Alzheimer’s disease is a devastating brain condition that affects 6.7 million Americans age 65 and older. The associated decline in cognitive function, memory, and behavior typically manifests as forgetfulness, confusion, and difficulty performing daily tasks. The exact cause of Alzheimer’s is not fully understood, but it’s believed to involve a combination of biological, environmental, and lifestyle factors. While Alzheimer’s can strike anyone, statistics show that women are more likely to develop the disease than men. In fact, nearly two-thirds of Americans with Alzheimer’s are women. What is behind this gender disparity, and what are some ways to help reduce the risk of being diagnosed with Alzheimer’s?

Longer Lifespan

One prominent factor contributing to the higher rates of Alzheimer’s among women is their longer average lifespan, which averages four to seven years longer than men’s. Because age is a significant risk factor for Alzheimer’s, the extended life expectancy of women means they have a greater opportunity to develop the disease. Simply put, the longer you live, the more likely you are to encounter age-related conditions, including Alzheimer’s. The biggest difference in Alzheimer’s rates between men and women is seen after age 80, according to a study in the Journal of Alzheimer’s Disease.

Built Different

Another intriguing aspect of the gender disparity in Alzheimer’s disease is the structural and functional differences between male and female brains. Some research suggests that women may have more connections between neurons, which benefits them cognitively but may also contribute to a more rapid disease progression once it sets in. For instance, in a study presented at the Alzheimer’s Association International Conference, scientists found that the connections in a woman’s brain may speed the spread of tau. This protein helps stabilize the internal “skeleton” or “scaffolding” of nerve cells in the brain. As Alzheimer’s sets in, an abnormal form of tau builds up, clumping into tangles and causing inflammation and damage.

In other research from the University of California, San Diego, scientists found that women’s brains use glucose (blood sugar) better than men’s brains, which may compensate for initial damage to brain structures, making it less likely for women to be diagnosed early through verbal skills tests.

This is Your Brain on Estrogen

Studies suggest that estrogen, particularly estradiol, has a protective effect on the brain. Estradiol is thought to increase the number of connections in the brain’s memory center, influence neurotransmitter (e.g., serotonin, dopamine, etc.) activity, and promote cognitive function. Menopausal hormone change is probably one of the most-studied aspects of women’s susceptibility to Alzheimer’s disease. The natural drop in estrogen after menopause affects women in many ways, and the brain is not immune to those effects. As a woman’s estrogen levels decline, there are losses in grey matter (brain tissue responsible for memory and mental functions) and an increased risk of developing Alzheimer’s.

Research on the benefit of hormone replacement on Alzheimer’s risk is not conclusive, and the effects of hormone replacement can be influenced by dose, type of medication, length of treatment, age, time of menopause onset, and genetics.

It’s in Your Genes

Genes carry the information that determines our traits, and each gene has a special job. Genes that have been changed are called variants, which may be partially responsible for many illnesses, including Alzheimer’s. Variants change the way genes do their job. Some variants can be inherited.

Typically, there is no single genetic cause of Alzheimer’s, and multiple genes influence risk in combination with how you live and the things in your environment. Indeed, certain genetic variations have been linked to an increased risk of Alzheimer’s, and some of these genetic variations may be more prevalent in women. For example, the apolipoprotein E (APOE) gene is known to influence risk. APOE comes in several forms or alleles, and the APOE ε4 allele is a known genetic risk factor for Alzheimer’s. Women are more likely to carry this gene variant than men.

According to researchers at the University of Wisconsin-Milwaukee, genetics (specifically, APOE variant composition) may also be an important factor in determining the benefit of hormone replacement.

Understanding your genetic risks means you could benefit from interventions and treatments sooner. It’s important to note that lifestyle factors, such as exercise, diet, exposure to chemicals, and smoking, can all influence how certain genes work.

The Gender Gap

Socioeconomic and lifestyle factors contribute to the gender gap in Alzheimer’s disease. In previous generations, fewer women pursued careers outside the home or higher education, both of which can influence Alzheimer’s risk in women by its influence on cognitive engagement and brain resilience. Engaging in mentally stimulating activities through work and education exercises the brain, making it more resistant to cognitive decline. Individuals with higher education levels also tend to adopt healthier lifestyles, including balanced diets and regular physical activity, and have better access to healthcare. All these factors help to reduce the risk of Alzheimer’s.

Women also often have different life experiences and roles compared with men, which can impact their risk. For instance, women are more likely to take on primary caregiving responsibilities for children and other family members. Caregiving can be emotionally and physically taxing, potentially increasing a woman’s stress levels and reducing sleep, further exacerbating risk.

Steps to Take

While the gender disparity in Alzheimer’s disease is a complex issue, there are steps women can take to reduce their risk and promote brain health. Lifestyle factors, such as diet, exercise, sleep, stress management, and social engagement, also significantly impact a person’s risk of Alzheimer’s.

Here are some actions to take that may help reduce your risk.

Maintain a Healthy Diet. Select fruits, vegetables, whole grains, healthy fats--including those found in oily fish--and lean proteins are particularly beneficial.

Stay Mentally Active. Engage in activities that challenge the mind, such as puzzles, reading, and learning new things, such as languages or musical instruments.

Stay Physically Active. Perform 30 minutes of moderate exercise 5 days a week to reduce the risk of Alzheimer’s development, memory loss, and cognitive decline.

Maintain Healthy Sleep. Get six to eight hours of quality sleep a night to reenergize cells, clear waste from the brain, and support learning and memory functions.

Socialize and Stay Connected. Maintain social interactions with friends and family, and consider participating in social activities.

Practice Self Care. Schedule time for your own joy and relaxation. Very often, women put themselves last as they lean into their caregiving roles.

Consider Hormone Replacement Therapy. Check with your healthcare practitioner to see if hormone replacement therapy (HRT) might be a good option for you, and discuss genetic testing that may help guide your options and outcomes.

The initial signs of Alzheimer’s disease differ from one person to another. For some individuals, the early stages of the disease may become apparent through a decline in cognitive functions other than memory, such as difficulties with word finding, spatial and visual problems (e.g., getting lost, becoming confused in new places, trouble identifying objects and people), or impaired reasoning and judgment. Women may be able to reduce their Alzheimer’s disease risk by understanding the various contributing factors, such as those presented in this article, and taking proactive steps to maintain brain health.

Changes within the brain are thought to begin 10 or more years before symptoms even start to appear. Women shouldn’t wait for symptoms to manifest before making lifestyle and nutritional changes. Make the changes now.