Have you ever walked into a room and suddenly forgot why you entered? Did that feeling frighten you? When it comes to dementia, Maria Torroella Carney, MD, MACP, is more concerned about a different kind of change: losing the ability to do something you've done for years.
“If you've lost a skill you used to do all the time, that's a problem,” says Dr. Carney, a geriatrician, palliative care physician, and executive director at Northwell’s Institute for Health Aging.
Even more unsettling? You may not be the person who observes the issue. “In my clinical experience, most people don't see it in themselves,” Dr. Carney says. “It's noticed by others.”
For women, understanding what to watch for when it comes to memory loss is particularly important, given that they make up nearly two-thirds of the Americans living with Alzheimer's. Researchers still don't fully understand why. Yes, women tend to live longer, but scientists are also studying the potential roles of hormones, education, and other factors. Women are also disproportionately likely to experience the disease from the other side: as caregivers for someone they love who's suffering from dementia.
So what should women know about this disease — and their likelihood of being diagnosed? Dr. Carney breaks down what researchers understand about the gender disparity, the changes that may signal something more serious than everyday forgetfulness, and the habits that can support brain health as we age.
Why Alzheimer's affects more women than men
Part of the disparity likely comes down to longevity: Women tend to live longer than men, and getting older increases the risk of dementia. But experts suspect that's not the whole story.
One theory involves education. Older generations of women historically had less access to education than men, and lower educational attainment has been linked with a greater risk of dementia. “Now that society has evened out, are we going to see fewer cases of dementia in women than previously?” Dr. Carney asks.
Estrogen is another area of interest. Hormonal changes during pregnancy, postpartum, perimenopause, and menopause have long been associated with “brain fog,” raising questions about estrogen’s broader role in brain health. “I think that’s something that we have to look at further,” says Dr. Carney.
But does something about the female brain make women more susceptible to Alzheimer's? “It's unclear,” explains Dr. Carney. One reason so many questions remain unanswered may be how researchers have historically studied the disease. “The literature that’s out there has really looked at things more holistically and not necessarily separated women and men,” Dr. Carney says. “I think we need to do more studies to look at the impact of hormones, early menopause, education, all of those things.”
The dementia warning sign families may notice first
One change worth noting is when a once-familiar task suddenly becomes difficult. Dr. Carney saw this transition firsthand with her mother, who had diabetes and had meticulously managed her own insulin since her 30s. In her 70s, after decades of drawing up and adjusting her insulin multiple times a day, she suddenly struggled to do it.
“That was her first sign of having a cognitive problem,” Dr. Carney says. “Something she did all the time, she suddenly lost the ability to do.”
That loss of function can look different from person to person. Memory can be involved, but so can language and word-finding, balance, or motor function. Lewy body dementia, for example, can also involve tremors, Parkinson-like symptoms, or visual hallucinations. What matters, Dr. Carney says, is whether a cognitive change begins interfering with someone's ability to function as they normally would.
And often, someone else sees that change first. Family members, friends, or even coworkers may notice that a person is struggling with something that once came easily — even when the person experiencing it doesn't recognize it themselves.
What to do if you notice cognitive changes
If you or someone close to you notices a concerning change, getting evaluated early can help identify what’s behind it — and potentially open the door to treatment sooner. A doctor may use cognitive assessments such as the Mini-Cog or Montreal Cognitive Assessment (MoCA), along with a full medical evaluation, bloodwork, and, in some cases, brain imaging. These evaluations can also uncover other potentially treatable causes of cognitive problems, including vitamin deficiencies, depression, or medication side effects. And for those who qualify, there are now four FDA-approved blood tests that can help doctors determine whether Alzheimer’s-related changes may be present.
If dementia is diagnosed, determining the type helps guide treatment. For Alzheimer’s, medications such as donepezil, rivastigmine, and memantine may help manage symptoms, while newer infusion therapies such as lecanemab and donanemab may be options for certain people in the early stages of the disease. “First assess the situation comprehensively,” Dr. Carney says. From there, doctors can determine what may be treatable and develop an appropriate plan.
Women carry much of the dementia caregiving burden
Women aren't only disproportionately represented among people living with Alzheimer's — about two-thirds of family caregivers for people with dementia are women. That stat comes from the Alzheimer’s Association, which also notes that many of those women are part of the “sandwich generation,” meaning they're simultaneously caring for children and aging parents.
And that caregiving commitment can last for quite a while. Dr. Carney says Alzheimer's involves an average of about four to eight years of care, while some people may require care for as many as 20 years. The demands also change as the disease progresses. Early on, someone with mild cognitive issues may remain relatively independent. Later, families may need help with bathing, dressing, grooming, mobility, and toileting.
Caregivers often need assistance of their own. “They want emotional support, they want resources,” Dr. Carney says. For families juggling caregiving with work, that might mean a home health aide or an adult day program.
There's a psychological burden, too. Not understanding the stages of dementia or what may come next can create anxiety and fear for families, Dr. Carney says. Behavioral symptoms such as agitation, mood changes, frustration, or hallucinations can make caregiving even more complicated.
“I've often thought that my patients have been not only the patient with dementia, but include also the family caregiver,” Dr. Carney says.
How to protect your brain health as you age
While researchers are still working to understand exactly why Alzheimer's disproportionately affects women, Dr. Carney says many of the best ways to support brain health are surprisingly straightforward. Start by protecting your head: Wear a seat belt in the car and a helmet for activities like skiing or cycling, and take steps to prevent falls as you age. Staying physically active and managing conditions like high blood pressure, high cholesterol, and diabetes matter, too. “Your heart and your brain are connected,” Dr. Carney says.
Then there's alcohol. While recommendations have evolved over the years, Dr. Carney's advice today is simple: “Moderation, moderation, moderation.” High levels of alcohol can damage the brain, and she recommends minimizing how much you drink.
Sleep deserves attention, too: Although our rest naturally becomes more fragmented with age, stress, anxiety, and health issues can make it worse. If something is regularly keeping you up, it's worth addressing promptly. “Sleep is good for the brain,” Dr. Carney says.
Finally, don't underestimate the value of simply continuing to challenge yourself. “Keep your brain active,” Dr. Carney says. Learn to play an instrument, study a new language, read, do a crossword or Sudoku, or play games like mahjong or bridge.
A dementia diagnosis doesn’t mean losing your independence overnight
There's one final misconception Dr. Carney wishes more people understood: Dementia doesn't instantly erase someone's enjoyment of life. “People think dementia is this all-or-nothing disease,” Dr. Carney says. “As if once you have dementia, you can't do anything.”
In reality, dementia exists on a spectrum. Alzheimer's tends to progress gradually, and people with mild cognitive issues may continue to socialize, participate in activities, and live with some independence for a significant period of time.
“You can live a full life with some memory or language or cognitive issues,” Dr. Carney says. “You can still socialize. You can find your independence and safety and quality of life.” In other words, there can still be plenty to look forward to.
The information provided on this site isn’t intended as medical advice, and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.
