Previous research has found that women have a higher lifetime risk of dementia than men; one explanation given was that women tend to live longer than men. However, a new analysis of data from nearly 30,000 people from 18 countries has found almost no evidence of sex differences in most known risk factors for dementia, including age. The risk of dementia among women, on the other hand, was significantly higher in poorer countries, suggesting economic disadvantages as a possible explanation.The results of the analysis were recently published online in the journal «Alzheimer’s and Dementia».
«In general, we found that the higher risk of dementia was more pronounced among women compared to men in poorer countries, suggesting that greater efforts need to be made to reduce health inequalities between women and men in these countries,» said lead scientist Jessica Gong, a doctoral student at the George Institute for Global Health in Newtown, Australia. «It is likely that socioeconomic factors may be more important than biological factors in assessing dementia risk.»
Global data
Most previous studies looking at gender differences in dementia risk have been conducted in high-income countries, Gong noted, leaving a gap in the literature on risk in low- and middle-income countries.
To address this problem, scientists conducted a meta-analysis of 21 studies from the «Cohort Studies of Memory in an International Consortium» with individual participants.The data analysis included information on 29,850 people from 18 countries on six continents. None of the participants had dementia at the start of the study, and the average age was 71.6 years. Over a median of 4.6 years, 2,089 people were diagnosed with dementia, 66% of whom were women.
Overall, women had a higher risk of dementia (HR, 1.12; 95% CI, 1.02-1.23) than men, but rates were highest in low- and middle-income regions (HR, 1.73; P = 0.03).
In 14 countries, the risk of dementia was higher in women than in men. The risk was highest in Nigeria, where the risk of dementia was more than twice as high in women (aHR, 2.11; 95% CI, 1.46-3.04), and lowest in Brazil, where the risk was 46% lower in women than in men (aHR, 0.54; 95% CI, 0.29-1.00).
In the US, the risk of dementia was seven percent higher in women than in men (aHR, 1.07; 0.73 -1.57).
Similar risk factors
In both women and men, older age, diabetes, depression, hearing impairment and APOE ε4 carrier were associated with a higher risk of dementia, while higher levels of education, greater hip circumference, current alcohol consumption (compared to never), and high physical activity (compared to no or minimal physical activity) were associated with a lower risk of dementia.
Of all these risk factors, sex differences were significant only with prolonged schooling and previous alcohol consumption, with both having a stronger association in men than in women.
Dementia rates worldwide are expected to triple over the next 25 years unless measures are taken to reduce risk factors.A 2020 report found that successful action against 12 modifiable risk factors could reduce the risk of dementia, including obesity, air pollution, diabetes, social isolation and arterial hypertension. All of these risk factors are more common in low- and middle-income countries, Gong said.
«These findings justify ongoing efforts to support programs to improve gender equity in cerebral health, particularly among underrepresented and underserved populations, to reduce disparities within and between countries,» Gong said.
Understanding the Riddle
Dr. Heather Snyder, vice president of the Alzheimer’s Association for Medical and Scientific Relationships, commented on the findings: «This is an interesting study looking at the risk factors for dementia and suggests that while some risk factors are more pronounced in men than in women, women may be at higher risk. to develop dementia,» says Snyder.»The findings highlight the importance of understanding underlying biology, particularly biology, which differs between men and women, for risk.»
The data on the country-specific and geographic differences highlighted in the study also point to a potential risk factor, she said.
«Studying geographic risk factors is important because it helps us understand the ‘why’ behind geographic differences in dementia risk,» Snyder said. «This kind of collaboration between countries and scientists is essential for us to understand these pieces of the puzzle.»
The study was funded by the UK’s Medical Research Council Skills Development Fellowship, Australia’s National Health and Medical Research Council Investigator Grant, and the National Institute on Aging, among others.
The article was originally published on Medscape.com and translated by Dr. Petra Kittner.
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