At Hometown Health DPC, our whole-person approach means we look at the full picture of your health — including the factors that put certain patients at greater risk long before symptoms appear. For women, dementia is one of the most important conversations we’re not having often enough.

The global prevalence of dementia in women aged 65 and older is 80 per 1,000 — compared to 55 per 1,000 in men. A large international meta-analysis confirmed women carry a 12% higher overall dementia risk. And yet, for decades, that disparity was written off as a longevity gap. We now know the reality is far more layered — and far more actionable.

The APOE ε4 factor: same gene, different risk

One of the clearest biological drivers of the sex gap is the APOE ε4 gene variant — the strongest known genetic risk factor for late-onset Alzheimer’s. But it doesn’t affect men and women equally. Women with just one copy of APOE ε4 carry a risk roughly equivalent to men who carry two copies. This is most pronounced between ages 60 and 75, and holds consistently across racial and ethnic groups.

Researchers believe estrogen loss during menopause may amplify this gene’s harmful effects — specifically by increasing vulnerability to tau protein accumulation, the kind of neuronal damage APOE ε4 already accelerates. Same gene. Greater hormonal context. Harder hit.

Menopause as a brain health event

A landmark 2026 review in the Journal of Clinical Investigation calls for a paradigm shift: the menopausal transition should be treated as a distinct, potentially modifiable neurological risk factor — not just a reproductive milestone. This is exactly the kind of evidence-informed, proactive thinking that shapes how we approach women’s care at Hometown Health.

Seven risks that hit women harder — and what you can do about them

The 2024 Lancet Commission identified 14 modifiable risk factors that together account for nearly half of all dementia cases. Several carry an outsized burden in women. One stands clearly above the rest.

Midlife is your window — and we’re here for it

A 2026 review in Stroke identifies ages 40–65 as the critical prevention window for women. This is when Alzheimer’s-related changes begin accumulating silently, and when lifestyle interventions carry the most weight. The 2024 AHA/ASA guidelines now recommend screening for adverse pregnancy outcomes — including preeclampsia and gestational diabetes — as part of vascular dementia prevention.

A Norwegian study estimated that addressing all 14 Lancet risk factors could prevent more than half of dementia cases, with additional preventive potential specific to women. The research is clear: dementia is not simply what happens when women live longer. It is shaped by a complex, intersecting web of biological, hormonal, and lifestyle factors — and many of them are within reach.

Sources: 2024 Lancet Commission on Dementia Prevention; COSMIC Consortium meta-analysis (29,850 participants); Journal of Clinical Investigation 2026; Stroke 2026; JAMA Internal Medicine (Bartz et al., 2020); 2024 AHA/ASA Guidelines; HUNT4 70+ Norwegian cohort. This content is for informational purposes only and does not constitute medical advice. © 2026 Hometown Health DPC.