What we know about why Alzheimer’s disproportionately affects women

Of the over 7 million Americans estimated to have Alzheimer’s disease, nearly two-thirds are people assigned female at birth (AFAB).

In fact, women over the age of 60 are twice as likely to develop Alzheimer’s as breast cancer. Yet it is often not discussed as a women’s health issue, or addressed with the urgency it deserves.

Alzheimer’s disease is the most common type of dementia, a general term that describes the progressive loss of language and other cognitive skills severe enough to interfere with daily life.

A new literature review published in JAMA sheds light on the long-held mystery as to why Alzheimer’s disproportionately affects women — though continued research is needed. While women’s longer life expectancy explains part of the difference, researchers point to a more complex and nuanced picture.

Contributing factors

One reason for this disparity is that the hallmark signs of Alzheimer’s disease — plaques and tangles — act differently in women’s brains, causing women’s cognition to decline more rapidly than their male counterparts.

Hormones and menopause may also play a role. According to the article, fluctuations in estrogen and earlier menopause is linked to lower cognitive scores, including memory scores, though some hormone therapies show promising results to help protect against this.

Additionally, women face higher rates of many risk factors for Alzheimer’s, including depression, physical inactivity, diabetes, smoking, poor sleep, social isolation, vision impairment, and lower educational attainment. Some of these risk factors are associated with worse cognition in women, but not in men.

Though not addressed in this JAMA article, it is important to note that Black women and other women of color face an even greater risk. Research shows that Native Americans, Black Americans, and Hispanics and Latinos are all more likely to develop Alzheimer’s or another form of dementia than their white peers.

Expanding dementia awareness and action

While we call for greater investment in research, these disparities also underscore the need for creating a healthcare system — and society — where individuals are better informed and equipped to take control of their care.

Compassion & Choices is helping make that happen by offering free, easy-to-use resources, such as the Dementia Values & Priorities Tool, which documents wishes for future care in case of dementia. We also recently co-created The Dementia Deck, a set of cards that open up dialogue about the kind of care you might want — and what matters most — if you are living with dementia.

Nationwide, we’re equipping healthcare professionals to normalize end-of-life conversations and expand dementia-specific advance care planning. Our new Essential Conversations Guide supports care providers in doing this work.

We’re also grateful for leaders in this space, including the Women’s Alzheimer’s Movement and the Women’s Alzheimer’s Research Initiative, who are dedicated to advancing research and educating and supporting women. Follow them to stay up to date on this critical issue.

Together, we can work to ensure that everyone — including women and all people facing dementia — can make informed decisions about their care.

Use these free resources to reflect on your wishes, plan ahead for a potential future with dementia, and start essential conversations with the people in your life.