Women's Brain Health: Why the Risk Is Different and What to Do About It

A large genetic association study by Walters and colleagues from Vanderbilt University Medical Center, published in JAMA Neurology in 2023, examined longitudinal cognitive data from 32,427 participants across four cohorts. The study found a robust sex interaction on baseline memory performance for the APOE epsilon 4 allele, whereby the negative effect of APOE epsilon 4 was significantly stronger in females compared with males. The authors concluded that biological pathways underlying APOE epsilon 4-associated risk are likely distinct and probably intersect with age-related changes in sex biology.

If the biological pathway to dementia in women involves different thresholds and different interactions with genetic risk, then tools calibrated to a single standard may be systematically less accurate for women.

The perimenopause years are now recognised as a neurologically active transition period. Research has documented real changes in cognitive speed, attention, and verbal fluency during perimenopause. For many women, these changes are temporary. For some, they represent the earliest signal of longer-term vascular cognitive risk, particularly when combined with rising blood pressure or changing lipid profiles.

A meta-analysis by Yeo and colleagues from NUS Singapore, published in JAMA Neurology in 2023, found that hearing aid use was associated with a 19% reduction in the hazard of cognitive decline. Studies examining lifestyle factors consistently show that modifiable risk factors can substantially offset genetic risk. The perimenopausal years are a window, not a wall.

If you are in your forties or fifties and have noticed changes in your thinking or memory, do not dismiss them. Ask your doctor about a cognitive screening.