Authors: Meghan Etsey, Rhea Manohar, MPH; Yun Weisholtz, MD-PhD on behalf of the AMWA Gender Equity Task Force

Every November, as we recognize Alzheimer’s Awareness Month, the conversation often centers on memory loss, caregiving, and the relentless progression of this disease. Yet one critical truth remains under-discussed: Alzheimer’s disease disproportionately affects women. Nearly two-thirds of those diagnosed are female. While this gap has long been attributed to women’s longer life expectancies, longevity differences tell only part of the story. Behind this imbalance lies a complex interplay of biology, genetics, and gendered social realities that reveal how deeply Alzheimer’s is intertwined with gender equity (Bartz et al., 2020; Zhu et al., 2021; Emrani & Sundermann, 2025; Hogervorst et al., 2023; Rubin, 2025). These disparities are further shaped by race, ethnicity, and socioeconomic status, factors that compound women’s risk and contribute to the higher prevalence of Alzheimer’s among Black and Hispanic women (Nianogo et. al., 2022).

The biology of Alzheimer’s tells a strikingly gendered story. During menopause, the abrupt loss of estrogen, long known to protect the brain, can accelerate tau protein and neurofibrillary tangle accumulation pathology. This, in turn, accelerates cognitive decline, particularly in women who carry the APOE ε4 gene variant (Rahman et al., 2019; Ajagbe et al., 2025; Coughlan et al., 2025). Estrogen helps maintain synaptic health and supports the brain’s ability to clear amyloid, one of the key proteins implicated in Alzheimer’s. When those protective effects fade, the risk of neurodegeneration rises (Kolahchi et al., 2024; Zhu et al., 2021). Recent research also points to sex-specific differences in mitochondrial energy metabolism, oxidative stress, and microglial activation, all of which may heighten women’s susceptibility to neurodegeneration after menopause (Cleland et. al., 2024).

On the other hand, men face a different biological landscape. Their risk is often tied to cardiovascular disease, which can lead to earlier mortality and, as a result, fewer men surviving to ages where Alzheimer’s becomes more apparent (Hogervorst et al., 2023; Rubin, 2025). These contrasting pathways show that gender doesn’t just influence risk; it shapes the entire course of disease development and progression.

Ironically, one of women’s cognitive strengths, verbal memory, can obscure early signs of Alzheimer’s. Women tend to perform better on verbal recall tests than men, even in the earliest stages of cognitive decline. While beneficial in daily life, this can delay diagnosis and mask the mild cognitive impairment seen in the early stages of Alzheimer’s (Emrani & Sundermann, 2025; Coughlan et al., 2025). By the time symptoms become undeniable, women often face more advanced disease and a steeper decline. Standard diagnostic tools were designed without accounting for sex differences and may therefore underestimate cognitive decline in women. This highlights an urgent need for sex-specific biomarkers and diagnostic approaches that can identify Alzheimer’s earlier in women—before their verbal strengths can hide the warning signs. 

Emerging evidence suggests that men and women may respond differently to new treatments. For example, in trials of anti-amyloid therapies like lecanemab, preliminary analyses hint that women may experience slightly less benefit than men. Though overall disappointing to hear the difference in treatment efficacy, sex-stratified outcomes are often not reported, leaving the public unaware (Rubin, 2025). Meanwhile, the debate around hormone replacement therapy (HRT) remains unsettled. Despite observational studies suggesting possible cognitive benefits, randomized trials have not shown consistent protective effects (Rahman et al., 2019; Hogervorst et al., 2023). The absence of nuanced, gender-aware clinical data underscores a broader issue: medical research still underrepresents women’s biology, particularly post-menopausal women, whose hormonal transitions profoundly affect brain health.

Biology isn’t the only driver of disparity; social and structural inequities also magnify women’s vulnerability. Women are more likely to experience depression, social isolation, and physical inactivity, all of which are potent predictors of cognitive decline (Bartz et al., 2020; Rubin, 2025). Moreover, historical inequities in education and career opportunities have left many older women with lower cognitive reserve, a key protective factor against dementia (Hogervorst et al., 2023). Adding to this burden, women are more often the caregivers for family members with Alzheimer’s. The emotional and physical demands of caregiving, usually unpaid and unrecognized, can exacerbate stress and accelerate health decline, creating a devastating feedback loop. Alzheimer’s is thus not just a neurological disease; it is also a mirror reflecting gendered inequities in health, labor, and longevity.

As we honor Alzheimer’s Awareness Month, we must also commit to closing the gender gap in Alzheimer’s research and care. That begins with requiring sex-based analyses in clinical trials, refining diagnostic tools to account for women’s cognitive strengths, and improving public health outreach to address gendered risk factors like social isolation and economic vulnerability (Emrani & Sundermann, 2025; Kolahchi et al., 2024). The future of Alzheimer’s medicine lies not only in molecular breakthroughs, but also in rethinking the biases embedded in our science from early recognition to treatment development. To build an equitable path forward, clinicians, researchers, and policymakers must recognize that understanding women’s health is not a subset of medicine; it is central to it.

Awareness alone isn’t enough. This November, let’s go beyond lighting buildings purple and commit to gender-informed innovation in neuroscience. We must fund more inclusive research, educate clinicians on sex-specific presentations, and advocate for equitable access to diagnostic and treatment resources. Alzheimer’s may not discriminate in whom it touches, but our systems too often do. By centering gender equity in Alzheimer’s research, we not only deepen our understanding of the disease, but we also take a crucial step toward a future where every mind, regardless of sex, has an equal chance to thrive.

References: 

  1. Ajagbe, A. O., Mobolaji, A. A., Onigbinde, O. A., et al. (2025). Sexual dimorphism and susceptibility to Alzheimer’s disease: Understanding genetic involvement and other risk factors. The Journal of Steroid Biochemistry and Molecular Biology, 106843. https://doi.org/10.1016/j.jsbmb.2025.106843 
  2. Bartz, D., Chitnis, T., Kaiser, U. B., et al. (2020). Clinical advances in sex- and gender-informed medicine to improve the health of all: A review. JAMA Internal Medicine, 180(4), 574–583. https://doi.org/10.1001/jamainternmed.2019.7194 
  3. Cleland NRW, Potter GJ, Buck C, Quang D, Oldham D, Neal M, Saviola A, Niemeyer CS, Dobrinskikh E, Bruce KD. Altered Metabolism and DAM-signatures in Female Brains and Microglia With Aging. Brain Res. 2024;1829:148772. doi:10.1016/j.brainres.2024.148772. 
  4. Coughlan, G. T., Klinger, H. M., Boyle, R., et al. (2025). Sex differences in longitudinal tau-PET in preclinical Alzheimer disease: A meta-analysis. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.0013 
  5. Cui, S. S., Jiang, Q. W., & Chen, S. D. (2023). Sex difference in biological change and mechanism of Alzheimer’s disease: From macro- to micro-landscape. Ageing Research Reviews, 87, 101918. https://doi.org/10.1016/j.arr.2023.101918 
  6. Emrani, S., & Sundermann, E. E. (2025). Sex/gender differences in the clinical trajectory of Alzheimer’s disease: Insights into diagnosis and cognitive reserve. Frontiers in Neuroendocrinology, 77, 101184. https://doi.org/10.1016/j.yfrne.2025.101184 
  7. Hogervorst, E., Temple, S., & O’Donnell, E. (2023). Sex differences in dementia. Current Topics in Behavioral Neurosciences, 62, 309–331. https://doi.org/10.1007/7854_2022_408 
  8. Kolahchi, Z., Henkel, N., Eladawi, M. A., et al. (2024). Sex and gender differences in Alzheimer’s disease: Genetic, hormonal, and inflammation impacts. International Journal of Molecular Sciences, 25(15), 8485. https://doi.org/10.3390/ijms25158485 
  9. Nianogo RA, Rosenwohl-Mack A, Yaffe K, Carrasco A, Hoffmann CM, Barnes DE. Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US. JAMA Neurol. 2022;79(6):584-591. doi:10.1001/jamaneurol.2022.0976.
  10. Rahman, A., Jackson, H., Hristov, H., et al. (2019). Sex and gender driven modifiers of Alzheimer’s: The role for estrogenic control across age, race, medical, and lifestyle risks. Frontiers in Aging Neuroscience, 11, 315. https://doi.org/10.3389/fnagi.2019.00315 
  11. Rubin, R. (2025). Trying to unravel why Alzheimer disease is more common in women. JAMA.https://doi.org/10.1001/jama.2025.16269 
  12. Zhu, D., Montagne, A., & Zhao, Z. (2021). Alzheimer’s pathogenic mechanisms and underlying sex difference. Cellular and Molecular Life Sciences, 78(11), 4907–4920. https://doi.org/10.1007/s00018-021-03830-w 

About the Authors

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world. 

Rhea Manohar, MPH, MS3

Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students abilities to navigate physician-patient communication. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.

Yun Weisholtz, MD-PhD

Dr. Yun Weisholtz is a physician-scientist and advisor with a deep commitment to mentorship and advancing equity in medicine. She completed her undergraduate studies at Stanford University, where she double-majored in Biological Sciences and Chemistry, and spent a year in Germany as a Fulbright Scholar. She went on to enter the MD-PhD program in Neuroscience at Harvard Medical School and MIT, where she developed her passion for research, teaching, and mentoring. Dr. Weisholtz is a Physician Advisor with MedSchoolCoach and the founder of MD-PhD Advising, a consulting practice dedicated to helping students navigate the medical school and residency application process. Outside of work, she enjoys collecting Delft pottery from the Netherlands and spending time with her family and pets.