How Alzheimer’s Disease Disproportionately Affects Women

Written by Abigail Hyson, Sponsorship Coordinator, FemHealth Insights

Alzheimer's disease is a progressive neurological disorder that is characterized by the degeneration of brain cells, ultimately leading to memory loss, cognitive decline, and behavioral changes. As the most common cause of dementia, it affects more than 55 million people globally. Notably, Alzheimer's disease disproportionately impacts women, who make up nearly two-thirds of those diagnosed. It’s important to understand the statistics and underlying factors that contribute to this gender disparity, as it is an essential piece for developing individualized care plans and support. Below are some key facts about Alzheimer’s and how the disease impacts women specifically:

1. Prevalence of Alzheimer's in Women:

According to the Alzheimer's Association, nearly two-thirds of Americans living with Alzheimer's are women. Approximately 11% of women aged 65 and older have Alzheimer's disease (compared to 6% of men in the same age group). Hispanic and African American women are among the people in the highest risk category.

2. Disease Progression:

Research shows that women with mild cognitive impairment (MCI), a precursor to Alzheimer's, progress to Alzheimer's at a faster rate than men. Women tend to have more amyloid plaques and tau tangles compared to men at similar stages of the disease. Amyloid plaques are found in the tissue between nerve cells that includes degenerating bits of neurons and other cells, and tau tangles are abnormal chemical changes from the disease that cause tau to break off and tangle within each other, ultimately interrupting how neurons communicate with one another.

3. Hormonal Influence:

The decline in estrogen levels during menopause is believed to play a role in increasing the risk of Alzheimer's in women. Estrogen has neuroprotective effects, and its reduction during menopause may contribute to accelerated brain aging and cognitive decline.

Listen to Episode 208 of the FemTech Focus Podcast on Estrogen and Memory Loss:

There are, however, research studies and databases that have been focused on women and Alzheimer’s Disease specifically. These are monumental in the push forward to help expand therapies and how sex plays a factor in prognosis, treatment, and symptoms.

1. The LUCINDA Trial (2020-Est. 2026):

This large-scale study addresses the hormonal changes unique to women that may impact Alzheimer's progression by looking at the combined effects of Lupron (a hormone therapy medication) with cholinesterase inhibitors (cognition-enhancing medication used by some Alzheimer’s patients). The study aims to slow cognitive decline in women aged 65-90 with mild to moderate Alzheimer's disease, and is expected to conclude by 2026. 

2. Alzheimer's Disease Neuroimaging Initiative (ADNI):

ADNI provided valuable data on sex differences in Alzheimer's disease progression. Their research found that women with MCI experience faster cognitive decline and more significant brain atrophy than men, emphasizing the need for gender-specific treatment approaches.

3. Framingham Heart Study (1948-Present):

This long-term study revealed that women are more likely to develop dementia than men, even after adjusting for age and other risk factors. The data emphasized the importance of considering sex differences in research and clinical practice. Additionally, the study found that atherosclerotic cardiovascular disease and risk factors are contributors to the development of dementia as they can lead to neuronal damage. 

4. Wisconsin Registry for Alzheimer's Prevention (WRAP):

WRAP research showed that women with a family history of Alzheimer's are more likely to experience early changes in brain structure and function, suggesting a higher genetic susceptibility among women.

When taking a look at Alzheimer’s disease as a whole, not only does it have a physical impact on the body, but it also has significant financial implications for patients and their families. Below is a brief outline of the direct costs of Alzheimer’s disease and how it affects women.

1. Direct Medical Costs:

The cost of medical care for individuals with Alzheimer's disease is substantial. This includes hospital stays, doctor visits, medications, and specialized care expenses. According to the Alzheimer's Association, the total national cost of caring for people with Alzheimer's and other dementias was estimated at $305 billion in 2020, with Medicare and Medicaid covering about $206 billion of this amount. Women, who make up nearly two-thirds of those living with Alzheimer's, face significant out-of-pocket expenses for medical treatments and long-term care. Additionally, the two most recently FDA-approved medications (Donanemab and Lecanemab) have per-unit costs of $695 and $637, respectively. 

2. Long-Term Care Costs:

Long-term care is a major financial burden for Alzheimer's patients and their families. The average cost for a private room in a nursing home was approximately $100,000 per year in 2021, while the price for an assisted living facility was around $54,000 yearly. Women with Alzheimer's often require prolonged care in nursing homes or assisted living facilities due to their longer life expectancy. This usually means women are more likely to outlive their savings and require extensive long-term care, depleting their financial resources and those of their families.

3. Informal Caregiving Costs:

Women are not only more likely to have Alzheimer's but also more likely to serve as caregivers for family members with the disease. Approximately 66% of caregivers for people with Alzheimer's are women. These caregivers often face reduced income due to taking time off work or leaving the workforce entirely to provide care. This dual role amplifies the financial impact and creates an opportunity for higher burnout rates for women caregivers. The Alzheimer's Association estimates that in 2020, more than 11 million Americans provided unpaid care for people with Alzheimer's, contributing an estimated 15.3 billion hours of care valued at nearly $257 billion.

4. Lost Wages and Retirement Savings:

Women with Alzheimer's or those caring for a loved one with the disease often experience significant disruptions to their careers. They may need to reduce working hours, switch to part-time employment, or retire early, resulting in lost wages and diminished retirement savings. According to a study by the RAND Corporation, the cost of lost wages for family caregivers of Alzheimer's patients amounts to about $57 billion annually. Women, who are more frequently caregivers, bear the brunt of this economic impact.

5. Increased Healthcare Costs for Caregivers:
The physical and emotional toll of caregiving can lead to increased healthcare costs for caregivers. Women caregivers often report higher levels of stress, depression, and other health issues, which require medical attention and treatment. A study published in the American Journal of Public Health found that caregivers of people with dementia have 23% higher healthcare costs compared to non-caregivers.

Addressing solutions for these financial impacts has to come from multiple places, including:

• Policy Interventions:

Expanding access to affordable long-term care insurance can help alleviate the financial burden on women with Alzheimer's and their families. Additionally, policies that support paid family leave and flexible work arrangements for caregivers can mitigate the economic impact of caregiving responsibilities.

• Support Programs:

Providing financial assistance programs for low-income families affected by Alzheimer's can ensure that women receive the care they need without depleting their financial resources. Expanding community-based services, such as adult day care and respite care, can provide relief for caregivers and reduce out-of-pocket expenses.

• Research and Advocacy:

Increasing funding for Alzheimer's research can lead to breakthroughs in treatment and prevention, ultimately reducing the financial burden of the disease. As June is celebrated as Alzheimer’s & Brain Awareness Month, advocacy efforts to raise awareness about the economic impact of Alzheimer's on women can help drive policy changes and support initiatives. With consideration to the financial implications of this disease, affordable drug prices are an important step to aid in a smooth patient journey. Groups such as the Institute for Clinical & Economic Review are helping to determine fair drug pricing. 

The companies and research organizations below are at the forefront of developing treatments and interventions specifically targeting Alzheimer's disease, focusing on understanding and addressing the unique challenges women face.

1. Biogen: Their drug Aducanumab (targeting amyloid-beta plaques) was approved by the FDA in 2021; aiming to slow cognitive decline in early Alzheimer's patients.

2. Eli Lilly: Eli Lilly's drug Donanemab (targeting amyloid plaques) has shown promise in clinical trials for slowing disease progression. It was also just recently approved by the FDA (July 2024) for use in slowing the progression of Alzheimer’s.

3. Alzheimer's Association: Their Women's Alzheimer's Research Initiative focuses on understanding why women are at higher risk and developing gender-specific treatments.

4. Cognito Therapeutics: This company is exploring non-invasive neurostimulation technologies to treat Alzheimer's, aiming to reduce cognitive decline through light and sound stimulation.

5. The Buck Institute for Research on Aging: The institute's research spans molecular, cellular, and systems-level studies to uncover the underlying mechanisms of Alzheimer's, focusing on age-related differences.

Alzheimer's disease poses a significant and disproportionate threat to women's health on a physical, financial, and emotional level. Addressing these medical disparities requires continued research and advancement into the unique risk factors, disease progression, and outcomes in women. By advancing gender-specific treatments and interventions, we hope to reduce the impact of Alzheimer’s disease and improve outcomes for millions of women worldwide.

About the Author:

Abigail Hyson is a writer, advocate, and Women’s Health enthusiast. She has worked at multiple women’s health startups, helping one exit successfully. With six years in the healthcare industry, Abigail is also an experienced strategist, focusing mainly on patient & customer journeys and creating a cohesive community voice. Her mission involves creating awareness around women’s health disparities to help close the health equity gap.