New Delhi: Alzheimer’s disease is commonly associated with ageing, but researchers are increasingly examining why women account for a larger proportion of people living with dementia. Women and men can both develop Alzheimer’s disease and other forms of dementia, yet the burden is not evenly distributed.
The World Health Organization (WHO) says women experience a disproportionate burden of dementia and provide around 70% of the care hours for people living with the condition.
Age is an important part of the explanation. Women generally live longer than men, while dementia risk rises considerably with advancing age. However, researchers say longevity alone may not fully explain the difference. Biological, genetic, hormonal, cardiovascular and social factors may also influence women’s dementia risk.
Why does Alzheimer’s affect more women?
1. Women generally live longer
Age is the strongest known risk factor for Alzheimer’s disease. Because women tend to have longer life expectancy, more women reach the age groups in which dementia becomes increasingly common.
However, this does not necessarily mean that being a woman itself causes Alzheimer’s disease. Researchers are studying whether additional biological and social factors contribute to the gender difference.
Globally, dementia affected an estimated 57 million people in 2021, according to WHO, with millions of new cases occurring each year. Alzheimer’s disease is the most common form of dementia.
2. Menopause may influence brain ageing
The transition through perimenopause and menopause involves significant hormonal changes, particularly a decline in oestrogen.
Researchers are investigating whether these changes influence brain ageing and the development of Alzheimer’s-related changes. Some brain-imaging studies have identified changes in brain metabolism and Alzheimer’s-related biomarkers around the menopausal transition.
However, menopause should not be considered a proven direct cause of Alzheimer’s disease. It is more accurate to view hormonal changes as one potential factor that may interact with age, genetics, cardiovascular health and other risk factors.
The midlife period is increasingly considered an important window for dementia prevention because managing health risks during this stage may influence brain health later in life.
3. Genes may affect women differently
The APOE e4 genetic variant is one of the best-established genetic risk factors for late-onset Alzheimer’s disease.
Having an APOE e4 variant does not mean a person will definitely develop Alzheimer’s. Many people who carry it never develop the disease, while people without the variant can still develop Alzheimer’s.
Research suggests, however, that the association between APOE e4 and Alzheimer’s risk may differ between women and men. Studies have reported a stronger association between the variant and progression towards mild cognitive impairment or Alzheimer’s disease among some female populations.
Scientists are continuing to investigate why sex might influence the effect of APOE e4.
Genetic testing should therefore not be interpreted as a simple prediction of whether someone will develop Alzheimer’s.
4. Heart health and brain health are closely connected
Several conditions associated with cardiovascular disease can also increase dementia risk.
These include:
- High blood pressure
- Diabetes
- High cholesterol
- Obesity
- Smoking
- Physical inactivity
The 2024 Lancet Commission on dementia identified 14 potentially modifiable risk factors, including untreated vision loss and high LDL cholesterol. It estimated that addressing these factors could potentially prevent or delay a substantial proportion of dementia cases at a population level.
This does not mean lifestyle changes can guarantee protection against Alzheimer’s. Instead, it highlights the importance of maintaining cardiovascular and metabolic health throughout life.
Keeping blood pressure, blood sugar and cholesterol under control, remaining physically active and following a balanced diet can support overall brain health.
5. Social and educational factors also matter
Women’s lifetime experiences may influence their cognitive reserve — the brain’s ability to cope with ageing or disease-related changes.
In some communities, women have historically had less access to education, employment, financial independence and cognitively stimulating activities. These differences can affect opportunities to build cognitive reserve.
Lower educational attainment has been identified as one of the potentially modifiable factors associated with dementia risk.
This does not mean a woman’s education, occupation or social background determines whether she will develop Alzheimer’s. Instead, it reinforces the importance of considering brain health across the entire life course.
Why Alzheimer’s may go unnoticed in women
Early cognitive changes can sometimes remain unnoticed because women may compensate for difficulties in managing household responsibilities, employment and family commitments.
Subtle symptoms can include repeatedly forgetting recently learned information, difficulty finding familiar words, struggling with routine tasks, becoming confused in familiar surroundings or experiencing changes in mood and behaviour.
Early assessment is important because not every memory problem is caused by Alzheimer’s disease.
Sleep disorders, depression, medication side effects, thyroid problems, nutritional deficiencies and other medical conditions can also cause cognitive symptoms. A medical evaluation can help determine the underlying cause.
Women also carry a major caregiving burden
The gender disparity extends beyond those living with dementia.
Women are also disproportionately represented among informal dementia caregivers, including wives, daughters and other female relatives. According to WHO, women provide around 70% of informal dementia care hours globally.
Long-term caregiving can have physical, emotional, social and financial consequences. Some caregivers may reduce their working hours or leave employment altogether while balancing household responsibilities with the needs of a family member with dementia.
WHO has highlighted the importance of providing caregivers with information, training, psychological support and social and financial assistance.
How women can support brain health
There is currently no guaranteed method of preventing Alzheimer’s disease. However, several lifestyle and health measures can contribute to healthier ageing.
Women can support their long-term brain health by:
- Maintaining healthy blood pressure and blood sugar levels
- Managing cholesterol and other cardiovascular risk factors
- Staying physically active
- Following a balanced and nutritious diet
- Maintaining healthy social connections
- Engaging in mentally stimulating activities
- Getting adequate and consistent sleep
- Avoiding smoking
- Seeking medical advice when persistent cognitive changes appear
The goal is not to eliminate the possibility of dementia but to address modifiable risk factors wherever possible.
Brain health should begin before old age
Alzheimer’s disease becomes more common with advancing age, but its risk factors can accumulate throughout life.
Longer life expectancy is an important reason more women live with dementia, but researchers are increasingly examining how hormonal changes, genetics, cardiovascular health, education and social circumstances interact with ageing.
Women also face a second dimension of the problem because they frequently provide care for relatives living with dementia.
For this reason, Alzheimer’s disease should not be viewed solely as an issue of old age. Women’s brain health is a lifelong concern, with opportunities to support cognitive health beginning in early life and continuing through midlife and older age.