Why Women are at Greater Risk of Developing Alzheimer's Disease

The Prevalence and Effects of Alzheimer’s Disease Among American Women

Description of Topic for Dissertation Research

At present, there are more than 5 million cases of Alzheimer’s disease in the United States, and this figure is projected to increase by 300% by mid-century (Vega et al., 2017). Although the Food and Drug Administration recently approved the first medicinal treatment for Alzheimer’s disease, its efficacy remains unknown at present and it is reasonable to suggest that many Americans will continue to suffer from this disorder as they grow older. While Alzheimer’s disease can occur at any time during the lifespan, it is generally regarded as an age-related disorder since it typically occurs among the elderly and represents the most common cause of dementia in this population (Beckman & Morrison, 2021). Despite a small decline in life expectancy rates attributable to the ongoing Covid-19 pandemic in recent years, people are still living longer today and ever before in history. Therefore, it is also reasonable to posit that unless and until the precise causes of Alzheimer’s disease are identified and efficacious treatments become widely available, the number of Alzheimer’s disease sufferers will continue to increase well into the foreseeable future (Beckman & Morrison, 2021).

. What is known for certain at present is that women have a higher lifetime incidence of Alzheimer’s disease compared to men (Peeters et al., 2022). Researchers have also determined that Alzheimer’s disease currently affects almost 50 million people globally, and that fully two-thirds of the cases in the United States are women (Beckman & Morrison, 2021). Moreover, the female population in the United States is becoming far more diverse, and the prevalence of Alzheimer’s disease among African American and Hispanic women is also higher compared to men, with the largest differences existing among the same ethnicity (Royse et al., 2021). In addition, African American women are also less likely to seek medical assistance when the symptoms of Alzheimer’s first occur, thereby exacerbating the condition and accelerating its devastating effects on the human mind and body (Lincoln et al., 2021). Taken together, these issues make the study of the prevalence and effects of Alzheimer’s disease among American women a timely and interesting topic that warrants further investigation.

Annotated List of Juried Articles

Andrew, M. K. & Tierney, M. C. (2018). The puzzle of sex, gender and Alzheimer’s disease: Why are women more often affected than men? Women’s Health, 14, 1-8.

This study cites the significant differences in the incidence and prevalence of Alzheimer’s disease between men and women as a problem that warrants additional investigation. The purpose of the study was to provide a comprehensive, critical analysis of these issues using a narrative review to identify gender- and sex-based influences in the onset of Alzheimer’s disease. In this regard, the authors note that there are multiple sex differences between men and women with respect to hormones, pregnancy and brain structure that may have an influence on the onset of Alzheimer’s disease. The findings that emerged from this study included the effects of longevity because women tend to outlive men as well as other biological differences such as hormonal and physicality which may play a role. In addition, gendered social roles and educational and employment opportunities may also be implicated in the onset of Alzheimer’s disease. Based on these findings, the authors suggest that additional research concerning the manner in which sex- and gender-based differences combine to place women at greater risk of developing Alzheimer’s compared to men. Likewise, the authors also call for further studies to determine how sex and gender should be taken into account for the optimal management of this disorder. A minor weakness in this study was the minimal discussion concerning the relationship between female frailty and the onset of Alzheimer’s although this factor was included in the calculus.

Kimura, A. et al. (2019). Malnutrition is Associated with Behavioral and Psychiatric Symptoms of Dementia in Older Women with Mild Cognitive Impairment and Early-Stage Alzheimer’s Disease. Nutrients, 11(8), 1951-1966.

This article emphasizes the fact that the world’s population is living longer with a concomitant increase in the prevalence of various types of dementia, most especially Alzheimer’s disease. In response to this problem, the purpose of this study was to analyze a population of 846 women (aged 65–89 years) suffering from different stages of dementia (including Alzheimer’s) using the Mini-Mental State Examination, Dementia Behavior Disturbance Scale and Mini Nutritional Assessment Short-Form. The findings that emerged from this study included the fact that nutritional problems, including weight loss, are common among women with Alzheimer's disease which is associated with suboptimal clinical outcomes such as high rates of institutionalization, rapid cognitive decline and increased mortality. An especially noteworthy finding was that these outcomes can even occur among women suffering from the early stages of the disorder. Based on these findings, the authors recommend additional research to identify efficacious preventative and management strategies for women experiencing the early stages of Alzheimer’s disease. Although not a weakness per se, this study used Japanese women only, meaning that there may be unidentified cultural issues involved that may also play a role in the onset of Alzheimer’s disease and that the above findings may not be generalizable to other populations.

Majoka, M. A. & Schimming, C. (2022, June). Effect of Social Determinants of Health on Cognition and Risk of Alzheimer Disease and Related Dementias. Clinical Therapeutics, 43(6), 922-929.

The problem of interest to this study using a systematic literature review was the risk of developing Alzheimer’s disease as well as associated disorders. The overarching purpose of this study was to examine the various social determinants of health that affect cognitive function and the risk of Alzheimer's and related dementias (ADRDs). The authors note that the term “Alzheimer disease and related dementias” refers to the combined effects of the most common types of neurodegenerative illnesses that include cognitive impairment and dementia. The key findings that emerged from this study included factors such as lower socioeconomic status, less education, manual labor, high body mass index in midlife, low food security, poor neighborhoods, and stress are clearly associated with an elevated risk of developing ADRDs. Conversely, higher levels of education, higher socioeconomic status, social engagement, and experiences with early-life adversity have a protective effect. The authors conclude that the future direction for this research should focus on reducing ADRDs in the future which could be achieved by enhancing education, improving socioeconomic conditions, and eliminating racial discrimination. The main weakness of this study was is broad focus on ADRDs (an umbrella term that includes Alzheimer’s disease but dementia with Lewy bodies. frontotemporal lobar degeneration, vascular dementia, and multifactorial dementias as well, which limited its applicability and generalizability to Alzheimer’s. The main strength of this study was the authors’ systematic discussion of the various ADRDs and how they affect the likelihood of developing one of the ADRDs discussed, including Alzheimer’s disease.

Schacter, A. S. & Davis, K. L. (2022, April). Alzheimer's disease. Dialogues in Clinical Neuroscience, 2(2), 1-100.

This study used a systematic review of the relevant literature concerning Alzheimer's disease in the context of it representing a significant public health concern. Despite growing recognition f the problem, Alzheimer’s disease remains undiagnosed and undertreated in far too many cases. The purpose of this study was to identify the causes of the disease and what progress is being made in developing innovative treatments. The authors note that advances have been made in diagnostic methods and treatments for both cognitive and behavioral symptoms. The main treatment for cognitive symptoms includes drugs such as donepezil, tacrine, rivastigmine, and galantamine. In addition, the use of estrogen replacement for women as well as anti-inflammatory agents, and antioxidants is still being studied. Behavioral symptoms are often treated with antidepressants, antipsychotics, mood stabilizers, anxiolytics, and hypnotics.

A particularly interesting finding from this study was that because women have an increased risk of developing Alzheimer’s and they tend to live longer than men with this disorder, there are currently twice as many women and men suffering from this disorder. The future directions for research identified in this study included techniques for diagnosing and treating Alzheimer's disease using functional brain imaging for early detection and evaluating the effectiveness of treatments.

Vega, I. E. et al. (2017). Alzheimer’s Disease in the Latino Community: Intersection of Genetics and Social Determinants of Health. Journal of Alzheimer’s Disease, 58(4), 979-992.

This study cites the effects of various social determinants of health on the Latino community in the U.S. developed Alzheimer’s disease at some point in their life as the problem of interest and examines these determinants using a review of the quantitative and qualitative data. The problem of interest is the estimated dramatic increase in diagnosed cases of Alzheimer’s by 2050. The purpose of the study was to what steps can be taken today to mitigate these disturbing projections. The main findings that emerged from this study included the fact that adult Latinos have a higher prevalence of metabolic syndrome compared to the general population which may represent a vulnerability to the onset of Alzheimer’s. Likewise, the high rates of diabetes among the Latino population in the U.S. may also increase the risk of developing Alzheimer’s. Based on these and other findings, the authors conclude that it is possible that the combination of the various social determinants of health account for the current disparities in the prevalence of Alzheimer’s disease among the Latino population in the United States. As a result, the authors recommend that additional research be conducted in this area to isolate the most significant determinant so that these disparities can be reduced or even eliminated.

Additional Women and Alzheimer’s Disease Articles

Beckman, D., & Morrison, J. H. (2021). Towards developing a rhesus monkey model of early Alzheimer’s disease focusing on women’s health. American Journal of Primatology, 83(11), 1–7.