By Sony Salzman
Boston University News Service

BOSTON — When you throw together a group of academics, clinical researchers, social workers, and industry scientists, you get more than just a room full of conflicting opinions – you get a room full of fresh ideas.

One such group of Alzheimer’s disease experts was organized by the Society for Women’s Health Research (SWHR) to critically evaluate differences in Alzheimer’s disease between men and women. This panel provided a set of recommendations for future Alzheimer’s research.

These recommendations were published in The Journal of Women’s Health. The paper called “Sex and Gender Differences in Alzheimer’s Disease,” address serious gaps in knowledge and provides guidance for future gender-based clinical research questions.

A Puzzle within an Enigma

Fresh ideas are exactly what the Alzheimer’s research community needs. According to the SWHR, of American’s aged 65 and older with diagnosed Alzheimer’s, 3.4 million are women compared to 1.8 million who are men.

While women have always been disproportionally affected, researchers had largely assumed that this is due to women’s longer life expectancy. In a recent paradigm shift, it is now becoming widely accepted that the lopsided incidence rate cannot be explained by life expectancy.

There are well documented sex differences in brain anatomy, age-related decline in brain volume, and brain glucose metabolism, yet the importance of these differences in the development of Alzheimer’s has not been conclusively determined.

“There are biological basis for sex and gender differences and we’re only now starting to get at those,” said Christine Carter, lead researcher on the paper and VP of Scientific Affairs at SWHR. “We know there are sex differences in the brain – that’s been well documented. To what extent to these sex differences create a scenario that ends in Alzheimer’s? We don’t know those connections yet.”

In addition, the known risk factors for Alzheimer’s disease are growing. According to Paul Raia, VP of Clinical Services at Northeast chapter of the Alzheimer’s Association, risk factors include aging, cardiovascular health, diabetes, head injury, depression, obesity, and genetics. Some of these risk factors, like diabetes and depression, are reported at higher rates in women than men.

To address these issues, the SWHR published a set of seven guiding frameworks for the future of research. Chiefly, the panel recommended that sex-based differences be analyzed systematically, including gathering sex as a primary outcome. The group also challenged the research community to define standards for biomarkers and diagnosis to determine how biomarkers relate to disease burden and risk.

Robert Stern, Director of the Health Outreach Program for the Elderly and Boston University Professor of Neurology, agrees that data should be stratified by gender.

“It is true that women are more commonly affected by Alzheimer’s dementia and the severity seems to be worse,” he said. “We still don’t know why this occurs.”

Alzheimer’s on the Women’s Health Agenda

Pamela Murray isn’t a researcher or a clinician. She owns and operates Pete’s Place, a group home for Alzheimer’s and other dementia patients in Los Angeles. Murray hopes that the SWHR publication will help put Alzheimer’s on the national agenda for women’s health.

Murray is a daily witnesses to the devastation caused by Alzheimer’s, not just for the patient but for the primary caregiver as well. Curiously, researchers are finding that simply being a caregiver of an Alzheimer’s patient is itself a risk factor for the disease.

In fact, one of the seven recommendations given by the panel of experts is to conduct more research into effective treatments so that “both the caregivers and the patients see and improvement in their quality of life and strength.”

“In a survey done by the Alzheimer’s Association, 59 percent [of caregivers] said they’re running at “high” or “very high” levels of stress,” Raia said. “So the act of caregiving, which is primarily done by women, is in and of itself a significant risk factor.”

According to Stern, Alzheimer’s is a “women’s health issue from both sides, both as patients and caregivers.” He feels the majority of the SWHR recommendations will be well received by the Alzheimer’s research community.

“Recommendations always need to start strong and then have discussions amongst groups of investigators and scientists to determine how they are implemented,” Stern said. “But clinical trials for Alzheimer’s disease need to be conducted differently – period.”