Why Most Alzheimer's Patients Are Women
An increasing number of American families are confronting the realities of aging, including the long-term care demands stemming from chronic illnesses, accidents, or cognitive decline. This situation places a multifaceted strain on family members, who often find themselves either directly providing care or overseeing professional care services, leading to financial, emotional, and physical challenges.
In a related vein, research indicates that nearly two-thirds of Americans diagnosed with Alzheimer's disease are women. This statistic has prompted researchers to reexamine the longstanding belief that women's higher prevalence in Alzheimer's cases is simply due to their longer lifespan compared to men. The inquiry into this discrepancy sheds new light on the complexities of aging and health in the American population.
Recent findings from a 2024 study conducted by the Cleveland Clinic are now offering fresh insights into this phenomenon.
Jessica Caldwell, Ph.D., a neuropsychologist at Cleveland Clinic, indicates that their research points to potential sex-based differences as contributing factors.
This study was designed to better understand the sex differences in Alzheimer's disease, and specifically we looked at whether or not the immune system and cell metabolism actually interact in different ways in men and women.
Researchers ultimately discovered that there is a difference.
Questions Being Asked
Investigators are exploring multiple avenues. They're examining what other factors might heighten a woman's susceptibility to cognitive decline. Questions are being raised about the potential involvement of genetics, the biological nuances in aging between women and men, and whether certain lifestyle choices could lead to a higher incidence of cognitive decline in women.
The fact is this risk is a real concern.
According to the Alzheimer's Association, there is a clear increased risk based on gender. By the time a woman reaches age 65, the risk of suffering from Alzheimer's is 1 in 6. What many people are unaware of is the risk of a woman developing Alzheimer's is double their risk of breast cancer. The association says Alzheimer's disease is the 6th leading cause of death in the United States. Alzheimer's is the only cause of death in the top 10 that cannot be prevented, cured, or even slowed.
Cognitive Decline Means Long-Term Care
While death marks the ultimate consequence of Alzheimer's, the disease's journey is marked by the necessity for supervision and assistance with daily living activities, imposing a substantial strain on families and finances. Traditional health insurance, including Medicare and its supplements, does not cover these long-term care needs.
The toll of Alzheimer's is doubly felt by women. Not only are they more susceptible to cognitive decline, but they frequently assume the role of caregivers for spouses or other family members in need of long-term care. The Alzheimer's Association reports that over 60% of unpaid Alzheimer's caregivers are women, with a significant number providing round-the-clock care.
According to the 2023 Alzheimer's Disease Facts and Figures Report by the Alzheimer's Association, caregivers of individuals with Alzheimer's or other dementias provided an estimated 18 billion hours of unpaid care in 2022. This staggering number translates to a value of $339.5 billion, calculated based on the average hourly wage for home health aides in the United States.
The commitment to caregiving often comes with significant sacrifices, particularly for women. About 19% of female Alzheimer's caregivers have had to leave their jobs due to caregiving responsibilities, leading to financial repercussions and emotional stress within family dynamics.
Women Also Caregivers
Annually, nearly 500,000 individuals pass away with Alzheimer's, highlighting the urgency of understanding why women are more prone to cognitive decline. Emerging research suggests that certain Alzheimer 's-related genes might have a more pronounced effect on women. Yet, it's acknowledged that genetics are only a piece of the broader puzzle in understanding and addressing this disparity.However, death is only a part, although the final part of the impact of Alzheimer's. The need for supervision and other help with routine activities of daily living is a tremendous burden on family and finances. Health insurance, including Medicare and Medicare supplements, will not pay for this care.
But there is more. Women get hit twice because of this disease. They often become caregivers for a husband or other family member who requires long-term care. Interestingly enough, women are more likely to care for others with Alzheimer's as well. So not only are women more likely to suffer from cognitive problems, they typically become the first caregivers.
"There are enough biological questions pointing to increased risk in women that we need to delve into that and find out why."
Maria Carrillo, chief science officer for the Alzheimer's Association.
The Alzheimer's Association had brought 15 leading scientists together to ask what's known about women's risk. Research is being conducted to find answers.
There is a lot that is not understood and not known. It's time we did something about it," she added.
"It is true that age is the greatest risk factor for developing Alzheimer's disease."
Roberta Diaz Brinton, University of Southern California professor
The World Health Organization had presented data on gender differences at a meeting of the National Institutes of Health.
"on average, women live four or five years longer than men, and we know that Alzheimer's is a disease that starts 20 years before the diagnosis."
Roberta Diaz Brinton
That's how early cellular damage can quietly begin. Brinton is researching if menopause can be a tipping point that leaves certain women vulnerable.
There's some evidence that once Alzheimer's becomes diagnosed, women may worsen faster; scans show more rapid shrinkage of specific brain areas.
Genetics?
But gene research offers the most startling evidence of a sex difference.
Stanford University researchers analyzed records of more than 8,000 people for a form of a gene named ApoE-4, long known to increase Alzheimer's risk.
Women who carry a copy of that gene variant were about twice as likely to develop Alzheimer's eventually as women without the gene, while men's risk was only slightly increased, according to Stanford's Dr. Michael Greicius.
It's not clear why. It may be in how the gene interacts with estrogen, Brinton said.
Amy Shives, 57, of Spokane, Washington, in a Yahoo News story recalled when her mother began showing symptoms of Alzheimer's. She says it wasn't until after her own diagnosis a few years ago that she looked up the gender statistics.
"That was alarming," said Shives, who is in the early stages of Alzheimer's, which struck at a younger-than-usual age and forced her retirement as a college counselor. "The impact on our lives and that of our families is extraordinary."
She points to another disproportionate burden that the majority of caregivers for Alzheimer's patients are women.
"My daughters are in their 20s and I'm already ill."
"It's very stressful for them to think about when their mother's going to need their help."
Amy Shives, mother
What drives the difference in Alzheimer's cases isn't clear, said Dr. Susan Resnick of the National Institutes of Health, pointing to conflicting research.
"We really have had a tough time understanding whether or not women really are more affected by the disease, or it's just that they live longer."
Dr. Susan Resnick of the National Institutes of Health
Data from the long-running Framingham, Massachusetts, health study suggests that because more men die from heart disease in middle age, those who survive past 65 may have healthier hearts that, in turn, may provide some brain protection.
Many of the same factors — obesity, high cholesterol, diabetes — that damage arteries also are Alzheimer's risks.
One question being asked is the role of hormones? That's has been hard for researchers to answer so far. Many years ago, a major study found that estrogen therapy after age 65 could increase the risk of dementia. However, later research showed hormone replacement around the onset of menopause did not pose an issue.
Brinton studies how menopause changes the brain. Estrogen helps regulate the brain's metabolism, how it produces the energy for proper cognitive function, and it must switch to a less efficient backup method as estrogen plummets, she explained.
"It's like the brain is a little bit diabetic."
Roberta Diaz Brinton
The question is whether this higher risk may relate to menopausal symptoms in women who later experience cognitive problems.
Carrillo notes that 40 years ago, heart disease was studied mainly in men, with little understanding of how women's heart risks can differ.
"How do we make sure we're not making that mistake when it comes to Alzheimer's?"
Maria Carrillo
All this research doesn't change the world we live in today and what we do with this knowledge. Unfortunately, despite many news stories about the risks of cognitive decline and long-term care, many people are unprepared for the physical, emotional, and financial burdens that American families face when a loved one requires long-term care services.
Preparing Your Family and Finances
The natural human reaction for many people is it won't happen to them, or they will deal with it when the time comes. The best way to address the financial costs and burdens of aging is with advance planning.
Affordable Long-Term Care Insurance offers guaranteed tax-free benefits that can be used to pay for your choice of quality care - including care in your own home. The best time to plan is in your 40s or 50s when premiums are low, and your health is still good. Don't wait until you have few or no options available.