Dementia in women: why it is more common and the symptoms to watch for

Dementia is a syndrome characterized by the progressive decline of cognitive functions, including memory, language, attention, and orientation, that interferes with daily life and independence.

The most common form is Alzheimer’s disease, but other types of dementia include:

• vascular dementia;
• dementia with Lewy bodies;
• frontotemporal dementia.

“Alzheimer’s disease primarily presents with progressive memory loss, whereas other forms of dementia may initially manifest with language, behavioral, or movement disorders,” explains Professor Salsone.

The higher prevalence of dementia among women results from a complex interaction of biological, hormonal, genetic, and demographic factors rather than a single cause.

Longer life expectancy: the main risk factor

The most important factor is women's longer life expectancy.

“Age is the strongest risk factor for dementia and other neurodegenerative diseases, including Alzheimer’s disease. Because women generally live longer than men, they are more likely to reach the age at which the risk of cognitive decline increases significantly,” Professor Salsone explains.

Hormonal changes after menopause

Another key factor is the hormonal changes associated with menopause, particularly the decline in estrogen levels.

“When ovarian function ceases, estrogen levels, especially 17β-estradiol, decline substantially. This hormone plays an important role in the central nervous system.

Estrogens are involved in several neurobiological processes: they promote neuronal survival, regulate synaptic plasticity, and have anti-inflammatory and antioxidant effects. They also help maintain healthy cerebral blood vessels by improving blood flow and the delivery of oxygen and nutrients to brain tissue.

A decline in estrogen levels may therefore increase the brain’s vulnerability to neurodegenerative processes,” Professor Salsone explains.

Genetic susceptibility and the role of APOE-ε4

Another important factor is the different genetic susceptibility between men and women, particularly regarding the APOE-ε4 allele, one of the strongest genetic risk factors for Alzheimer’s disease.

“An allele is simply a different version of the same gene—a variation in the genetic instructions inherited from our parents that can influence certain characteristics of the body. In the case of APOE-ε4, this specific gene variant is associated with an increased risk of developing dementia,” the specialist explains.

Several studies have shown that women carrying the APOE-ε4 allele have a higher risk of developing dementia than men with the same genetic profile. This suggests that hormonal and genetic factors may interact to increase women's susceptibility.

Clinical and social factors affecting cognitive risk

Biological factors also interact with clinical and social conditions, including the higher prevalence among women of:

• depression;
• reduced social networks in older age;
• living alone later in life.

All of these factors may indirectly contribute to cognitive decline.

Additional risk factors in women

Other factors that appear to increase dementia risk particularly among women include:

• early menopause, which shortens the duration of hormonal protection;
• depression and social isolation;
• cardiovascular disease, which is often underdiagnosed in women despite its strong association with brain health;
• sleep disorders (sleeping fewer than six hours per night);
• osteoporosis;
• vision impairment.

Women also tend to progress from the earliest stages of dementia to more advanced disease more rapidly than men.

The first signs of dementia in women are often subtle and may easily be mistaken for normal aging. Common early symptoms include:

• recent memory loss, particularly difficulty remembering recent events;
• language difficulties, such as finding the right words or following conversations;
• disorientation in time and place;
• behavioral changes, including irritability, apathy, or social withdrawal.

“At this stage, some individuals may also experience Subjective Cognitive Decline (SCD), a condition in which a person perceives worsening cognitive function despite performing normally on standard cognitive tests.

Although SCD is often associated with stress, insomnia, or depression, in some cases it may represent an early warning sign. When accompanied by attention deficits, the risk of progression to a neurodegenerative disease appears to be higher,” Professor Salsone notes.

Early diagnosis plays a key role in slowing disease progression. The main diagnostic tools include:

• neuropsychological testing to assess memory, attention, and language;
• brain imaging, including MRI and PET scans;
• multidisciplinary evaluation involving neurologists, neuropsychologists, and other specialists.

“Identifying conditions such as Subjective Cognitive Decline at an early stage allows us to recognize individuals at increased risk and implement targeted preventive strategies,” explains the neurologist.

According to the latest evidence, up to 45% of dementia cases may be preventable by addressing modifiable risk factors.

The most important preventive strategies include:

• maintaining regular cognitive and social engagement;
• following a Mediterranean diet;
• controlling blood pressure, diabetes, and cholesterol;
• engaging in regular physical activity;
• ensuring adequate sleep quality.

Prevention is most effective when started early, often many years before the appearance of clinical symptoms.