Understanding and Preventing Alzheimer’s in Women

Alzheimer’s disease (AD) is the sixth leading cause of death in the United States, with someone diagnosed every 65 seconds. According to Mayo Clinic, AD is the most common cause of dementia, a group of brain disorders that lead to a decline in memory and cognitive function.

AD is characterized by the accumulation of proteins called tau and amyloid-beta and the degeneration of brain cells resulting in memory loss and progressing to further cognitive decline.

Why Does Alzheimer’s Affect Women More Than Men?

Although it was originally thought to be simply due to the fact that women live longer than men (and would, therefore, be afflicted with more diseases in their lifetime), researchers are now finding more specific factors that may play a role in why more women are affected by AD.

Approximately one in six women will develop Alzheimer’s disease, compared to one in eleven men. Furthermore, women are most susceptible to developing this disease in the decade following menopause, highlighting the importance of conducting more research into the link between someone’s sex and AD.

Genetics

Women are twice as likely to develop AD if they carry a copy of a particular form of the gene ApoE-4. Men who have this same gene do not have such a dramatic increase in risk. So why the huge increase for women? It could have something to do with how the ApoE-4 gene interacts with the female hormone estrogen.

ApoE is a gene that instructs the body on how to make a protein that carries cholesterol through the bloodstream. It comes in three variants: ApoE-2, ApoE-3, and ApoE-4. Everyone has two of these genes, one inherited from each of their parents, but the issues arise when someone inherits ApoE-4. Having this gene variant significantly increases someone’s risk for both cardiovascular disease and AD.

Hormones

Perhaps the most convincing evidence has to do with estrogen. A 2017 study of the metabolic and hormone changes in women’s brains during perimenopause and menopause suggests that the loss of estrogen could increase female susceptibility to AD. As such, they concluded that the “optimal window of opportunity for therapeutic intervention in women is early in the endocrine aging process.” A 2018 study had similar results, stating that “estrogen deficiency could lead to anxiety development and memory impairments.”

Scientists have recently been looking at other hormone changes that affect the female brain, too. A 2018 study in Neurology analyzed over 2,000 people in their 40s and found that those with the highest levels of the stress hormone cortisol performed the worst on memory, organization, and other visual tests. High cortisol levels were also associated with brain changes often seen in AD. The link between cortisol and cognition was especially strong in women during midlife, a time of significant mental and physical stress.

Other studies suggest that heart health could have something to do with AD risk differences between the sexes. Because men have a higher risk of dying from heart disease during middle age, those who live past the age of 65 years might have stronger, healthier hearts that consequently have a protective effect on the brain. AD and heart disease share several similar risk factors, like obesity, diabetes, and high cholesterol.

What Are the Signs of Alzheimer’s and When Can They Start?

AD starts approximately 10-20 years before symptoms appear. In fact, signs of early-onset Alzheimer’s typically appear in a person’s thirties through sixties.

If someone has any of these common early signs of AD, they should be further evaluated by a healthcare provider:

• Memory loss that interrupts daily life, especially of things they recently learned
• Difficulty in problem-solving, concentrating, organizing, or planning
• Trouble finishing familiar tasks that used to be second nature
• Confusion around understanding time or place
• Difficulty reading, judging distance, and driving
• New language and word problems in speaking or writing
• Unusual misplacement of items and the inability to retrace steps
• Poor hygiene
• Impaired judgment and decision-making
• Social withdrawal from familiar groups, people, and activities
• Drastic personality or mood changes in the form of acting anxious, fearful, paranoid, aggressive, or depressed

Alzheimer’s Prevention

Like most chronic diseases, the most significant weapon in preventing AD is a healthy lifestyle. Whether you are pre-, peri-, or postmenopausal, making healthy choices when it comes to diet, physical activity, and everyday behaviors are essential preventive measures.

Exercise

A 2018 study by the Alzheimer’s Association found that individuals who carry the ApoE-4 gene could reduce their risk for cognitive decline and dementia by engaging in at least 2.5 hours of physical activity every week.

Those who exercised more had lower levels of biomarkers for AD, such as lower tau protein in their cerebrospinal fluid. Whether you’re into walking, running, swimming, or aerobics, science says that regularly incorporating these activities into your routine can make a big difference in preventing cognitive decline.

Plant-Based Diet

Like an expensive car, your body requires the highest quality fuel to perform at its best. The brain makes up only 2% of our body weight, but because it utilizes 25% of the body’s energy, it’s especially vulnerable to your dietary choices.

What is a high-quality diet? When it comes to AD and many other chronic diseases, the most beneficial diet is a whole-food, plant-based eating pattern that provides a number of essential vitamins and minerals, healthy unsaturated fats, quality protein, and antioxidants—while minimizing processed foods.

Research presented at the 2018 Alzheimer’s Association International Conference found that individuals who eat a Mediterranean diet based on whole plant foods cut their risk of developing dementia by one-third.

Adequate Sleep

Interrupted sleep is one of the most common complaints that women report during menopause, often as a result of hot flashes or insomnia. Unfortunately, inadequate sleep appears to impact levels of beta-amyloid in the brain, the accumulation of which is connected to AD risk.

So, whatever you can do to improve your sleep patterns during menopause (not napping during the day, turning the temperature down at night, dressing in light pajamas) is a good idea.

A 2018 study in the Proceedings of the National Academy of Sciences scanned the brains of 20 healthy participants, ages 20-72 years, looking for beta-amyloid protein (an indicator of AD). Researchers found that beta-amyloid in their brains increased by around 5% after a night of poor sleep. The change occurred in parts of the brain that are most vulnerable to damage in early AD, the thalamus and the hippocampus.

Learning New Things

Although the evidence is not as strong, learning new things might help to slow cognitive decline with age. This theory is based on the idea that learning helps protect current neural pathways in the brain while also creating new ones, slowing the process of memory deterioration.

A 2017 study published in Neuroepidemiology found a weak correlation between education and protection from memory changes. A 2015 study found that cognitive activities delayed the onset of cognitive impairments at a five-year follow-up but not 10-year follow-up of study participants. Doing things that challenge the brain, like solving crossword puzzles, meeting new people, or learning a language, might help—and at the very least, won’t hurt—your brain.

Can Alzheimer’s Disease Be Reversed?

There are currently no effective treatments for AD, but researchers are working hard to find potential interventions. Prevention is at the forefront. The Center for Alzheimer’s Research and Treatment, associated with Brigham and Women’s Hospital and Harvard Medical School, conducts clinical trials to help find treatments and improve early diagnosis.

One idea is that memory loss may be able to be reversed through the targeting of a specific enzyme involved in communication between brain cells. There are also theories that, because of the strong link between gut health and brain health, interventions targeting gut bacteria could be therapeutic for the brain.

Until a promising treatment is discovered, the best approach to protecting the brain is prevention. Take the initiative to make healthy lifestyle choices as much as possible.