The Gender Gap in Alzheimer’s: What Palliative Care Providers Need to Know About Brain Fats and Women’s Cognitive Health
Alzheimer’s disease disproportionately affects women. Nearly two-thirds of all patients living with Alzheimer’s are female, and while increased life expectancy explains part of this difference, it does not tell the full story. Emerging research suggests that biological factors—including differences in brain lipid metabolism—play a critical role in why women develop dementia at nearly twice the rate of men.
A 2025 study (Wretlind et al., Alzheimer’s & Dementia) found that women with Alzheimer’s disease have 70% fewer healthy brain fats—particularly the omega-3 fatty acids DHA and EPA—compared to men with the same disease severity. For palliative care providers, this finding underscores the importance of understanding gender-specific vulnerabilities and tailoring care approaches accordingly.
Why Brain Fats Matter in Dementia
The human brain is nearly 60% fat, and omega-3 fatty acids—especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—are essential to neuronal membrane stability, synaptic signaling, and inflammation regulation. Lower levels of these fatty acids have been linked to:
• Accelerated cognitive decline
• Smaller brain volume on imaging
• Increased risk of Alzheimer’s disease
• Greater inflammatory burden
For women with dementia, the depletion of these protective fats appears to be especially pronounced and may help explain faster disease progression compared to men.
Biological Factors Driving the Gender Gap
1. Hormonal Changes in Menopause
Estrogen plays a protective role in omega-3 metabolism. It enhances the brain’s ability to incorporate DHA into cell membranes. After menopause, estrogen levels plummet, and this protective mechanism disappears. Without estrogen, omega-3 breakdown accelerates, leaving women more vulnerable to neuronal injury and inflammation.
2. Stronger Immune and Inflammatory Responses
Women generally mount stronger immune responses than men. While protective in infection, this heightened reactivity can backfire in chronic illness. In the brain, stronger inflammatory cascades consume omega-3 fatty acids more rapidly, leaving fewer available for neuroprotection.
3. Earlier and Faster Depletion
The study noted that DHA and EPA differences appeared early in the course of disease and correlated with faster cognitive decline. This means that women may start from a position of disadvantage long before they exhibit symptoms.
Implications for Palliative Care Practice
For palliative care teams, these findings highlight several key areas of practice:
1. Anticipating Faster Decline in Women
Recognize that women with Alzheimer’s may experience earlier and more rapid functional decline. This may necessitate earlier interventions with supportive services, caregiver education, and advance care planning.
2. Nutritional Support as Symptom Management
While omega-3 supplementation cannot reverse Alzheimer’s, maintaining adequate intake may help slow decline, improve mood, and support quality of life. Palliative teams should consider:
• Encouraging diets rich in fatty fish (salmon, sardines, mackerel, herring) or algae-based omega-3 supplements for vegetarians.
• Discussing supplementation with families, especially in peri- and post-menopausal women at risk.
• Coordinating with dietitians to integrate brain-healthy nutritional support into care plans.
3. Monitoring for Malnutrition and Inflammation
Patients with advanced dementia often suffer from protein-calorie malnutrition. Given the role of inflammation and omega-3 depletion in women, addressing weight loss, poor intake, and inflammatory comorbidities (e.g., diabetes, cardiovascular disease) becomes even more important in female patients.
4. Individualized, Gender-Sensitive Counseling
Family counseling should reflect this new evidence:
• Educate caregivers that women may decline differently than men, even with the same diagnosis.
• Set realistic expectations for progression and care needs.
• Discuss the potential role of nutritional interventions early, before cognitive symptoms become severe.
The Bigger Picture: Prevention and Research
The study raises important public health questions:
• Are current omega-3 recommendations too low for women? Heart health guidelines may not be sufficient for brain protection, particularly after menopause.
• Should prevention strategies start earlier? Optimizing brain fat levels in midlife—or even earlier—may reduce dementia risk later in life.
• Do we need gender-specific dementia guidelines? Just as cardiovascular medicine has moved toward sex-specific recommendations, dementia care may need to follow.
Practical Takeaways for Palliative Providers
Women with Alzheimer’s are at greater biological risk due to omega-3 depletion, independent of longevity.
Estrogen loss and inflammation are major contributors to this disparity.
Nutritional support—though not curative—may slow decline, ease symptoms, and improve quality of life.
Early, gender-sensitive counseling helps families prepare for the more aggressive trajectory of dementia in women.
Future care models may include omega-3 monitoring and supplementation as part of a holistic approach to cognitive health.
Conclusion
For palliative care providers, the recognition that women with Alzheimer’s disease have 70% fewer healthy brain fats than men is more than an academic curiosity. It has real implications for care planning, symptom management, and family education. As we continue to provide whole-person care, acknowledging gender-specific differences in disease biology will allow us to better support patients and families through the challenges of dementia.
References
Wretlind et al. Lipid profiling reveals unsaturated lipid reduction in women with Alzheimer’s disease. Alzheimer’s & Dementia. 2025.
Chêne G, Beiser A, Au R, et al. Gender and incidence of dementia in the Framingham heart study from mid‐adult life. Alzheimer’s & Dementia. 2015;11:310‐320.
Beam CR, Kaneshiro C, Jang JY, Reynoldsb CA, Pedersen NL, Gatz M. Differences between women and men in incidence rates of dementia and Alzheimer's disease. J Alzheimers Dis. 2018;176:139‐148.
Lopez‐Lee C, Torres ERS, Carling G, Gan L. Mechanisms of sex differences in Alzheimer's disease. Neuron. 2024;112(8):1208‐1221.
