Why is dementia different for women?

More women are affected by dementia than men. Worldwide, women with dementia outnumber men 2 to 1. Here we discuss the biology behind dementia risk.

Dementia risk is a complex puzzle. Understanding the differences of the sexes is one way that could help dementia researchers understand its causes and develop new treatments.

Dr Aoife Kiely, Research Communications Officer at Alzheimer's Society, explores why being male or female could affect dementia risk and diagnosis.

Two elder women smiling in conversation

Facts about women and dementia

  • More women are affected by dementia than men. Worldwide, women with dementia outnumber men 2 to 1.
  • Brain scans tell us that the rate at which brain cells are dying in the brain is faster in women than in men.
  • Women are more likely to live longer than men. However, although risk increases with age, dementia is caused by diseases of the brain not age alone.

The importance of female data in research

Animals are sometimes used in dementia research to understand the condition and develop new effective treatments.

We know data from female animals has generally been ignored in brain research. In the past, researchers have dismissed data from female animals or results from drugs trials that involved them.

The data was seen as too odd or inconvenient. Today, the use of female data has sparked debate among dementia researchers.

Jacqueline Mitchell, an Alzheimer’s Society funded researcher at King’s College London, says:

'We are very aware of sex-based differences – we always make sure to use a balance of male and female so that we can statistically compare any differences that arise in response to drug treatments.’

It might be a surprise that we haven’t learned more in the lab about how males and females respond differently to drug treatments.

However, women were only included in clinical trials from 1993.

Understanding the effect of oestrogen

Women have a lifelong relationship with the female hormone called oestrogen. Oestrogen affects the brain, mental health, the cardiovascular system, the liver and more. There have been some studies that show oestrogen might protect brain cells.

Some researchers have suggested that if a woman has more oestrogen throughout her life, she might be less likely to develop dementia.

For example, if she starts her periods at a younger age, has at least one child or goes through menopause later.

Yet, before we can think of oestrogen as a wonder drug, it has some hurdles to overcome.

Hormone replacement therapy and dementia

Oestrogen is used in hormone replacement therapy (HRT). Some women going through menopause choose this to help relieve some of the symptoms, such as hot flushes and anxiety.

HRT fell out of favour when it was decided that the risks of heart and breast cancers outweigh any potential benefits on thinking and memory. Researchers are currently hard at work to develop better, more naturally-acting HRT. They are investigating whether starting HRT earlier could reduce dementia risk.

How sex impacts dementia diagnosis

Oestrogen affects how a woman’s brain grows and functions. Researchers think this might be why women have a better memory for words and verbal items than men. To assess this part of our memory we measures memory of a list of words or a short story.

Women keep these skills even if they have mild memory and thinking problems. The first step in dementia diagnosis is a verbal memory test. This poses a problem for men and women. As women have a strong verbal memory, they tend do well on memory tests, even if they have cognitive problems. This means they are under diagnosed with dementia.

Men are more likely to be incorrectly diagnosed with dementia because their verbal memory skills might not be as strong. At Alzheimer’s Society, we champion person-centred care. This must begin with a method of diagnosis that takes into account certain factors. These could include things such as cultural background, education, on and off days and sex

Does heart health play a role in dementia risk?

We know that what is good for the heart is good for the head. Improving heart health seems to be a good way to lower dementia risk. The health of a heart affecting dementia risk might also be linked to sex. For example, high blood pressure in midlife is believed to increase risk in women but not men, even though it is more common in men.

Professor Patrick Kehoe is an Alzheimer’s Society funded researcher based at University of Bristol. He says:

'It is possible that the complex relationship of oestrogen to the renin angiotensin system, which regulates blood pressure and has roles in cognitive function, influences a woman’s risk of developing Alzheimer’s. Following menopause with the influence of oestrogen on this system a woman is at greater risk of high blood pressure and so perhaps also dementia, but we need to test this in more detail.’

Looking to the future

The G8 and the Prime Minister's Challenge have committed to finding a disease modifying therapy for dementia by 2025.

With women being 65 per cent of the people affected by dementia, we must make sure that any new therapy works for them as well as men.

From lab to the pharmacy, it's important dementia research, care and treatment can improve the lives of both men and women.

How to reduce your risk of dementia

Although getting older is the biggest risk factor for dementia, evidence shows there are things you can do to help reduce your own risk. 

Find out more

34 comments

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Hi Carole, Just revisited this blog, Thanks for your interesting comments as you say not everyone fits the pattern of poor education ect your husband certainly sounds an exception to the best known risk factors, if you would like to share more please do.

Hi! I have been wondering, has anyone made a study, can there be a relation between cosmetics and alzheimer? We girls are most likely using all sort of chemicals... Dying our hairs, using all sort of products just few centimeter away from our most important organ... And skin is not waterproof...🤔🤔🤔

Hi Kati, thanks for your comment.

As far as we know, no research has been published on this topic. All beauty products that are sold in the UK are subject to safety testing by a qualified professional like a pharmacist to check that they are safe for people to use: https://www.gov.uk/guidance/making-cosmetic-products-available-to-consu… This makes it very unlikely that using cosmetics would increase a person's risk of dementia.

Read more about what can increase a person's risk of dementia: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…

We hope this helps,

Alzheimer's Society website team

Very interesting theories re why females out number males with regards to Dementia. Has anyone ever thought about the dramatic drop in the "male" hormone TESTOSTERONE in post-menopausal females? Women suffer a very marked decline in this vital hormone but in the UK it is rarely considered important to replace this hormone. Why not? It may be the "missing link" to the mystery of why women seem prone to this horrible disease.

Women use scents from an early age
Other professions (lab techs, nurses,, hairdressers. etc) are exposed to strong scents. Could this have a bearing on this?

Hi Reg, thanks for your comment.

The link between dementia risk and solvent exposure is still unclear and not much research has been carried out in this area. We have a page on our website which discusses the link between dementia and air pollution, and how more work is needed to solidify if pollutants can influence dementia risk. You can read that here:
https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…

Hope this helps,

Alzheimer's Society website team

My mother and her 3 sisters, and now my own sister all had and died of Alzheimer’s. I had my mother and one of her sisters tested over a few months years ago by their geriatric doctors and a team from a hospital for Alzheimer’s. They tried to understand the difference between two of the sisters. My mother was married many years, had four children, suffered the loss of a young child. Her sister was never married and had no children. They all began small symptoms about age 75 (I’m 74) my sister is 83 and has been in a hospital about 6 yrs. none of them had any other illness or were on medication . They all died in about 10 yrs around 86. They were all educated , professionals, no obesity and avid readers and loved news papers and cross word puzzles. My sister played golf at least three times a week. I of course am scared to death of suffering that sad ending.

Hello Nancy,

We're really sorry to hear about your family. This must be a difficult time for you, and it's understandable that you feel worried.

It sounds like you may benefit from joining our online community, Talking Point, where people affected by dementia can share experiences, and offer advice and support. This could be a great place for you to chat with other people who have been in, or are going through, similar situations:
https://www.alzheimers.org.uk/get-support/dementia-talking-point-our-on…

Remember that you can always call our Dementia Connect support line on 0333 150 3456 for more dementia information, advice, and support specific to your situation. More details about the support line (including opening hours) are available here: https://www.alzheimers.org.uk/dementia-connect-support-line

We hope this helps, Nancy.

Alzheimer's Society blog team

So interesting yesyes

I live with 25 people who have various stages of dementia. I find it fascinating how they relate differently to certain stage of activities .

My mother was diagnosed with premature dementia after a lifetime of physical and mental abuse from my Father, my Sister developed dementia and my brother has been diagnosed with Lewy bodies, both my sister and brother drank heavily I am wondering what are my chances of developing dementia.

My mom repeats everything and worrys alot telling me what am i going to do i cant remember anything. She will ask the same question over and over for 4 to five hours i explain and tell her we have problems solved and she still says what am i going to do repeating and starting conversation over. Need advice.

Hello Linda, thanks for getting in touch.

People with dementia often carry out the same activity, make the same gesture, say the same thing, make the same noise or ask the same question over and over. Often if someone is repeating the same question, they need reassurance rather than information. Learn more about repetitive behaviour, and read some tips: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/sym…

For further advice on what to do, we'd recommend speaking with one of our trained dementia advisers who can listen to the situation and provide support. You can call the Dementia Connect support line on 0333 150 3456: https://www.alzheimers.org.uk/dementia-connect-support-line

Some people also find it helps to talk to others going through a similar situation. If that appeals to you, take a look at our online community, Talking Point. You can share your experiences and ask questions of the community, or just read what other people have to say: https://forum.alzheimers.org.uk/

We hope this is helpful. Remember to call our helpline whenever you need dementia advice or support.

Alzheimer's Society blog team

that is a very common behavior with people with dimentia. I work in a memory care and we have all these people that shows the same behavior like your mom.

When my mother did this, we wrote down answers to reassure her. She like to read and could read what I printed out for her again and again without having me to repeat. This helped since I worked part time from home and needed to focus. We also wrote other things like the day of the week and so on to help her be more oriented.

I agree with the comment made above, but one has to be careful of who they are talking about.

my wife has FTL dementia I spend a lot of time trying to work out why she has this, one thing I wonder is could being sterilised after having our children be a cause or other medical procedures ? There is nothing in her family.

Hi David,
Thanks for getting in touch.
We are often asked by our supporters whether general anaesthetics used in surgical procedures might increase risk of dementia, but the research on this subject is not conclusive: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…
In most cases, however, researchers think dementia is caused by a range of different factors, rather than one single cause. These include things such as genetics, lifestyle and other environmental factors.
It is very difficult to know for any individual exactly what may have caused their condition.
-
Alzheimer's Society Research team

Hi Georgina, a good link to begin with is:
Does Brain Development in Childhood Set the Stage for Dementia?
Series - Alzheimer's Association International Conference 2015:
20 Aug 2015
It’s clear by now that in dementia, a disease mostly of old age, trouble starts decades earlier—but how early? Well—how about in the womb? Data presented at the Alzheimer's Association International Conference, 2015, held July 18-23 in Washington, D.C., lend some support to this radical idea. Scientists presented epidemiological, imaging, and even genetic studies that drew associations between early brain development and some atypical forms of Alzheimer's disease.
They also grappled with what those associations mean. “Might how your brain is wired in early stages influence how it degenerates later in life? That’s an extremely interesting concept,” said Jonathan Schott, University College London. Zachary Miller, from the University of California, San Francisco, stressed that early developmental patterns are not necessarily risk factors for later disease. "A more parsimonious explanation is that if you are going to get some form of dementia, then where it presents first, or the ‘locus of least resistance,’ might be determined by how your brain has developed," he told Alzforum. Whatever the cause and effect, researchers agreed that studying how learning disabilities and brain development influence later dementia could yield valuable insights into the disease processes, and even provide an opportunity for very early intervention.

Researchers have suspected for some time that there is a connection between learning problems and dementia. In 2008, researchers led by Marsel Mesulam at Northwestern University, Chicago, reported that people with learning disabilities..

The rest of the article is online..
My focus of interest is now on the daily and seasonal circadian rhythm, if you google Images for serotonin and melatonin it speaks volumes about insomnia.

I have often wondered if having ADHD makes dementia more likely. I mean - forgetting stuff is part of ADHD.

It would be really useful to have a link to the research studies mentioned in the articles to read. Apologies if I have missed it!

Obviously a lot of factors that need to be controlled for and investigated. Some of the data analysis is too crude e.g. the number of children doesn’t factor in the number of years on the pill, miscarriages etc which will also change the Oestrogen levels and maybe even if you breastfed for over a year. But the sleep thing is really interesting as snoring husbands have a much bigger and longer impact than pregnancy or menopause, shitty as the later is. I wonder whether that is being taken into account or whether it’s too politically incorrect to raise it ?

What about B12 and Pernicious Anemia? A lot of study is now been seen showing that low levels of Iron and B12 over your life time effects neurology. One of the first signs of Pernicious Anemia is what they call “brain fog”. Women suffer higher instances of Iron and B12 Anemia than men. Is there not something in this? If so how easy would it be to make sure your B12 levels are high and not deficient.

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