Are women more at risk of developing Alzheimer's?
You have probably heard that Alzheimer's is considered a pathology of women, and although it is a generalization, it is not entirely wrong. Let's see it with data; Alzheimer's dementia has a prevalence of 7.1% in women and 3.3% in men over 55 years of age. In other words, women have twice the risk of developing this type of cognitive impairment compared to men.
But why does this happen? Current studies at Fundació ACE, and other institutions dedicated to dementia research, devote many efforts to understanding the causes of Alzheimer's and, although we still do not know what causes this type of dementia, we have been able to elucidate some important elements. Let's analyse them.
In terms of genetics, we know that apoliprotein Ԑ4 (APOE) is the main risk factor for Alzheimer's. It is present in 45% of cases, although it is unknown how it intervenes in its development. Thanks to studies such as the ADAPTED project of Fundació ACE, we also know that the APOE4 allele supposes a greater risk of developing Alzheimer's in women.
If we talk about risk factors, women would also be more likely to develop Alzheimer's for various reasons. One of them is the hormonal changes linked to their reproductive system, basically due to the action of estrogens during the menopausal stage, which implies an increased risk of dementia, as well as the risk of thyroid disease observed in women. In addition, the use of psychotropics, hormonal and immunosuppressant drugs and opioids, which are more frequent in women than in men, produce a disruptive effect on cognitive function and, therefore, an increased risk of Alzheimer's.
And finally, we know that the higher the intellectual activity, the lower the risk of cognitive decline. If we talk about the Spanish population, a great part of the women born during the post-civil war period did not have access to a basic education, so that, in age groups over 70 years old, women have a higher risk of developing Alzheimer's. Some studies suggest that in the future it is possible that the prevalence data will tend to balance out.
Women in clinical trials
We have said that women have a higher prevalence in Alzheimer's dementia. To expand the data, in Spain, during 2018, Alzheimer's caused 14,929 deaths; 10,475 of them were women, which represents 5% of total female mortality.
The data is clear, but why are women not equally represented in the screening of people with Alzheimer's for clinical trials? According to a recent study by Fundació ACE, fewer women are recruited for various reasons. The most important, education. As we have previously pointed out, older women usually have a lower level of education compared to men. This affects both in that the neuropsychological tests that are used to determine the cognitive performance of people with dementia in clinical trials cannot be easily used in the population with low educational level because they depend on literacy and the need to unify the scores according to the educational level.
The woman as caregiver
Finally, Alzheimer's is a pathology of women in all its facets, since 2 out of 3 caregivers are women. According to a study carried out by Fundació ACE, in cases where a woman with a male relative ends up developing dementia, it is most likely that the person acting as caregiver will be the daughter-in-law or partner of the male relative.
The fact that women continue to carry the burden of care affects their professional and personal development. All of this is compounded by the lack of training around caring for people with dementia and the scarcity of resources for emotional support.
At Fundació ACE, in addition to diagnosing and offering support to people with dementia, we care about their environment. From our Social Work area, we offer a series of training workshops for caregivers in order to provide tools for the work they perform.