Understanding the Overlooked Majority in Alzheimer’s Disease

Women are significantly more likely than men to be diagnosed with Alzheimer’s disease and related dementias, and they face unique biological, life-course, and caregiving challenges that influence risk, diagnosis, and treatment. Although research on sex-based differences in AD has expanded significantly, clinical guidelines and policy frameworks have yet to fully incorporate these insights, creating urgency to better address women’s brain health as both a scientific and strategic priority.

As the AD, diagnostic and therapeutic landscape rapidly evolves, advances in biomarker science, disease-modifying therapies, and diagnostic innovations are reshaping how patients are diagnosed and treated.  Amid this transformation, one reality has become increasingly clear: women  account for more than two-thirds of Americans living with AD and related dementias and face unique clinical and care challenges. Historically, this prevalence disparity was largely attributed to longer life expectancies, but recent evidence suggests  more underlying complexity, underscoring sex-linked biological factors, genetic variations, or differences in life experiences such as metabolic changes, hormonal transitions (including pregnancy and menopause), sleep disturbances, and chronic stress.

The burden of illness disparities extend to caregiving: Women comprise more than 60% of AD and dementia caregivers, are often unpaid, and balancing along with additional roles at work and at home. Altogether, more than 12 million women in the United States are either living with AD or caring for someone with it. Female caregivers spend more time caregiving than male counterparts, and because of these duties, are more likely to experience adverse consequences such as depression and adverse health outcomes.

Redefining Women’s Brain Health through Research and Policy

Pioneers in AD among women have explored topics on the impact of hormonal transitions (e.g., menopause) on brain metabolism, the neurobiology of menopause and AD, and the biological and environmental drivers of sex differences in brain health. These advancements—alongside growing research investment and the efforts of vocal advocates for more women’s health research—have shifted public awareness and scientific discourse around women’s brain health and the potential role of hormone therapy and precision medicine in advancing diagnosis and treatment.

However, the clinical guidelines that define “gold-standard” care have not kept pace with these scientific developments. Major guidelines published by the Alzheimer’s Association and the American Academy of Neurology are typically updated every three to five years. Although there is recognition of sex-based differences, explicit sex-specific recommendations remain limited, downplaying factors such as:

• Menopause-related cognitive changes
• Hormonal transitions (e.g., pregnancy, menopause) and their neurobiological impact
• Differential APOE4-associated risk in women
• Sex-stratified treatment risk considerations
• Caregiving burden as a modifier of treatment feasibility.

Although these complex dynamics have always been important to providing adequate care to women, they are becoming more consequential as the field shifts from late-stage symptomatic management toward earlier diagnosis and disease-modifying treatment pathways. While this shift creates new opportunities to alter disease trajectories, it also raises new questions around real-world effectiveness, access, safety monitoring, and affordability, particularly for populations that make up most patients.

Moreover, drug pricing and Medicare coverage are under increased scrutiny in the Inflation Reduction Act (IRA) era. The IRA introduced new clinical and economic implications for investments in new drug developments that can amplify sex-based disparities when it comes to access, patient education, and affordability. Overall, understanding how AD and related dementia manifest differently for women can help with the earlier identification of cognitive changes and support women as both patients and caregivers as they navigate changes across their lifetime.

Dive Deeper

Avalere Health co-leads the Coalition for Women’s Brain Health (CWBH), whose mission is to ensure women have access to cognitive health resources and are empowered to actively invest in their cognitive well-being. The CWBH unites organizations and individuals promoting women’s brain health and addresses the disproportionate burden of neurological disease on women through a focus on research, advocacy, and collaboration. Connect with Naila Wahid to learn more about Avalere Health’s work in women’s brain health.