How Alzheimer's Differs In Men & Women, From Risk Factors To Preventive Strategies

Alzheimer's disease affects around 6 million people in the United States alone, with an expected 15 million patients by the year 2050. (To put that in context, that's the entire populations of New York, Chicago, and Los Angeles added together). 

However, according to neuroscientist, nutritionist, and associate director of the Alzheimer's Prevention Clinic at Weill Cornell Medical College Lisa Mosconi, Ph.D., there is a huge nuance in the statistics that typically gets overlooked. 

"Almost two-thirds of all those patients might be women," she tells me on this episode of the mindbodygreen podcast. "So for every man suffering from Alzheimer's, there are two women."

Why are there so many more women than men who suffer from this neurological disease? It's a question Mosconi has been trying to answer in her research, and it's one that we discuss at length during the episode (no, it's not just because women statistically live longer). 

Believe it or not, the major risk factor for men is being single. According to Mosconi, men need a support system—studies have shown that men who are not married had a higher risk of cognitive decline. 

While the existing research has only studied the effects on heterosexual married men, Mosconi would argue that a loving relationship—no matter the label—is an important factor for preventing Alzheimer's. As long as men have a support system, Mosconi says, their risk of Alzheimer's can decrease. 

"Physically, men need to be in a relationship," she says. "But just being in a solid, nurturing relationship with your spouse, friend, or partner is actually supportive of your health." 

It makes sense, as a supporting, loving partner will most likely make sure you're eating right and seeing the doctor for routine checkups. So, men, in particular, might want to thank their partners for that not-so-subtle nag to exercise more or cut back on processed foods. The effects, says Mosconi, could be paramount for brain health down the line. 

For women, Mosconi notes that the No. 1 risk factor is their hormonal health, specifically menopause.

"In women who are going through menopause, the brain starts showing reductions in brain energy levels, which correlates with the formation of amyloid plaques, or Alzheimer's plaques, in women's brains," she explains. 

Think of women's hormones as "superpowers" for their brains; once women lose those superpowers during menopause, the brain becomes a little more vulnerable—whereas in men, their testosterone stays pretty stable throughout their lifetime. That said, women might want to check if they are in perimenopause or postmenopause and figure out whether they want to start hormonal therapy, as early as their mid-40s, says Mosconi.

"Menopause seems to be the turning point for these medical risks to become potential medical issues," she explains. "So for me, it's really helpful if I can see the risks right now, when you're 45 or 50, so we can get a strong baseline and put you on an Alzheimer's prevention plan." 

So, what does an Alzheimer's prevention plan look like, according to Mosconi? Because the No. 1 risk factor for women is their hormonal health, Mosconi notes that it's best to optimize their hormones—which is relatively doable using diet and lifestyle factors. She mentions a few tips that are specifically beneficial for women:

It wouldn't be a podcast on brain health if we didn't mention the Mediterranean diet. In terms of the healthiest eating plan, the Mediterranean diet racks up a ton of points these days. And just like other nutrition experts, Mosconi says the benefits of this vegetable-packed, olive-oil-leaning eating plan are unparalleled when it comes to preventing Alzheimer's. 

"This diet seems to work really well for women and for men," she says. "It's a very sensible diet. It's rich in veggies, fruits, whole grains, and legumes. The omega-3 fatty acids from fish, especially DHA and EPA, are really crucial for brain health." 

While both genders see benefits from the Mediterranean diet, Mosconi notes that this diet is particularly brain-health-boosting for women: "Women on the Mediterranean diet, as compared to women on the Western diet, have a much lower risk of cognitive decline, depression, heart disease, stroke, cancer, and they also have fewer hot flashes," she says. 

"EDCs are very specific chemicals that could be in your household that could potentially disrupt estrogen," Mosconi says. "These compounds are health hazards, especially for pregnant women and young girls. So it's really important that we have hardly any plastic in the house." 

We recognize plastic use as a problem from a sustainability standpoint, but we should also emphasize that the chemicals in plastic can pollute our food, water, and—believe it or not—our hormones. 

"Even when you read that your plastic container is BPA-free, there are still chemicals that can leak inside your food or your drinks, especially as you reheat the container," Mosconi notes. Now, that's not to say you should stress about the plastic toys in your home (as we know, chronic stress does no good, either). But using glass bottles and containers whenever you can, especially when it comes to heating food, is key. 

All the coffee-obsessives out there will be pleased to know that Mosconi recommends drinking a couple of cups of coffee a day as helpful for preventing Alzheimer's. However, it's a fine line before crossing over to risky territory. Basically, you want to be in that sweet spot of a coffee buzz—not too much and not too little. 

"If you drink no coffee, your risk of Alzheimer's disease is as high as that of a person who drinks a ton of coffee," Mosconi says. "But if you're right in the middle, which is about two cups of coffee a day, that seems to be really helpful." 

Another caveat, according to Mosconi, is that the response to caffeine depends on women's menstrual cycles. Ever feel like you just can't get that caffeine buzz, even after four or five cups? That's because you're probably in the second part of the menstrual cycle, where you're progesterone is higher and inhibiting that response to the stimulant. 

On the other hand, in the first two weeks of your cycle when your estrogen levels are higher, you won't need as much coffee to feel that energy boost. That said, women, in particular, should make sure they're always hitting that "sweet spot" when it comes to drinking coffee—even if they feel like it may not be working. "Your hormones might not let it work for you, but your heart will suffer, and your sleep will suffer," Mosconi notes. 

Finally, Mosconi believes in the importance of exercise. When it comes to hitting the gym, Mosconi says that the time (and sweat) you put in is truly an investment. 

"Especially for women, if you have a decent level of fitness throughout your lifetime, your risk of dementia is low when you are in your 70s and 80s," she notes.

That said, she recognizes the importance of exercising from a young age and suggests that you get moving. Whether it's HIIT, yoga, or a simple walk through the neighborhood, moving your body has long-lasting effects on your brain health. 

While Alzheimer's is a scary disease, people like Mosconi are hopeful that we can figure out what's actually driving those frightening diagnoses. Needless to say, it's high time we talk about the differences between women and men in terms of cognitive health and find targeted methods of treating and preventing the disease. In the case of brain health, personalized medicine has never been so important.