Print This PostIn the last 15 years or so, there’s been a growing focus on trying to understand the increased risk of dementia faced by women. Not only is it the leading cause of death for women in the UK, but women are also more likely to take up caring roles for loved ones living with dementia. Why is the impact of dementia greater for women compared to men? In parallel, we’re seeing fewer female dementia researchers in senior positions and gaining research funding. In this blog, I discuss reasons for why this might be the case, as well as the need to develop and retain more female dementia researchers.
In 2011, dementia became the leading cause of death for women in the UK, and it has remained unchanged since. Currently, two thirds of people living with dementia are women. We don’t fully understand why this is, but the importance of finding out has never been more urgent, as the prevalence of dementia in our society is only predicted to increase.
Although the greater prevalence of dementia in women compared to men is significant, it’s important to note that this difference is only seen amongst those diagnosed with Alzheimer’s disease. Amongst those diagnosed with other dementia-related neurodegenerative diseases, such as vascular dementia, dementia with Lewy bodies, and frontotemporal dementia, there’s actually a higher prevalence in men than women. So when we’re taking about an increased dementia risk faced by women, we’re really talking about an increased risk of Alzheimer’s disease. This is the most common neurodegenerative disease that causes dementia, so it makes sense that if more women are diagnosed with Alzheimer’s disease compared to men, there will be a higher proportion of women with dementia overall. So the more specific question is: what’s causing the increased risk of Alzheimer’s disease in women?
A good place to start is by looking at known risk factors for dementia and specifically Alzheimer’s disease, and seeing whether women are more likely to be impacted`by these risk factors compared to men. Age is the biggest risk factor for dementia for both men and women. However, as women typically live longer than men, they are more likely to be impacted by any age-related disease or condition, including dementia. Despite this, having a longer life expectancy cannot on its own explain why women have an increased risk of dementia compared to men, because women only live an average of four years longer than men. We know that the brain diseases which cause dementia develop and progress for potentially up to 20 years before clinical symptoms are present, so it’s unrealistic to think that a longer life expectancy of less than five years is sufficient to account for a doubling of the number of women living with dementia compared to men.
There are clear biological differences between men and women which could help explain the difference in prevalence between the sexes, at least to some degree. For example, women typically experience the menopause at around 50 years of age, and it involves changes to the levels of sex hormones known as oestrogen and progesterone. A decrease in oestrogen is thought to have a particularly negative effect on the brain, as it’s usually important for generating energy for the brain in order to maintain healthy function. This is done through facilitating the uptake of glucose in neurons, but with lower levels of oestrogen this can’t happen as efficiently, which leads to impaired neuronal function and eventually neurodegeneration.
There are also social differences between men and women related to known risk factors for dementia. For example, historically women experience less education and are more likely to take time out of work for family caring responsibilities. This could lead to an increase in social isolation. Women are also more likely to experience intimate partner violence which comes with an increased risk of experiencing traumatic brain injury (TBI). Less education, social isolation, and TBI are recognised as modifiable risk factors for dementia, so these are things that can be changed, and would reduce women’s risk of dementia.
The problem isn’t just about trying to understand women’s increased risk of dementia in order to try and reduce it.
Women continue to be disproportionately impacted in other negative ways, such as when it comes to dementia care.
For example, one study showed that in the UK, women with a dementia diagnosis have fewer GP appointments and therefore less health monitoring compared to men. As a consequence, there are fewer opportunities for medications to be reviewed, so it’s unsurprising that the study also found that women living with dementia were more likely to remain on potentially harmful medication, such as antipsychotics or sedatives, for longer than men. This has serious implications for women already living with a life-altering and life-limiting condition.
The disadvantages women experience when it comes to the impact of dementia are evident outside the clinical and care sectors too. In research, preclinical animal studies, which are used to investigate disease mechanisms and therapeutic drugs, predominantly use males. This is due to assumptions around greater variability in female animals, which I’ve written about in a previous blog. In addition, women are more often excluded from taking part in medical research as they are more likely than men to experience co-morbid health conditions which could impact on trial results. This can, and does, lead to development of drugs which inevitably affect men and women differently, both in terms of efficacy and the degree to which side effects are experienced. Perhaps the de-prioritisation of females in both preclinical and clinical research isn’t surprising when we know that despite the majority of dementia researchers being women, they predominantly occupy junior roles. Moreover, a recent study revealed that more than half of early career dementia researchers surveyed reported experiencing sexism.
Many women will leave research, and many will simply never be promoted to a senior role.
Many of my female peers have achieved great success with fellowships, only to find themselves facing an unemployment cliff edge at the end. Despite being in a permanent position, I’ve been open in a previous blog about facing redundancy.
If we’re serious about addressing the inequalities faced by women when it comes to the impact of dementia, we need to develop and retain more female dementia researchers. It isn’t appropriate for research into a condition which disproportionately affects women in so many ways, to be predominantly led by men.
Dr Kamar Ameen-Ali
Author
Dr Kamar Ameen-Ali is a Lecturer in Biomedical Science at Teesside University & Affiliate Researcher at Glasgow University. In addition to teaching, Kamar is exploring how neuroinflammation following traumatic brain injury contributes to the progression of neurodegenerative diseases that lead to dementia. Having first pursued a career as an NHS Psychologist, Kamar went back to University in Durham to look at rodent behavioural tasks to completed her PhD, and then worked as a regional Programme Manager for NC3Rs.
Dr Kamar Ameen-Ali
