Alzheimer's Disease in Women

Abstract

Alzheimer Disease (AD) was first described in a woman, Augusta D, whose case revealed the classic neuropathological features of amyloid plaques and neurofibrillary tangles. Decades later, another paradigmatic case, that of Aliria Piedrahita Villegas in Colombia, provided unique findings: although she carried the PSEN1-E280A mutation associated with early-onset AD, the homozygous presence of the APOE3 Christchurch variant delayed her dementia for decades, showing how genetics can modify the clinical course.

AD affects women disproportionately, a phenomenon attributed to multiple factors such as longer life expectancy, hormonal influence (loss of the neuroprotective effect of estrogens after menopause), genetic variants like APOE4 (which may confer higher risk and faster progression in women over 65 years), and social determinants such as educational level. However, taken together, these factors do not fully explain the reason for this difference.

Biomarkers help improve diagnostic accuracy, showing, in some cases, sex-related differences in levels and patterns of pathology. Understanding these particularities is essential to optimize diagnostic, therapeutic, and public health strategies, which may require a gender-based approach, thereby positively influencing the quality of life of individuals affected by AD.