Alzheimer’s disease (AD) and other forms of dementia are on the rise. Almost 7 million older adults have AD in the United States, which experts predict will double by 2060.
Researchers like Jill Goldstein, PhD, MPH, a Mass General Brigham psychiatric neuroscientist, are studying risk factors for AD in early midlife. Midlife describes the ages between 40 and 65. Risk factors for AD include: age, genetics, family history, hypertension (chronic high blood pressure), and mental health conditions, such as depression and anxiety.
Dr. Goldstein is the founder and executive director of the Innovation Center on Sex Differences in Medicine (ICON-X) at Massachusetts General Hospital and works in the Department of Psychiatry at Mass General. Dr. Goldstein and her colleagues recently published a study on how hypertension in early adulthood affects cognition in midlife. In this study, cognition included essential abilities like memory, attention, reasoning, and planning.
Dr. Goldstein and her team found that not only are hypertension and cognitive decline linked, but that men and women are affected differently. Understanding these differences could change how patients are screened and treated for dementia in the future.
“Finding and treating modifiable risk factors for dementia that may differ for men and women can help with early prevention,” explains Dr. Goldstein. “It’s estimated that 8% of dementia cases in the United States are partially due to midlife hypertension. A 10 to 25% reduction in midlife hypertension cases could decrease AD prevalence by up to 100,000 cases.”
Dr. Goldstein and the team worked with patients from the New England Family Study. This large, more than 60-year-long study examined thousands of community participants’ long-term medical and mental health outcomes. They recruited 195 patients from that study: 100 men and 95 women, ages 45 to 55. These patients completed several memory and cognition tests, including:
Recalling lists of numbers and words in order
Coming up with as many words as possible for a given letter within a set timeframe
Looking at pictures of faces paired with names and occupations, doing another task, and then trying to remember the information when shown the faces again
Participants also shared their medical histories, including if and when they had been diagnosed with hypertension.
The researchers found that people with midlife hypertension had worse cognition scores than people with normal blood pressure. There were also differences between the sexes. More men than women had hypertension, but women had worse memory results. None of the participants had dementia at the time of the study, but these subtle differences could be used to predict who may be at risk for memory loss in the future. Goldstein’s team is following these individuals over time and currently assessing potential markers of AD, such as amyloid and tau proteins in the brain.
Historically, heart disease and hypertension were thought to affect men more than women. Men tend to develop hypertension earlier in life, but women take longer to get diagnosed. “In fact, high blood pressure and heart disease in women is very common. Heart disease is the number cause of mortality and disability in women and men,” says Dr. Goldstein.
High blood pressure signs or symptoms can include:
Shortness of breath
Hypertension can cause serious problems like:
Hypertension affects blood flow throughout the body, including the brain. This may be part of the reason hypertension is a risk factor for memory loss and AD. If women are diagnosed with hypertension later in life, there is more time for blood vessel damage to accumulate.
In the United States, almost 2 in 3 patients with Alzheimer’s disease are women. There are more women with dementia in part due to longer lifespan among women. However, scientists, including Goldstein’s team, have shown this is not only due to age.
Early signs or symptoms of AD or dementia can include:
Repeating the same questions in a short period of time
Frequently losing things
Trouble remembering words when speaking and writing
Difficulty problem-solving or making plans
Forgetting to do tasks like paying the bills
Withdrawing from social activities
Researchers like Dr. Goldstein are trying to determine other risk factors for women, including understanding the role of menopause. Some things like age, genetics, and family history can’t be controlled, but treating other risk factors such as hypertension could help prevent the disease. In the future, sex-dependent treatments could help prevent or delay memory loss for high-risk people in a sex-selective way.
“Incorporating the impact of one’s sex into developing therapies and prevention strategies is the ultimate goal for precision medicine,” says Goldstein. “That is one of our primary missions at the Innovation Center on Sex Differences in Medicine (ICON-X) at Mass General.”