Alzheimer’s disease could be better prevented by gender-based personalized medicine, according to new research. Women account for two-in-three patients, with incidence twice as high even after accounting for longer lifespans.
Doctors say focusing on gender-specific interventions might be more effective for patients in the long run.
“Our findings are important because women are disproportionately affected by Alzheimer’s disease,” says lead author Dr. Richard Isaacson, of Florida Atlantic University, in a statement. “Population-attributable risk models suggest that managing risk factors can prevent up to one-third of dementia cases, highlighting the immense potential that lies in addressing modifiable risk factors.”
Isaacson says there are simple steps we can take every single day to strengthen our brains and reduce the risk for Alzheimer’s. The disease starts in the brain 20 to 30 years before the first signs of memory loss. We should all be thinking about prevention, including eating, exercising and sleeping well, he adds.
The study is the first to show sex significantly affects cognitive outcomes in people who follow individually-tailored, multi-domain clinical interventions. It also finds that the risk of developing cardiovascular disease and Alzheimer’s were also affected by gender.
Other studies have focused on the role of hormones and sex-specific risk factors. But none have explored if the interventions result in differences in real-world clinical practice.
The number of dementia cases worldwide are set to triple to more than 150 million by 2050. With no cure in sight there is an increasing focus on protective lifestyle factors such as a healthy diet and plenty of exercise.
The study analyzed data from the Comparative Effectiveness Dementia & Alzheimer’s Registry (CEDAR) trial launched in 2015. It has already demonstrated individualized, multiple interventions improved cognition and reduced Alzheimer’s risk in both women and men.
Dr Isaacson and colleagues evaluated results in 80 higher-compliance participants from the original cohort of 154. The findings show risk reduction care led to greater cognitive improvements in women than men.
“While care in an Alzheimer’s Prevention Clinic setting is equally effective at improving cognitive function in both women and men, our personally-tailored interventions led to greater improvements in women compared to men across Alzheimer’s and cardiovascular disease risk scales,” says Isaacson, “as well blood biomarkers of risk such as blood sugar, LDL cholesterol, and the diabetes test HbA1C.”
After increasing age, the most significant risk factor for Alzheimer’s disease is sex, with females most prone.
At the outset volunteers underwent medical checks including a detailed clinical history, physical examination, anthropometrics, blood biomarkers, apolipoprotein-ε4 (APOE-e4) genotyping and cognitive assessment. Patients in the CEDAR study were given individually-tailored, multi-domain intervention recommendations informed by these clinical and biomarker data.
Recommendation categories included patient education/genetic counseling and individualized pharmacological approaches (medications/vitamins/supplements). They also got advice on exercise, diet, vascular risk reduction, sleep hygiene, cognitive engagement, stress reduction, general medical care and other evidence-based interventions.
“Our latest results suggest the individualized management approach used by the CEDAR study in a real-world clinic may offer equal cognitive benefits to both women and men, as well as better mitigation of calculated Alzheimer’s disease and cardiovascular disease risk in women compared to men,” says Isaacson. “Our work also highlights the need for larger studies focusing on sex differences in Alzheimer’s-related cognitive trajectories, as the existing body of knowledge lacks conclusive evidence on this issue.”
The researchers are planning trials involving larger cohorts to further define sex differences in Alzheimer’s risk reduction. They hope to launch a multi-site international study soon to draw more definitive conclusions.
The study is published in the Journal of Prevention of Alzheimer’s Disease.
Report by Mark Waghorn, South West News Service