Costing $172 billion a year for health care and research funding, Alzheimer's disease affects one in three families and has a widespread impact on our economy and aging population. Most notably, it plagues women twice as much as men.
At a congressional briefing held by the Society for Women's Health Research, experts in Alzheimer's research discussed the need to examine the sex differences in Alzheimer's disease, both for the cause, prevention, and treatment, as well as the caregiver role.
Alzheimer's disease is the seventh leading cause of death in the U.S. and affects 5.4 million people. Those these numbers are expected to skyrocket as the baby boomer population ages. George Vradenburg, founder of USAgainstAlzheimer's, says research of the disease is severely underfunded, and efforts need to be focused on Alzheimer's like they were for the HIV/AIDS epidemic in the 1980s by stimulating the private sector to invest in fighting the disease.
Discussing Alzheimer's specific impact on women, Pauline M. Maki, professor of psychiatry and psychology and director of women's mental health research at the University of Illinois at Chicago, says the goal for Alzheimer's research is to find ways to halt the disease. Alzheimer's disease will affect more than 15 million people over the next 15 years, with costs exceeding $20 trillion. Maki says that even small gains made in potential treatments will mean huge costs savings.
More women than men die from Alzheimer's, and females have a greater risk of developing the disease in their lifetime.
"Sex differences in risk factors for Alzheimer's are depression, exercise, genetics, menopause and menopause treatments, and drugs to treat osteoporosis and breast cancer," Maki says.
Women suffering from depression have a 90 percent increased risk compared with men and an even greater risk after menopause, due to decreased estrogen levels. Another risk factor is having a hysterectomy and ovaries removed. Women who remove their ovaries before the age of 48 have a 70 percent increased risk of developing Alzheimer's. However, if that woman used estrogen hormone therapy until menopause, she reduces her risk. Maki's research shines a light on the unique female biology that contributes to women's higher incidence of Alzheimer's disease.
Roberta Diaz Brinton, a professor involved in biomedical engineering and neurology at the University of Southern California, says the most common theory initially was that because women live longer than men, they are more affected by Alzheimer's disease. In truth, women only live on average five years longer than men, and it is more likely the difference in their brains and physiology that contributes to the greater rate of the disease in women.
Type II diabetes is a major risk factor for Alzheimer's disease as it affects the brain first. Hypometabolism in the brain is a hallmark of Alzheimer's disease since an Alzheimer's-afflicted brain has less glucose, appearing shriveled when compared to a disease-free brain. A maternal family history of Alzheimer's predisposes the brain to hypometabolism more so than a paternal family history. While current therapies intervene at time of diagnosis, Brinton says therapies should be applied before the disease takes hold.
Mary S. Mittelman, director of the psychological research and support program and the Center of Excellence for Brain Aging and Research at New York University Langone Medical Center, says the burden of care for people with Alzheimer's disease likewise falls 60 percent on women, most of whom are family members.
"Nearly 15 million Americans provide 17 billion hours of unpaid care for a person with Alzheimer's disease valued at over $202 billion," says Mittelman. "Eighty percent of care is provided at home by family caregivers and provided at substantial personal cost."
Family caregivers are at higher risk for depression and physical illness due to the high emotional stress of nursing an Alzheimer's patient.
Caregivers are more likely to say their health is fair or poor or that their health has worsened since becoming a caregiver. The physical and emotional impact of caregiving on Alzheimer's disease caregivers is estimated at $7.9 billion in increased health care costs in the U.S.
However, there are some psychosocial interventions in place to help caregivers manage their emotional and physical problems, such as education that provides improved coping strategies and skills training, formal services, and enjoyable shared activities that are an outlet for the caregiver and the patient.
All of the panelists say that exercise and maintaining a healthy weight to prevent heart disease and diabetes are the best lifestyle strategies to prevent or delay Alzheimer's disease.
Alzheimer's disease devastates not only the patient but also the family and caregiver responsible for administering care and support, researchers and others say.
"Through focused research and prevention methods, we can delay progress of the disease with improved treatments and even find a cure," says Phyllis Greenberger, president and CEO of the Society for Women's Health Research. "With the influx of aging baby boomers, we know that time is of the essence. SWHR will continue to advocate for increased research on women and Alzheimer's disease."
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