Women and Alzheimer’s Disease (Podcast)

An expert reviews risk factors and prevention strategies specific to women

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While Alzheimer’s disease may not be the first condition people think of when it comes to women’s health, two out of three individuals diagnosed with the disease are women. In 2020, Cleveland Clinic opened the first Alzheimer’s disease prevention clinic for women in the United States.

“It’s important to know that there is hope when it comes to Alzheimer’s disease,” says Jessica Caldwell, PhD, a neuropsychologist and director of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic, part of the Lou Ruvo Center for Brain Health in Las Vegas. “There are things that women — and everyone — can do to start reducing risks.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Caldwell takes a close look at women and Alzheimer’s disease, covering:

  • Risk factors for men and women, as well as those that affect women specifically
  • Presentation of Alzheimer’s disease in women
  • The role of estrogen and menopause in brain health
  • Prevention strategies related to modifiable risk factors and behavior changes
  • New research in the field on improved hormone replacement therapy and targeted treatment

Click the podcast player above to listen to the 25-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: What types of prevention strategies are we looking at for women?

Dr. Caldwell: In my clinic, we focus on two categories of behavior change. One involves working directly on what are termed modifiable risk factors for Alzheimer’s disease. This comes from work published in the Lancet over the past five or six years that shows up to 40% of current cases might have been preventable if we had known about changing behavior 20 years ago. Things on that list include medical conditions such as high blood pressure and diabetes. If women come in at risk for those conditions due to family history, we talk about really watching to avoid those things — taking even more care about diet and exercise than they might otherwise do.

The list of modifiable risk factors also includes things like getting enough physical activity. While we work with every woman on physical activity, there are some women who really need to get moving to a higher degree. It also includes things like reducing alcohol intake. There is a particular level of alcohol above which people actually increase their risk for Alzheimer’s disease. If a woman comes in within that range, then we would work together on how to get that reduced.

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In addition to those modifiable risks, of which there are 12, we know a lot about different behaviors that support brain health that aren’t on that list. One example that arises often in the clinic is sleep. We know that sleep is important for memory consolidation. During sleep we clear out amyloid from the brain that’s the protein that builds up in Alzheimer’s. And menopause can disrupt sleep, so frequently we work with women in the clinic to change their routines around sleep. Or if a woman has a more chronic sleep problem, we have her work with a therapist to really routinize her sleep and change some of the dysregulations at play.

Another thing that’s not on the modifiable risk factor list that is of course so important for overall health is nutrition. Women may come in with great diets, or they may be eating a lot of processed food, so we’ll work individually with each woman to try to change things in a way that can be sustainable over time.