Alzheimer’s Disease in Men

Learn about the roles that one’s sex (determined by genes and chromosomes), and gender (social role and preferred orientation) play in the risk for developing Alzheimer’s disease in men. We examine how they may impact the course of the disease.

Hector’s story and his examination results suggest that he is in the early stage of a mild cognitive decline, possibly the one in which memory is most affected. For many people, this condition is an early step on the path to Alzheimer’s. As a man, Hector’s sex (determined by his genes, and specifically by his possession of a Y chromosome) and his gender (his social role and preferred orientation) play important roles in his risk for developing Alzheimer’s and the course that his disease will take. Clinicians and researchers have been learning more about this issue lately, and here are some of the things they’ve found:

• As a man, Hector’s risk of developing Alzheimer’s is less than a woman’s. The average 65-year-old man, for example, has a 6.3 percent risk of developing AD during the remainder of his life, while the risk for a 65-year-old woman is 12 percent, nearly twice as great. There is still uncertainty about whether this is because women live longer. Sex-related effects help to lower men’s risk. One way that sex affects risk is through the male hormone testosterone. Some testosterone is transformed into estrogen, and estrogen seems to protect healthy brain cells. Men in later life do not experience the massive decrease in estrogen levels that women do after menopause, and that may reduce men’s risk for Alzheimer’s. Sex also affects the danger of various risk factors. One of these, the E4 version of the apolipoprotein gene, referred to as ApoE4, is a less potent risk factor for men than for women.


• Hector’s gender and his culturally determined role behavior also play key roles in his risk of developing Alzheimer’s. In some ways, gender has worked on Hector’s behalf. As a man in his 70s, he was raised during an era when men typically reached a higher level of education. Men of his era also tended to be more physically active than women. Higher educational levels and physical activity have protective benefits against Alzheimer’s.
  
  On the other hand, his generation of men smoked and drank alcohol more heavily than women, and these are risk factors for developing Alzheimer’s. The demographics of these risk factors are changing as women’s educational achievements match men’s. Unfortunately, women now smoke and drink more, too.


• Hector is married, which has a protective benefit for men and also means that his wife and daughter are likely to become his caregivers if his mild neurocognitive disorder progresses to Alzheimer’s. Hector’s family will want to know that men with Alzheimer’s experience a slower cognitive decline during the course of Alzheimer’s. On the other hand, men do not survive for as long a period as women after diagnosis, perhaps because they are typically diagnosed later in the course of the disease.


• As a man with Alzheimer’s, Hector may become challenging to care for at home. Men with Alzheimer’s are more likely than women to develop combative or aggressive behavior. In one study, hospitalized men with dementia and behavioral symptoms were less likely to be discharged back home than women with dementia and behavioral symptoms. The women’s symptoms were less likely to include aggression.

Summary

Some of the ways in which sex and gender affect risk, and disease course are modifiable through healthy lifestyle changes such as smoking cessation and physical activity. Hector’s family will be better prepared to support him through the course of his illness by understanding how his sex and gender may alter the path of his journey, and theirs, through his illness.