AAIC 2026 | What are the biological mechanisms underlying the higher prevalence of AD in women?

Yeah, it’s really important. Women are twice as likely as men to develop Alzheimer’s disease, and we really need to understand the reasons why this might be different between men and women. So really, I think the research needs to focus on the biological mechanisms, the explanations for why women are more likely. So estrogen is one of the possible reasons. That’s why we’re pointing to things like menopause. But even beyond that, we need to understand why having reduced levels of estrogen starts to result in other cardiometabolic risk factors. One of the things that my lab is looking at is mitochondrial function, which has to do with the brain and the body’s ability to use fuel in an efficient way. So the foods that we ingest and how our brain cells make use of this fuel. So there is some evidence that this is a process that’s impaired both in the menopause transition and also impaired in Alzheimer’s disease. So it seems like a reasonable place to start to look to find out whether there are explanations that we can look at for why the two are related, but also places we can intervene with things like diet and exercise.

So we had two recent papers come out in the last year looking at older women who reported about their use of hormone-based birth control in their 20s and also menopausal hormone therapy in their 40s and 50s. And we found that use of both of these types of medications were protective in their older adulthood, so 60s and 70s. The women who used these hormone therapies for a longer duration of time were both more likely to have better cognitive function and had larger brain volumes in an MRI investigation. So it contributes to the literature that suggests that accumulation of estrogen exposure over the lifetime is protective for the female brain.

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