Carol could not understand why her identical twin sister had suffered from Alzheimer’s for 10 years while she herself showed no signs of the disease. “After all,” she reasoned, “we have identical genes.” Like many of my patients, Carol thought that genes alone determined her risk of Alzheimer’s. In fact, genes only tell part of the story. While Carol and her sister share identical genes, they have not lived identical lives. The lifestyle choices an individual makes play a pivotal role in determining their risk of developing dementia. For Carol, that has made all the difference.

A variety of lifestyle factors are strongly linked to the development of Alzheimer’s disease, many of which are potentially modifiable or reversible. Advances in the new field of epigenetics have allowed us to understand that lifestyle factors mediate their effects by altering gene expression. Healthy lifestyle factors promote beneficial gene activity, while unhealthy lifestyle factors have the opposite effect. In other words, although you cannot change your genes, you can alter their activity for better or worse depending on your lifestyle choices.

This is especially important for women. Alzheimer’s is not only more common in women, many of these modifiable dementia risk factors are more prevalent in women compared to men. For example, women have higher rates of obesity and are less physically active. In addition, women have more mental health disorders, higher rates of insomnia, lower levels of educational attainment, and less mentally challenging occupations. All of these risk factors may be exacerbated by women’s lower socioeconomic status which is itself, a risk factor.

Globally, low education contributes to the largest proportion of Alzheimer’s Disease cases. According to a study by Ngandu in the journal Neurology, high school education lowers the risk of dementia by a whopping 80% when compared to less than five years of formal education. Women are at a significant disadvantage due to dramatically lower levels of educational attainment and lower socioeconomic status. In many developing countries, girls are denied an education or have limited opportunities to attend school. Similarly, women are less likely to have mentally challenging occupations compared to men. In addition, women often sacrifice educational goals and cognitively challenging careers to raise children and care for ailing family members.

Promoting educational equality, addressing gender disparities, and raising brain health awareness is key to advancing women’s brain health. Additionally, women need to know their personal risk factors for Alzheimer’s. A thorough medical checkup focused on brain health is the best way to get started. From hypertension and depression to sleep disorders and chronic stress, there are many treatable conditions that negatively impact the brain and increase the risk of cognitive decline. In addition, a health professional can provide the latest guidelines and recommendations to maximize brain health. Empowering women begins with empowering the female brain.