When women start menopause, their bodies and brains have to calibrate to the sharp drop in estrogen, Dr. Caldwell explains. “For some women, that appears to be quite hard on memory.” Many people experience lapses in memory, brain fog, or trouble finding words, Dr. Rosenbloom says. Plus, the decline in estrogen can lead to issues like depression and insomnia, which can also impact your cognition, Dr. Bevins adds.
Some research suggests that women who start menopause earlier and/or start menstruating later are at higher risk for Alzheimer’s—presumably because they have less estrogen exposure over their lifetime, Dr. Caldwell says. “But the literature isn’t entirely consistent, so we’ve got to do some more work.” It’s also unclear if hormone therapy (HT) is helpful, Dr. Bevins says. Some research suggests HT lowers the risk of AD, while other research shows the opposite. Other studies have found HT only lowers your AD risk when it’s started earlier in menopause and taken without progestin, Dr. Bevins says. “So it’s very complicated.”
Other biological and genetic differences might play a role too. For instance, one of the main disease drivers in Alzheimer’s is something called neurofibrillary tangles—when strands of a protein, called tau, accumulate inside brain cells, Dr. Rosenbloom explains. “There have been some studies that have found that women may have higher levels of tau in the brain, and that tau may spread more readily in a female brain.” And while Alzheimer’s isn’t entirely genetic, carrying a gene called APOE4 is linked to a higher likelihood of developing the disease—and the effect seems to be much stronger in women than men, Dr. Rosenbloom says.
Then there are social factors. Getting less education earlier in life is a risk factor for AD, since learning is thought to build up the brain’s resilience against cognitive decline in older age, Dr. Bevins explains. “And historically, women have not had the same access to higher education as men,” or career opportunities. So the current aging population of women may have less of that protective effect.
Meanwhile, many middle-aged women today are expected to do so much—act as the primary caretaker, work full-time, take care of aging parents—that they have less time to do things for themselves that can help reduce their risk of Alzheimer’s, like working out and engaging in cognitively stimulating activities, Dr. Caldwell explains. (Research shows that women are, on average, less physically active than men.)
How to protect your brain health as you age
The good news is, there’s a ton you can do to reduce your risk of Alzheimer’s (and dementia in general), starting now. A 2024 review of dementia research published in The Lancet estimates that about 45% of dementia cases are preventable. Your brain is malleable throughout your life, Dr. Bevins explains, meaning your current lifestyle habits can improve your brain health down the road. “It’s never too soon to start thinking about this,” Dr. Bevins says. “The earlier the better.” So let’s get into it.
1. Exercise, exercise, exercise.
Physical inactivity is a known risk factor for dementia. In fact, the evidence shows that the number one thing you can do for your brain is move your body on the regular. “If you have time for nothing else, exercise is where to start,” Dr. Caldwell says.
