That ratio appears to hold throughout the world; twice as many women have dementia than men. One explanation could be that women tend to live longer than men, leaving them more isolated as they move into old age. We certainly know that connection with others is vital for or brain health.

A new large study from the George Institute for Global Health suggests that lack of education may explain why more women end up with dementia than men.

The researchers examined dementia risk in almost 30,000 people from 18 countries covering all six continents. They found that rates of dementia were highest among low to lower-middle-income countries, and higher in women than in men. 

The focus of the study was women living in poorer countries where the likelihood of developing dementia is higher.

The researchers starting point was based on the 2020 Lancet Commission Report that suggested as much as 40 per cent of dementia risk could be attributed to 12 modifiable risk factors. These are factors that may be changed by individuals. These factors were education, hypertension, diabetes, obesity, depression, hearing impairment, smoking, excessive alcohol consumption, physical inactivity, traumatic brain injury (not quite sure how modifiable that is, except doing you best to avoid it)??, low social contact, and air pollution.

Many of these risk factors (diabetes, older age, depression, hearing impairment and APOE4 a genetic variation that relates to fat metabolism in the brain) were found to be associated with a greater risk of dementia in men and women.

The researchers found moderate evidence for a sex difference with years spent in education. Previous studies have found education to be protective against developing dementia. One explanation is that challenging the mind encourages to the brain to build more synapses (connections).

Previous studies have shown that education is a key to building a level of “cognitive reserve” which works as a buffer against loss of function in people with brain damage.

A concern for Australia is according to the OECD report, 40 to 50 per cent of adults here have literacy levels below the international standard required for participation in work, education and society. These deficits may reduce the ability of the brain to develop this all important cognitive reserve.

Another potential connection for women and dementia is menopause. Studies are focusing on FSH ‘follicle-stimulating hormone’. FSH is produced in the brain by our pituitary gland, it causes ovarian follicles to enlarge and produce oestrogen. As women age, of course, fewer follicles remain to be stimulated and oestrogen levels decline.

The decline in oestrogen leads to an increase in FSH, as too little oestrogen is being produced to serve as a switch and halt the brain’s production of FSH. Men also naturally have FSH which helps regulate the production of sperm, unlike women, after puberty, levels tend to remain stable for men.

In mouse studies scientists found that the concentration of FSH strongly increases and excessively binds to its receptor in brain cells, this activates the C/EBPβ/AEP pathway which is believed to promote amyloid plaques and tau tangles.

Clearly women need to address as many of the modifiable risk factors as possible, we can’t control genetics however we can have a big effect on whether or not those genes get “triggered”, and this is called epigenetics. Genetics is the loaded gun and epigenetics is controlled largely by lifestyle choices, it has a major impact on whether or not the genetic “gun” is fired.


More information on George Institute study:

Cognitive reserve study:

Menopause and dementia:

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