I’m sure that everyone is aware that women account for two-thirds of Alzheimer’s cases.
- Why are women at a higher risk of developing Alzheimer’s disease?
- How can we know if we have a higher risk?
- What can we do to help reduce the risk of Alzheimer’s?
Before we get into all that, let’s back up for a second and differentiate between Dementia and Alzheimer's.
I know a lot of people (myself included) kinda overlap Alzheimer’s and Dementia.
Dementia is like the umbrella with several diseases sitting under it:
- Alzheimer’s
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
- Mixed dementia
The following conditions can cause dementia, but not everyone with them will necessarily have dementia in every case.
- Parkinson’s disease dementia
- Huntington’s disease–related dementia
- Normal pressure hydrocephalus–associated dementia
- Creutzfeldt-Jakob disease.
The most common condition that causes dementia is Alzheimer’s disease (60-70% of all dementia cases worldwide).
The next common is vascular (often related to stroke or small vessel disease), Lewy body disease next, then frontotemporal dementia, with mixed dementia (Alzheimer’s plus vascular changes).
Yes, I am wordy, but the takeaway here is Alzheimer’s is the most common condition for dementia, and women are more at risk.
And it’s really scary to think about. Everyone has or knows someone who has a loved one that suffered from Alzheimer's. Awful, sad, confused, frustrated, the utmost depths of grief cannot even convey how it feels to watch and lose someone to Alzheimer’s.
I know we want to live great, happy, healthy lives. But it is truly the ‘brain and pain’ that scares the daylights out of us. No one wants to lose their brain or suffer chronically in pain. No one wants that for our loved ones, and especially for ourselves.
Wiping my eyes, let's get back to science and learn some stuff.
What is Alzheimer’s?
Alzheimer’s disease occurs when abnormal proteins called amyloid plaques and tau tangles accumulate in the brain.
This leads to progressive damage to brain cells over time.
There is also a progression of brain inflammation, metabolic dysfunction, loss of connection between brain neurons, and gradual shrinkage of areas of the brain involved in memory and cognition.
To sum it up: Amyloid plaques accumulate, tau becomes abnormal and tangled, neurons lose function, degenerate, and symptoms occur.
What are the symptoms of Alzheimer’s?
Symptoms often begin subtly and gradually become more noticeable and severe over time.
- Memory loss
- Repeating questions or stories
- Difficulty with problem-solving
- Confusion about time or place
- Difficulty finding the words or following the conversation
- Poor judgment or poor decision-making
- Change in mood and personality (irritability, suspicion, anxiety, depression)
- Withdrawal from social activities, work, and hobbies
I know what you are thinking, or at least what I am thinking. I think I have Alzheimer’s!
My husband will attest to my repeating myself, zoning out of our conversations, and acting cranky. I drop words, forget words, and lose my phone daily.
When I told him this, he laughed and said then everyone has Alzheimer’s. It’s called being busy and stressed, and yes, those hormone changes in perimenopause and menopause can certainly make you feel like the scarecrow in the Wizard of Oz.
But I am not making light of Alzheimer’s. It is a horrible, horrible disease. Which is why when I look at that list of symptoms, we all wonder, is this the beginning of something serious?
Why Do Women Have a Higher Risk of Alzheimer’s?
- Longer Lifespan: This is what everyone says. Women live longer than men, which can influence overall stats. But this is really an oversimplification and dated logic.
-
Estrogen decline in perimenopause and menopause
- How the brain uses glucose (fuel)
- Increase inflammation
- Less neuron protection.
- Other factors are a web of influences, including cardiometabolic health, genetics, insulin resistance, vascular disease, environmental exposures, and lifestyle factors.
So it is probably not a single culprit but a stacked deck of hormones, metabolism, inflammation, genetics, and lifetime exposures, all interacting over time.
What hormone increases the risk of Alzheimer’s in women?
- Surgical menopause (uterus and ovaries out) without HRT is associated with the highest risk. Especially high if surgery occurred before age 45.
- Natural menopause before 45 years old without HRT
How Can We Know?? How do I know I have a risk for Alzheimer’s?
There is some testing to give us insight into an increased risk of Alzheimer’s disease.
For this article, I will talk about the APOE genetic testing, the P-tau217 blood test, and fasting insulin testing.
APOE genetic testing: this can be done by blood or cheek/saliva swab.
Everyone has two APOE alleles, one from each bio-parent.
The APOE (Apolipoprotein E) gene is involved in lipid transport, brain repair, synaptic/synapses function, amyloid clearance, and neuroinflammation (brain inflammation) regulation.
There are three APOE alleles:
-
APOE-e2
- Lease common and may be protective and associated with lower Alzheimer’s risk
-
APOE-e3
- Most common, neutral, and considered the baseline for population risk
-
APOE-e4
- Associated with increased risk and the strongest genetic risk factor
What are the possible genotype combos:
- e2/e2
- e2/e3
- e3/e3
- e2/e4
- e3/e4
- e4/e4
Risk increases in this pattern:
e2/e2 → e2/e3 → e3/e3 → e2/e4 → e3/e4 → e4/e4
• e3/e3 → ~10–15%
• e3/e4 → ~20–30%
• e4/e4 → ~40–60%
P-tau217 blood test:
This stands for phosphorylated tau at amino acid position 217.
What does that mean?
Tau is a protein inside brain neurons that helps to stabilize the microtubules. The microtubules help transport the brain cells.
In Alzheimer’s, the Tau becomes abnormally phosphorylated and loses its form, causing neurofibrillary tangles. The neurons lose their structure and integrity.
The P-tau217 is one of the most specific blood markers for Alzheimer’s disease and is more accurate than earlier tau marker testing. A high P-tau217 does not automatically mean that a person has or will develop Alzheimer's, but it suggests that changes are occurring in the brain.
AND/BUT, P-tau217 appears to rise years before an actual Alzheimer’s diagnosis.
What Can I Do?
There are many strategies we can implement for our brain health. Diet, exercise, sleep, stress management, as well as avoiding toxins and pollutants, and taking certain supplements. But for this article, I want to focus on two main approaches to help women and brain health, and reduce the risk of Alzheimer’s.
If you are serious about protecting your brain as you age, this is where the conversation becomes more nuanced. In clinical practice, In the full article, I will walk you through strategies I focus on with my patients to support brain health.
