Women and Cognitive Decline in Old Age
Cliff: The latest research results being announced at the Alzheimer’s Association International Conference taking place in Washington DC this week have become big news stories. So Len and I thought it would be good to look in detail at two of these stories…..the ones that pertain to the women in our lives; our mothers, partners, sisters, daughters, nieces, friends and patients. As Len will discuss, not only do we care about the health of the women we love, but if something impacts them, it surely will affect us.
For many years we’ve thought that women are at higher risk for developing dementia from Alzheimer’s disease and men are at higher risk for dementia from other causes, such as stroke, Lewy body disease or frontotemporal dementia. According to the Alzheimer’s Association, almost two thirds of people with Alzheimer’s disease are women. We’ve always thought that this is mostly due to the fact that women live longer than men and older people are at very high risk for Alzheimer’s disease. But a new study by Dr. Katherine Amy Lin and colleagues at Duke University Medical Center in Durham NC, found that once people develop mild cognitive impairment (memory problems but not yet functional decline), women declined twice as fast as men on a commonly used measure of cognitive function (the Alzheimer’s Disease Assessment Scale-cognitive subscale). This was true even when age and other important variables were accounted for. Only a person’s ApoE4 status (whether they had zero, one or two copies of that particular gene which is well known to determine risk of Alzheimer’s disease) had more power to predict rapid cognitive decline than did gender. Many people with mild cognitive impairment have early Alzheimer’s disease, which is very likely to progress to dementia (loss of independent function because of cognitive decline) over time. The reasons why women with Alzheimer’s disease progress more rapidly than men with the disease aren’t known.
In a second report out of the conference in Washington DC this week, Dr. Katie Schenning and colleagues from Oregon Health and Science University in Portland OR, reported that whereas both men and women declined in cognitive performance, functional status and brain volume in the months following general anesthesia for surgery, women declined at a faster rate than men. Women who have had multiple surgeries declined at an even faster rate. Whereas we’ve long been aware that surgery frequently results in transient confusion in older adults (“postoperative delirium”), only recently have we known that people often don’t return completely to their pre-operative baseline of memory and thinking ability. This study provides evidence that this decline is measurable and even seen in reduced brain volume on MRI. The investigators were not able to determine why this is the case. So, right now, we do not know the reason why women appear to be more susceptible to brain injury from either Alzheimer’s disease or surgery. Many people are examining the possible contributing factors of hormones, genes and environment.
What we do know is that with the rapid aging of our population in Maine, we are seeing this decade a nearly doubling of the numbers of people with dementia, especially from Alzheimer’s disease. Our health care systems and social networks need to be better prepared for this. In future columns, we will revisit what is known about healthy cognitive aging and the prevention of dementia.
Len: The recent news about Alzheimer’s disease and who is most likely to be at risk is sobering. I’m thinking it should serve as a wakeup call for all of us and especially those people who continue to think it just happens to the other guy, or more accurately, the other gal. The fact is, too many individuals and families are at risk.
Here are the hard facts: In Maine, 26,000 people over the age of 65 have the disease and that number will increase to 29,000 in 2020 and 35,000 in 2025. That means one in every ten older Mainers now has the disease. In Maine, between 2015 and 2025 the disease is expected to increase in prevalence by as much as 35%. Some 400 Mainers die of the disease each year. In our state it is the 6th leading cause of death. And by the way, it remains the only cause of death among the top ten killers that cannot be prevented, cured, or slowed.
Across the U.S., every 67 seconds someone gets Alzheimer’s disease and that is projected to increase to every 33 seconds by 2050. More than five million Americans now live with the disease and the number could increase to 16 million by 2050. Nearly one in every three older adults who die each year has Alzheimer’s or another dementia.
The statistics are certainly alarming and represent what must continue to be a call to action for all of us and especially those families with older adult relatives. In fact, the trends tell us, in no uncertain terms, that we all need to be on high alert. Not just families but friends, neighbors, and other members of the community are going to be needed to pitch in as well.
Thankfully caregivers of Alzheimer’s patients can and do make all the difference in the world by helping those who are diagnosed with the disease deal with this devastating condition. Families are and always have been the front line defense as Alzheimer’s disease and related disorders advance in severity and become more and more disabling. Moving someone to a long-term care facility is not the preferred answer for many families nor is it an option even if it is warranted since only 5% of the nursing home beds in Maine are reserved for Alzheimer’s patients (350 of 7,000 beds). This means loved ones in the community will continue to be the primary support system available to those with the disease making their remaining years more comfortable and satisfying.
There are some 68,000 unsung heroes (also called caregivers) in Maine of persons with Alzheimer’s disease. These are the people who know the person grappling with the disease the best. They are the ones who understand the needs and wants of the person with the disease even better than a professional who is likely to be sent from an agency to provide care. Two thirds of these “informal” caretakers are women and more than half of those who provide care to individuals with dementia are children caring for parents. They are uncompensated for their efforts and frequently provide care over a period of years while simultaneously raising a family and holding down a job.
This brings me to remark on the major implications that the recent reports about the disease have for all us men out there who are husbands, male partners, sons, and grandsons. Since two thirds of older adults with the disease are women, we will, increasingly, need to prove the naysayers wrong and step up to the plate. I have said it before and will say it again, a “caring man” need not be an oxymoron.
Many of those men who have risen to the challenge report the caregiving experience to be difficult as hell for sure but also extremely meaningful – sometimes even life changing and transformational. Many men have said the caregiving experience proved to be an unexpected opportunity for them to give back to parents who had cared for them for so many years, or enabled them to express the love they feel for a spouse or partner in no uncertain terms. Along the way, many have also learned some important life skills (like how to cook a decent meal, manage the household, and become a discriminating shopper). An unexpected benefit that results from men stepping up to the plate and serving as caregivers is the opportunity for them to serve as role models for the next generation of men in the family who will hopefully be willing and able to do the same for someone else in need of assistance.
Until we discover how to prevent and/or cure this killer disease, we can only hope that families and other members of Maine’s caring communities will continue to contribute their time and effort and make a difference. They always have and I believe always will. But, men need to know they will be turned to in growing numbers to provide a heavier dose of that help. As individual communities and as a state, we need to start preparing now for how this disease will impact us. We will need the support of all caring men along the way.