Does Alzheimer’s affect men and women differently?

Does Alzheimer’s affect men and women differently?

9 July 2018

According to a recent review led by Dr. Maria Teresa Ferretti (University of Zurich, Switzerland) and Professor Harald Hampel (Sorbonne University, Paris, France), sex differences in Alzheimer’s disease should be considered for providing the best possible care to each patient.

Several diseases are known to affect men and women differently. For instance, male and female stroke symptoms and risk factors are not the same. Decades of one-sex (men) centered clinical research has led to treatments and preventative campaigns that were optimized for and aimed at men only, resulting in significant lower quality of care in women affected by stroke. This issue is now openly discussed by the medical community, and the American Heart Association has recently issued guidelines for sex specific prevention of stroke.

Could this be true also for Alzheimer? Unfortunately, we know very little about this. Most laboratory and clinical studies are still neglecting the sex and gender effects in their results. In fact, data derived from men and women populations are being analyzed and reported cumulatively, without further analysis of differences between groups. Women represent two thirds of Alzheimer’s patients worldwide –but beyond this epidemiological data, research into sex differences is astonishingly limited.

A group of international scientists, called ‘Women’s Brain Project’ (WBP) – a GADAA member organisation, has decided to campaign for awareness and for promoting sex and gender-sensitive precision medicine in the field of neurology and psychiatry. The group has teamed up with the ‘Alzheimer’s Disease Precision Medicine Initiative’ (APMI), the first international research working group dedicated to the implementation of breakthrough precision medicine for Alzheimer’s disease.

Together, the WBP and APMI have reviewed the scientific literature to document whether and how Alzheimer’s disease differentially affects men and women.  The authors looked at sex- differences in symptoms, biomarkers, risk factors, and in response to medical intervention.

This extensive review ‘Sex differences in Alzheimer disease —the gateway to precision medicine‘, published in the leading international journal Nature Reviews Neurology, clearly demonstrates that sex and gender differences are indeed of very high relevance for diagnosis and treatment of Alzheimer’s disease, as supported by several independent studies. However, this important issue has only begun to be addressed by the community, and more systematic and rigorously controlled work needs to be done.

The Authors believe “that a lot more work should be done in this field, requiring a concerted effort form the scientific community, policy makers, drug developer and regulators”.

Professor Harald Hampel, senior author of the publication and Chair of the Alzheimer Precision Medicine Initiative (APMI) reports:

We have found consistent sex differences in the progression of the disease and in risk factors reported in the literature. For instance, women show faster cognitive decline and brain shrinkage than men, once first memory symptoms appear and the Alzheimer dementia stage is diagnosed. On the other hand, some metabolic risk factors such as obesity seem to be stronger represented in men. These differences have to be taken into consideration when designing personalized disease models for prevention, diagnosis and treatment. A one-size-fits all approach in Alzheimer’s has not worked – Alzheimer’s is highly heterogeneous and we have to take into consideration the specific needs of each patient. We believe that studying sex-differences will be crucial to ensure that men and women receive the best possible treatment in the framework of precision medicine for Alzheimer’s disease

Lead author Dr. Maria Teresa Ferretti further commented:

Biological, as well as cultural factors might explain the differences observed. Low education, low work attainment, caregiving, metabolic disorders are all modifiable risk factors for Alzheimer’s that hit women more often (and possibly harder) than men, especially in low and middle income countries. Sex-specific strategies for Alzheimer’s prevention in women worldwide should be envisaged. These might include increased level of education and employment of young girls, support to female caregivers and early screenings of at risk populations”.

Dr. Annemarie  Schumacher Dimech, President of the Women’s Brain Project:

We hope this landmark publication will raise critical awareness amongst the scientific community and the public at large regarding the importance of studying sex-differences in brain health and disease, for both men and women” This work runs alongside our campaign in generating social awareness around the importance of brain health and engaging policy makers, pharmaceutical companies and regulators to effect positive change”.

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, a GADAA Steering Committee member, said:

“We have known for some time that women are at a greater risk of developing dementia than men. This work is long overdue and it’s great to see real focus on why that might be and its impact.

It’s vital we accurately understand how dementia impacts women and men to ensure both have access to the accurate diagnosis and the most appropriate treatments.

Dementia is a highly individual condition and we need to look at how treatment and care can be personalised to maximise their impact taking into account gender.”

Further resources

Women’s Brain Project

The Women’s Brain Project, established in 2016, is a non profit organization composed by scientists, patients and caregivers, that aims to stimulate a global discussion on gender and sex determinants of female vulnerability to brain and mental disease.  To find out more, visit www.womensbrainproject.com