Women May Have Faster Cognitive Decline in Old Age, Study Suggests

 Previous studies have noted that dementia risks are higher for women, and new research published in JAMA Network Open suggests one factor may be faster cognitive decline in certain functions compared to men.

Researchers looked at data from five studies representing nearly 50 years and over 25,000 participants and compared memory, executive function such as focus and following directions, and global cognition — which involves reasoning, acquiring new knowledge, and using information.

They found that women tended to have a higher baseline performance than men in all cognitive areas. However, they also showed faster declines in global cognition and executive function as they aged, even though decline in memory was about the same.

The results were independent of education, race, age, and cardiovascular risk factors, says study co-author Deborah Levine, M.D., M.P.H. of the Cognitive health Services Research Program at the University of Michigan, and are consistent with previous research that suggests women may be diagnosed with mild cognitive impairment earlier than men. What was surprising, he adds, is the similar losses in memory.

“The finding was notable because memory decline is the clinical hallmark of Alzheimer’s Disease, a common cause of dementia, and some studies suggest women have a higher incidence of the condition,” she says.

Factors for Decline

Although the research review didn’t pinpoint potential causes for faster cognitive decline for women as they age, past research has indicated that factors might include:

• Longer life than men, so more time to show cognitive effects
• Hormone changes from menopause
• Genetics
• Lifestyle factors like lower rates of exercise
• Lower gray matter volume

Women are also more prone to small vessel disease, says Levine, a condition in which the smaller arteries in the heart and brain don’t dilate properly.

In the brain, this is known as cerebral small vessel disease and is considered a very common neurological disease in older people, according to commentary in Stroke and Vascular Neurology. The issue causes up to 45 percent of the cases of dementia worldwide, and about 20 percent of all strokes.

Strategies for Prevention

Although there is no single, proven way to prevent all forms of dementia, there are some actions both men and women can take that might be helpful.

One of the most notable is physical activity, which has been shown to reduce inflammation overall, improve heart and brain function, and improve sleep. All of these have been connected to better cognitive health, says Scott Kaiser, M.D., geriatrician and director of geriatric cognitive health for Pacific Neuroscience Institute at Providence Saint John's Health Center.

Other strategies that may be protective are:

• Reducing alcohol consumption
• Quitting smoking
• Eating a healthy diet
• Maintaining social connections
• Learning new skills or mental challenges

Also vital is addressing other health problems, Kaiser adds. For example, heart issues and dementia are often connected because lack of proper blood flow to the brain can speed cognitive decline.

Recognize Early Signs

Often, memory loss is highlighted with dementia, and for good reason since it’s one of the key symptoms of the condition. But it’s certainly not the only one. As the recent study showed, declines in other areas, such as organizational skills and following directions, could also start declining in later years.

Kaiser says other signs worth considering include:

• Mobility issues
• Confusion
• Significant emotional changes
• Paranoia
• Language difficulty
• Inability to recognize sarcasm

That last one tends to be surprising, says Kaiser, but it’s related to being unable to pick up on facial or vocal cues, which could indicate communication problems.

Although these might be mild, it’s helpful to get a cognitive screening, according to Jasmeer Chhatwal, M.D., Ph.D., a neurologist at Massachusetts General Hospital and assistant professor of neurology at Harvard Medical School. Even if you have no genetic factors or think your condition isn't that disruptive, it's useful to know where you stand in terms of cognitive function, he suggests.

"If your symptoms are minor, a screening will at least give you a baseline you can compare to later screens if those symptoms should worsen," he says. "If nothing else, this can be a wake-up call to look at your lifestyle habits and see if anything needs improvement."