression and increase the risk of Alzheimer's.” So make an effort to regularly decompress from stress with exercise, meditation, yoga, deep breathing or whatever technique works for you.
Get plenty of good sleep. “When we get good-quality sleep, the brain rests and housekeeping is done,” Yaffe says. “A lot of the toxins, including things like amyloid and tau [which are implicated in Alzheimer's], get cleared out.”
Consume a balanced diet. In this respect, what's good for your heart is good for your brain, Petersen says, and a Mediterranean-style diet is optimal.
Protect your head from injury. Traumatic brain injuries are an important risk factor for dementia, Yaffe notes, so be sure to wear helmets for biking or skiing.
Control chronic health conditions. "There's a connection between heart health and brain health,” Yaffe says, “and hypertension, diabetes and obesity have a big effect on the brain because of the vascular effects and other effects.” Take steps to prevent these health problems or keep them under tight control.
"Taking care of themselves with short-term investments in their health and well-being will pay long-term benefits for women,” Lock says. “It's like what they tell you on the airplane — to put on your oxygen mask first before you help others. It does go against the grain for many women to do that, but you really have to. If you're going to be able to care for other people in your life in the long run, you've got to preserve yourself."
The price of caring for a loved one
Currently, 16 million people in the U.S. provide care for people with Alzheimer's or other forms of dementia, according to the Alzheimer's Association, and over 60 percent of caregivers for people with Alzheimer's are women.
"Most [family] caregivers work outside the home and care for other loved ones,” notes Jill Lesser, president of WomenAgainstAlzheimer's. “And the vast majority of dementia care happens outside the health care system. Most dementia care is paid for out of pocket,” which strains caregivers’ finances.
Moreover, family caregivers often pay a price in terms of their own health. After all, the caregiver must navigate the loved one's confusion, disorientation and mood swings, and as the dementia progresses, the patient's difficulties expressing him- or herself effectively. In addition, family caregivers are particularly susceptible to anxiety and depression and have higher risks of heart disease, as the GCBH report notes. Some research suggests that caregivers of dementia patients may face a higher risk of cognitive decline themselves because of that excess stress.
That's why, as a caregiver, it's important to “try to get as much support as you can,” Yaffe says. “Don't be afraid to ask for help and support.”
To ease the caregiving burden, it's also important for “women to ask for paid leave, to expect their health care providers to provide real assistance when it comes to cognitive decline, and to demand real change for long-term care services and support financing,” Lock says. “The fact that we don't have a sustainable long-term care system is at the heart of why women have to bear the brunt of providing these services. We need help!"
Looking to the future
Scientists have begun to study changes in women's brains at midlife that may signal an increased risk of dementia when they're older. More attention is being paid to women's genetic and socioeconomic risks as well. These are all steps in the right direction, but many questions remain about the causes of dementia in women, how it progresses and how women respond to treatment. That's why more gender-based research is needed into the biology, behavior and risk factors for dementia in women — and how they may interact.
In many ways, the GCBH report is a call to action for women to feel empowered to take care of their brain health and help lead the charge toward meaningful progress in reducing the gender disparities with dementia and improving its treatment. As the report concludes, “Doing so will improve the lives of women and men throughout the world — not just today but for generations yet to come."