Alzheimer's: A new study examines the disease in women

Yet, experts say science does not seek to explain why the disease affects women more than men. "Age is the biggest predictor of Alzheimer's disease, so for a long time, there was this notion that women are more at risk than because they live longer," he said. Pauline Maki, Professor of Psychology and Psychiatry at the University of Illinois. . "No one paid attention to what was happening in the brains of women throughout a woman's life."

"I was asking for money to do estrogen research, and the commentators asked me, "Why are you doing this? & # 39; said presenter Carey Gleason of the Alzheimer's Disease Research Center of Wisconsin

In recent years, this has changed.

"We are at a very exciting time on the ground" said Rachel Whitmer, professor of public health science at the UC Davis School of Medicine. "Rather than repel it as" women are living longer and it's the end of the day. " history, "science is breaking it down to a deeper level to understand where, when, why, and how."

Reproductive Life

The Kaiser Permanente Study, which looked at the number of births and the risk of dementia, followed women who used the company's health care most of their lives.This allowed researchers to access the medical records of every woman between 1964 and 1973, then from 1996 to 2017.

It was important, say the researchers, because they did not rely on a woman's memory of her reproductive and medical history, "

" I myself sometimes have trouble remembering which happened last week, "said Whitmer, who co-led the study. "But we actually have the questionnaires that they filled in the '60s and' 70s."

"We could then compare that to their risk factors in midlife like hypertension, stroke, diabetes and heart disease" Paola Gilsanz, a staff member of Kaiser Permanente who co-directed l & # 39; study. "In that sense, it's very, very powerful."

When the study began in 1964, all women were between 40 and 55 years old. Their medical records documented the history of reproduction, education, race, and health in quarantine, as well as the timing of menstruation, menopause, and the length of procreation. The diagnosis of dementia and chronic diseases later, such as heart failure and diabetes, were drawn from the records between 2016 and 2017.

In addition to finding that multiple pregnancies protect against dementia, but the Multiple abortions are not, the study found Women who were fertile for only 21 to 30 years had 33% more risk of dementia than women who were fertile for a longer period. They also found that women who started their first menstrual cycle at age 31 or older likely to have cognitive problems than women who started at age 13.

What do all these results mean? It's too early to tell, Whitmer said.

"It's an observational study," she said. "It does not tell you the mechanisms, but it tells you who is at higher risk and lower. This information allows basic scientists to take the next step and do more experimental work and really dive in."

"Korean, Greek and American women are quite different genetically," said Dr. Richard Isaacson, a researcher on Alzheimer's disease, who was not involved in any studies. "You must be very careful with the generalization of these studies, for example, the studies done in China on stroke, but you can not generalize these results to US patients in the United States unless they are Chinese-Americans or born in China. "Alzheimer's disease is a life-threatening disease in my opinion," said Isaacson, who founded the Alzheimer's Prevention Clinic at NewYork-Presbyterian Medical Center / Weill Cornell. "The risk begins in the womb and is then affected by your genes, your early risk factors, your level of education, your diet and your exercises, and much more."

] Better Cognitive Assessment

Another study presented at the conference focused on the need for more accurate screening tests for Alzheimer's disease – tests that consider the innate benefit of the woman on men in verbal memory

] "If you go to the store without your grocery list, a woman will do the best job for you to remember," said Maki, who led the study. "A man will be better at visuospatial things, like finding the way home."

The cognitive tests used to diagnose Alzheimer's disease strongly rely on the recall of word lists, histories and other verbal materials. This means that women who have mild cognitive decline can achieve normal results, said Maki, thus preventing them from starting taking medication and adopting appropriate lifestyle changes. It could also mean that some men may have a false positive memory test, she says, and be diagnosed with brain changes when they are normal.

Maki then tested a new scoring mechanism for the memory test of Alzheimer's disease, making it more difficult for women to obtain a "passing grade" while making it easier for men . She found that 10% of women who had shown the pathology of Alzheimer's disease on brain scans could now be identified; She also found that 10% of men who would have been found to be cognitively impaired were now considered normal.

"Further research is needed to apply these findings to larger populations, but this shows the need for a reassessment of the tests we use to diagnose Alzheimer's disease so that men and women can get the help they need.

The Role of Estrogen

A third study at the conference, presented by Gleason's Wisconsin Center for Research on Alzheimer's Disease, examined more studies recent on the cognitive effects of hormone replacement therapy, a subject with a controversial history.

"We recognize that our models were too simplistic," she says, "and that there are many more things to be aware of, including the underlying health of a woman, her genetic profile and when it starts and stops. "

For years, science has believed that giving women hormone replacement therapy, or HRT, at menopause was beneficial to the aging brain and would help prevent heart disease. But the preliminary results of the Women's Health Initiative, a long-term national study designed to examine ways to prevent heart disease, osteoporosis and breast and colon cancer in women, shocked.

Results from 2002 and 2004 revealed that the estrogen-progesterone combination of HRT increased the risk of heart disease, stroke, blood clots, dementia, and breast cancer.

The use of HRT dropped. Then, 10 years later, the Women's Health Initiative reversed its findings. As the original analysis looked at older women, who were already at risk for heart attack, blood clots and stroke, the initial findings were wrong because they did not take into account the Age of the woman at the beginning of the replacement treatment.

Today, it is believed that hormone replacement therapy may help control the symptoms of menopause by the time most women undergo change in their late forties and early fifties. when their risk of chronic disease is lower. Taking hormones later in life, when the risk of blood clots, stroke and cancer is higher, should examine their risk factors and discuss the option carefully with their doctor.

HRT might also not help the older brain: Women who start hormone therapy in their 70s, said Gleason, have shown persistent declines in cognition, working memory, and the ability to organize and to do things. ] For younger women, Gleason stated that more recent research has found no cognitive or benefit effect on many forms of HRT if they start in a few years of menopause unless the woman has diabetes. type 2.