Alzheimer’s Disease: Women Carry the Load
by Scott Kaiser
Women’s Health and Alzheimer’s
- Almost two-thirds of Americans with Alzheimer’s disease are women. Of the 5.1 million people age 65 and older with Alzheimer’s in the United States, 3.2 million are women and 1.9 million are men.
- A woman’s estimated lifetime risk of developing Alzheimer’s at age 65 is 1 in 6 (compared to 1 in 11 for men). Women in their 60’s are about twice as likely to develop Alzheimer’s disease during the rest of their lives as they are to develop breast cancer.
- The majority of family caregivers are women. In 2017, more than 16 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer’s or other dementias. This care is valued at more than $232 billion.
Brain Health: A Critical Role in Women’s Health
While we should all be concerned about maintaining a healthy brain, brain health should be at the top of every woman’s healthy living checklist. In fact, women are more likely to experience and report memory complaints, far more likely to develop Alzheimer’s disease, and are found—resoundingly more often than men—playing a caregiver role in supporting someone else with dementia or other chronic disease.
Most of us accept and expect a certain decline in cognitive functioning with increasing age; however, at the Pacific Brain Health Center, this is something we are striving to reverse. Our specialists are not willing to accept cognitive decline as a foregone conclusion and we have developed many programs to be proactive about maintaining our brain health, especially the brain health of women.
According to the Alzheimer’s Association, every 65 seconds someone in the US develops Alzheimer’s disease—a striking statistic with particular relevance to women who represent nearly two-thirds of the total population of those suffering from dementia.
What is the Sex Difference?
To make matters worse, we don’t yet fully understand why this sex difference occurs. It was previously believed that the longer life trajectory of women best accounted for the gender difference; however, it is now clear that a greater life expectancy alone cannot explain why women develop dementia at higher rates and that there are other factors at play.
For one, we are gaining an increased understanding of the role hormones, namely estrogen, may play in mediating cognitive health and the independent effects of estrogen variability on cognitive decline. There are correlations, for example, between the length of a woman’s productive years and a decreased risk for developing dementia.
Still, this relationship is not fully understood and with many potential mechanisms involved, for which we need further investigation, many questions remain. For example, could the differences be mediated by estrogen’s regulation of the APOE4 gene in affected women? Might the connections be found in relation to sex differences in heart health? Could this all be related to on overall inflammatory process and differences in anti-inflammatory pathways?
Hormonal Shifts Cause Brain Changes
Given the role estrogen and changing levels of hormones play, menopause can be a time that brings cognitive issues into focus for women and an important time to take a more proactive approach. In fact, as women reach menopause cognitive and mood changes are among the most common complaints—second only to hot flashes. While significant controversy surrounds hormone replacement therapy, some studies suggest that hormone supplementation, including estrogen, may lower the risk of dementia if taken at menopause for a short period of time. It appears, along with this, that there may be a somewhat narrow window for this intervention to be effective as estrogen replacement may not be as beneficial if taken years after menopause—when changes in brain neurons affecting memory and thinking may have already occurred. Given the broad potential impacts of hormone replacement therapy on overall health and quality of life, along with the remaining uncertainty of course, women should always consult their healthcare providers prior to determining the role hormone replacement therapy may play in addressing their cognitive health.
Taking Charge of Your Brain Health
While menopause may provide a critical inflection point, maintaining brain health should be part of a life-long healthy living strategy for women. So what are just a few of the things all women can do to take charge of their brain health?
- Know your risk.
Have a frank discussion with your doctor about your concerns, your general health and your risk factors for potential cognitive decline.
- Invest in your own self-care.
It’s important to take the time and energy to take care of yourself (easier said than done, especially when, despite modern times, the reality is that more women still run households and act as the caregivers in their families). Take a cue from the airline safety instructions on this one: place your oxygen mask on first. A major component of this self-care, of course, is stress management. While stress is part of everyday life, over time and uncontrolled, it can lead to increased inflammation, vascular changes and other imbalances that are damaging to cells throughout the body—including those in our brain. By managing your stress levels, you can improve your overall brain health and reduce your risk of dementia. In particular, a mode of self-care with benefits well beyond stress-reduction alone, regular meditation practice has been associated with improved cognitive health and can be a way to reduce our dementia risk.
- Exercise is the best medicine.
Evidence supporting the beneficial impacts of exercise on cognitive health is abundant and incontrovertible. Potential benefits of exercise on our brain health may include the overall cardiovascular benefit (what’s good for your heart is good for your brain), its anti-inflammatory effects, increases in BDNF (a protein involved in the growth of nerve cells or neurons, sometimes referred to as “miracle grow for the brain”) and overall hippocampus size (a part of the brain involved in the formation of new memories and which shrinks in size in those with Alzheimer’s disease), and other impacts directly within the brain for which there remains much to be studied. Still more, additional research studies suggest that regular exercise not only improves cognition but also promotes overall longevity through its wide broad range of health benefits, even impacting the length of cellular DNA telomeres (key players in the genetics of aging).
- Food as medicine:
While dietary fads come and go, the relationship between what we eat and our cognitive health is real and is here to stay. The negative impacts, for example, of highly processed foods and refined sugars are clear. Correlations have been found between elevated blood sugar levels over time, drastic spikes in blood sugar, and overall refined carbohydrate intake and increased rates of cognitive decline (even in those with blood sugars below the threshold of a diabetes diagnosis). These refined carbohydrates are thought to have broad sweeping inflammatory effects, including an adverse effect on our brain health. There are studies suggesting the benefits of a Mediterranean diet, or even diets developed to optimize brain health such as the “MIND Diet.” Of course, while you should consult with your healthcare providers to determine the best dietary approach for you, there are some safe bets and things to clearly avoid. Watching your sugar intake, avoiding processed foods, and eating plenty of dark leafy greens is a great place to start. Eat well, eat often.
- A Good Night’s Sleep.
Researchers have identified clear connections between our sleep—the quantity and quality—and our cognitive health. Trouble falling or staying asleep, poor sleep quality, and, of course, not enough sleep (or even, perhaps, sleeping too much) are now recognized as potential risk factors for dementia. Knowing this, it’s important that we learn to balance our priorities—even amidst the never-ending juggling act of our busy lives—and put getting a good night’s sleep consistently at the top of the list. Moreover, if you find yourself struggling to sleep well, talk to your doctor and be proactive in pursuing many of the safe and effective strategies that exist to restore our sleep hygiene, rewire our sleep habits, and help us achieve consistent, regular, and refreshing sleep.
- Let the Sunshine In.
Time outside in nature and exposure to sunshine, while not yet directly linked to risk for cognitive decline are beneficial for overall mental/emotional health. Just as in getting a good night’s sleep, researcher are continuing to learn more about our circadian rhythms and the impact their regulation may have on our cognitive and overall health. As part of our overall self-care, especially in our increasingly over-scheduled and technologically-driven lives, a healthy dose of natural light, fresh air, and sunshine are probably a safe bet.
- Stay Connected, Find your Purpose.
While the value of a healthy diet, regular exercise, and getting a good night’s sleep in maintaining our brain health may seem like old news, the profound role social connection and purpose play are starting to grab the headlines. While it may not yet be on everyone’s radar, researchers continue to identify a striking interplay between the quality of our social connections and our life-long cognitive health. While there is still much to be learned about the impact of social connection on cognitive health, it seems that both the presence of meaningful relationships and the absence of a sense of loneliness play a role. Likewise, several studies have demonstrated the correlation between having a clear sense of purpose—a strong sense of one’s contribution to the greater good and that “reason to get up in the morning”—and overall brain health. For each of these two factors of social connection and sense of purpose, the correlations with brain health have consistently been observed across a wide range of study methodologies.
Time to Take Brain Health Seriously
As a final note to this limited review of information regarding Alzheimer’s disease and other types of dementia in women, it’s disproportionate impact, unique factors and theories, and just a few ways to reduce one’s risk, please know there are excellent sources of information and resources that can help you take a proactive role in improving your brain health. Visit our Brain Health Center website, schedule a consultation, connect with others, pass along this information and help combat the terrible impact of Alzheimer’s disease and other dementias on women. Now is the time to optimize your brain health.
For more information, please contact us at 310-582-7641.
About the Author
Scott Kaiser, MD, a board-certified family physician and geriatrician, is the Director of Geriatric Cognitive Health and provides specialty geriatric medical consultations at the Pacific Brain Health Center. Focused on the needs of older patients, he works with his colleagues to provide an integrated and holistic approach to their cognitive challenges. With this “whole person” approach, Dr. Kaiser works to connect patients and their families with a broad range of resources to support their overall health and well-being. In addition, Dr. Kaiser is Chief Innovation Officer at the Motion Picture & Television Fund (MPTF), a charitable organization serving members of the entertainment industry community. In this role, Dr. Kaiser leads efforts to improve population health and well-being through social and community-based interventions that aim to support people in living and aging well.
Last updated: February 23rd, 2021