Women already had the upper hand in the Alzheimer's lottery, but new research suggests they're also more vulnerable to the usual suspects that mess with your brain. Scientists at the University of California San Diego School of Medicine, in a study published May 19, 2026, in Biology of Sex Differences, analyzed data from over 17,000 middle-aged and older adults and found that certain modifiable dementia risk factors pack a bigger punch for women's cognitive function than men's.
"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. "This suggests that prevention efforts may be more effective if they are tailored not just to risk factor prevalence, but to how strongly each factor affects cognition in women versus men." So, the same old advice might need a pink ribbon.
The researchers examined 13 established dementia risk factors - including education level, hearing loss, smoking, alcohol consumption, obesity, depression, physical inactivity, hypertension, diabetes, and other cardiometabolic conditions - using data from the Health and Retirement Study, a nationally representative group of U.S. adults. They found that while high blood pressure hit about six out of 10 participants regardless of sex, and average BMI for both sexes fell in the overweight-to-obese range, women had slightly lower average educational attainment, which is a known risk factor.
But the real kicker: heart and metabolic issues like hypertension and elevated BMI showed steeper negative associations with cognition in women. Hearing loss and diabetes, despite being more common in men, were also tied to lower cognitive scores in women. "These differences highlight the importance of considering sex as a key variable in dementia research," said senior author Judy Pa, PhD, professor of neurosciences. "Sex differences are profoundly overlooked among many leading causes of death like Alzheimer's, heart disease and cancer." Indeed, women account for nearly two-thirds of Alzheimer's cases in the U.S., and longer lifespans alone don't explain the gap.
The study supports the push for precision medicine - tailoring prevention and treatment to individual characteristics, including sex. For women, that might mean focusing on managing depression, increasing physical activity, and improving cardiovascular health, especially untreated hypertension. "Ultimately, a more nuanced understanding of these differences could help us design smarter, more targeted interventions," Fitzhugh said. "That's an essential step toward reducing the burden of dementia for everyone, but especially for women, who are disproportionately affected." The research was funded by the National Institute on Aging and the Alzheimer's Association.