Women have a dementia problem. Across the US and most of Europe, women are around twice as likely as men to develop dementia. In the UK, Alzheimer’s and other forms of dementia have been women’s leading cause of death for over a decade.
Yet, despite all that, we’re not always that great at spotting it in women. A large part of the issue is that dementia is about more than just memory loss, with men and women displaying symptoms in different ways.
A new study from the Montreal Neurological Institute at McGill University found that women with dementia can maintain seemingly normal verbal memory for around 2.7 years longer than men, despite having the same Alzheimer's-related brain changes.
That matters because several tests used by doctors rely on verbal memory to detect early dementia. As a result, they can miss the first signs of cognitive decline in women. It is often only around three years later, when women's cognitive abilities decline much more rapidly – by 25–50 per cent more than men's – that these tests begin to detect the problem.
Yet women often show other symptoms long before this happens, says Dr Antonella Santuccione Chadha, a neuroscientist and CEO of the Women's Brain Foundation. The problem is that many of us simply don't know what to look for.
And you’d be forgiven for not knowing, especially if you are female. “Our survey conducted in Germany and the US showed that men knew more about the disease [than women],” Chadha says.
But knowledge is power. Spotting the early warning signs and getting a diagnosis sooner can help delay further cognitive decline. So we asked Chadha what symptoms women should look out for—and why dementia is so often missed in women in the first place.
Women are more likely to be impacted than men
So, why are women impacted at such a great volume? Well, no one has identified a singular reason, at least not yet.
The medical community does have theories, though. First is the notion that women tend to live longer than men, and simply have more time for them to develop dementia.
Another theory centres on hormones. Oestrogen is thought to have a protective effect on the brain, but levels fall sharply after menopause. In fact, after menopause, men can end up with higher oestrogen levels than women.
Brain structure may also play a role. Men's and women's brains differ in several ways, and some research suggests the hippocampus – a region critical for memory – may be more vulnerable to atrophy in women. Both factors have been proposed as possible contributors to women's higher dementia risk.
Biology is only part of the picture, though. Social and environmental factors, such as differences in education, healthcare access and lifetime stress, may also influence who develops the disease.
It's also worth noting that sex and gender don't always align neatly. Transgender and non-binary people can also face higher rates of certain dementia risk factors – including depression, kidney problems and heart disease – that aren't necessarily tied to hormones or brain biology at all.
One study, for example, found transgender men, transgender women and non-binary adults had a higher late-life Alzheimer's risk score than cisgender adults, driven in part by higher rates of these conditions within the group.
Dementia symptoms present differently
Dementia doesn't look the same in men and women – and that gap in presentation is exactly what's driving the delay.
That masking doesn't mean women's early symptoms are invisible – just harder to catch. They're more subtle, says Chadha, in ways that tests like the Rey Auditory Verbal Learning Test (RAVLT, a memory test used in diagnostics) simply aren't built to detect.
She believes the fix is designing separate assessments for men and women. A study conducted with the Women's Brain Foundation, for example, found that digital biomarkers – tracking things like microtremors, memory, gait and movement – were more accurate than traditional scales at spotting cognitive decline, especially in women.
Misdiagnosis is also common because dementia can look like a mental health condition in women, Chadha explains: "Women often have more depressive symptoms; they might be delusional, they might have the feeling that someone is spying on them, or they start to become introverted."
Sleep disorders are common too – and together, these symptoms can lead women to be misdiagnosed with depression or anxiety, and sometimes even given antipsychotic medication or institutionalised.
Part of the problem traces back to how neuroscience itself is done: animals used in research are five times more likely to be male than female, meaning key sex-based nuances can be missed before a drug or test ever reaches a patient.
Biases and social differences
A lack of awareness isn't the only reason dementia can be missed. Bias and discrimination may also play a role. "Women get taken less seriously than men," says Chadha.
A UK government inquiry found that many women felt their concerns were not taken seriously by healthcare professionals, with some reporting that their symptoms were dismissed as being "all in their head". Delays like these can contribute to later diagnoses.
Bias may even extend to who is assessing the patient. Research has found that dementia was rated as more severe when both the doctor and caregiver were women than when either was a man.
"If the caregiver and doctor were women, the rating of the dementia was evaluated as more severe. If it was a man, it was evaluated as less severe," explains Chadha.
Life circumstances can also play a role. Women tend to live longer than men (by about five years in the US and four years in the UK), so it's more likely for women not to have a caregiver to bring them to a doctor and get diagnosed.
None of this is set in stone, though. The gaps in how dementia is diagnosed and treated in women are, in Chadha's view, fixable – and there's a growing body of research working to close them, including at the Women's Brain Foundation, that could reshape how Alzheimer's is caught and treated in the years ahead.
Signs to look out for
If there's one person most likely to spot the early signs of dementia, it's probably you. Research suggests that family members often notice subtle changes long before they become obvious during a medical assessment. After all, you know your loved one's normal behaviour far better than any doctor or nurse ever could.
With that in mind, there are a few symptoms to look out for in your loved ones, according to Chadha:
- subtle difficulties in finding words;
- recurrent falls;
- depressive symptoms;
- anxiety;
- sleep disturbances;
- delusions and
- a profound sense that ‘something has changed’ in themselves.
“Women often perceive the earliest signs of cognitive decline before medicine does. The problem is not that they are wrong; the problem is that our tools were never designed to hear them,” she says.
None of these symptoms necessarily means someone has dementia, and many can have other causes. But if you notice persistent changes in yourself or someone close to you, don't ignore them. Speak to your doctor, who can assess the symptoms and, if necessary, refer you for further investigation.
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