Blog: Women and Dementia

Globally, two-thirds of individuals with Alzheimer's disease are women, with the likelihood increasing with age. To mark International Women’s Day in March 2024, About Dementia held an insightful policy drop-in focusing on the crucial topic of women and dementia. 

Dr Shireen Sindi, a researcher from the Karolinska Institute in Sweden and Imperial College London, shed light on the significant sex differences in dementia prevalence, risk factors, and outcomes.

To begin, Dr Shireen Sindi highlighted what we mean by the terms "sex" and "gender."

 "When we talk about sex differences, we're really referring to the biological attributes of a person," she explained, emphasizing that this includes physiological features like genetics and hormones. In contrast, gender refers to socially constructed roles and identities.

In the context of dementia research, the focus has predominantly been on sex differences, comparing men and women based on biological attributes.

Here, we share key takeaways from the event, highlighting why understanding these differences is essential for better diagnosis, treatment, and support.

"Recent results from 43 countries show that the prevalence of Alzheimer disease cases is higher for women throughout, with the largest differences among those 85 years and older."

This suggests that the risk increases significantly for women as they age, particularly beyond their mid-80s.

Risk factors: Why Are Women More Affected?

One common question is whether the higher prevalence of dementia in women is simply because they live longer. While women do have a higher life expectancy, this alone does not explain the discrepancy. Factors such as cardiovascular health, hormonal changes, and educational opportunities also play significant roles.

Educational impact

Women benefit more from higher education in terms of reducing dementia risk.

"Women tend to benefit more from higher education than men,” pointing to long-term studies showing that higher levels of education correlate with a lower risk of dementia.

Hormonal and Reproductive Factors

The hormonal changes women experience throughout life - during puberty, pregnancy, breastfeeding, and menopause - may influence dementia risk.

 "Women have much more pronounced rises and declines in hormones compared to men," which could contribute to their higher susceptibility.

Depression and Stress

Women are twice as likely to be diagnosed with depression, which can be both a risk factor for and a symptom of dementia. Chronic stress, often due to caregiving responsibilities, also plays a significant role.

"Women make up on average 60% of all family caregivers, leading to chronic stress that can become a risk factor for various health conditions, including dementia."

Diagnostic and Treatment Challenges

Diagnosing dementia in women can be more complicated due to inherent differences in cognitive abilities. Women generally perform better in verbal memory tests, which can delay their diagnosis.

"This delay means that by the time women are diagnosed, their cognitive decline is more advanced, limiting treatment options."

Interventions and Clinical Trials

Lifestyle interventions like nutrition, exercise, and cognitive training have been shown to benefit women more significantly in terms of memory and executive functioning. However, women are still underrepresented in pharmacological clinical trials, despite experiencing more adverse drug reactions.

"Only 58% of participants in clinical trials are women, even though they make up about 64% of the dementia population."

In addition to these factors, there is emerging research that indicates women’s differential experiences of traumatic brain injuries may also play a part. In a presentation at the Alzheimer Scotland Conference in September 2023, Professor Maria Teresa Ferretti highlighted that domestic abuse is a significant cause of concussion among women. This is often either disguised or underplayed by the individual, or not taken seriously by the medical professionals treating them.

While there is significant funding now looking at the link between traumatic brain injury and dementia in men’s sport, the incidence of domestic abuse is significantly higher but under examined.

Rachel Allen, a PhD student at the Alzheimer Scotland Centre for Policy and Practice at the University West of Scotland, is conducting research which aims to explore how women living with young onset dementia in Scotland experience life and work in the context of career. Here she emphasizes the importance of addressing these disparities in clinical trials:

“For many people who develop dementia at a younger age, work will play a significant part in their life. As symptoms develop, adjustments may be needed for working life, but there are other activities in our careers as well as paid work. We have hobbies, we may volunteer in our communities, enjoy our families, value our friendships, we might enjoy gardening or studying. These are all part of our careers. It's important we have research that explores what helps or hinders these important things to continue. Careers don't stop when dementia starts.

“My study is focused on women's experiences and the reason for this is because in recent decades, the career landscape for women has changed significantly and the expectations we have in society about women's workforce participation, and their role within the home and family has changed, and gender is an important aspect of our identities. Women are mums and grandmas, employees and employer’s, carers and are cared for. By focusing on women in this research, I hope we can better develop services and support structures that meet their needs.”

 Understanding the distinct ways dementia affects women is critical for developing better prevention, diagnosis, and treatment strategies. By recognizing and addressing these differences, we can improve the quality of life and outcomes for women living with dementia.

We thank Dr Shireen Sindi and Rachel Allen for sharing their expertise and encourage our community to stay informed and engaged in the ongoing conversation about dementia and its impact on women.

About Dementia remains committed to supporting ongoing research and advocacy efforts in this vital area.

You can find out more about our groups and get involved via our website.

If you’re interested in taking part in Rachel Allen’s study, or would like further information, email her at rachel.allen@uws.ac.uk.