New Research Highlights Sex-Specific Impacts of Dementia Risk Factors
Women account for nearly two-thirds of Alzheimer’s disease cases in the United States, a disparity often attributed to their longer life expectancy. However, new research suggests that biology and lifestyle factors may play a more complex role in cognitive decline than previously understood. According to a study published May 19, 2026, in Biology of Sex Differences, certain modifiable risk factors for dementia appear to have a more profound impact on the cognitive function of women compared to men.
The Disproportionate Burden on Women
Researchers at the University of California San Diego School of Medicine analyzed data from more than 17,000 middle-aged and older adults using information from the Health and Retirement Study. The goal was to determine how 13 established dementia risk factors—including hypertension, diabetes, smoking, and physical inactivity—influence cognitive health across sexes.
“Looking beyond which risk factors are most common, we found that some have a disproportionately larger impact on women’s cognition,” said Megan Fitzhugh, PhD, assistant professor of neurosciences at UC San Diego School of Medicine and first author of the study. The findings indicate that while some conditions are more prevalent in one sex, their neurological consequences may vary significantly.
Key Differences in Risk Factors
The study identified distinct patterns in how men and women experience dementia-related risks:
- Risk factors more common in women: Women reported higher rates of depression (17% vs. 9%), physical inactivity (48% vs. 42%), and sleep problems (45% vs. 40%).
- Risk factors more common in men: Men showed higher rates of hearing loss (64% vs. 50%), diabetes (24% vs. 21%), and heavy alcohol use (22% vs. 12%).
Notably, the researchers discovered that cardiovascular and metabolic conditions, such as hypertension and elevated body mass index, were more strongly associated with poorer cognitive performance in women. Even in cases where a condition was more common in men—such as diabetes or hearing loss—the negative association with cognitive scores remained steeper among female participants.
Moving Toward Precision Prevention
These findings underscore the necessity of precision medicine in neurology. By identifying which risk factors are most damaging to specific groups, clinicians can develop more targeted intervention strategies.
“These differences highlight the importance of considering sex as a key variable in dementia research,” said Judy Pa, PhD, professor of neurosciences at UC San Diego School of Medicine and senior author of the study. “Sex differences are profoundly overlooked among many leading causes of death like Alzheimer’s, heart disease and cancer.”
For women, the researchers suggest that proactive management of cardiovascular health, addressing depression, and prioritizing physical activity may be critical steps in mitigating cognitive risk. Because many of these factors are modifiable, there is significant potential for prevention if care is tailored to individual needs rather than a “one-size-fits-all” approach.
Future Directions
While the study reveals a clear disparity in how risk factors affect the brain, the exact biological and social mechanisms remain under investigation. Potential drivers include hormonal fluctuations, genetic differences, and disparities in healthcare access. Further research is required to translate these findings into clinical practice and to refine prevention efforts that could reduce the overall burden of dementia.
The study, titled “Sex differences in modifiable risk factors of dementia and their associations with cognition,” was funded by the National Institute on Aging (RF1AG088811, PI: Pa) and the Alzheimer’s Association (SAGA23-1141238, PI: Pa). The authors reported no conflicts of interest.
Key Takeaways
- Sex-Based Disparity: Women are more strongly affected by several modifiable dementia risk factors, which may partially explain why they represent a majority of Alzheimer’s cases.
- Cardiovascular Impact: Hypertension and high body mass index showed a stronger negative association with cognitive health in women than in men.
- Precision Medicine: Experts emphasize that dementia prevention should be tailored to an individual’s sex and specific risk profile rather than relying on population-wide averages.
- Modifiable Risks: Managing mental health, sleep, and metabolic conditions remains a vital strategy for preserving long-term cognitive function.