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Why are women more likely to develop Alzheimer’s disease?

senior woman assembling a jigsaw puzzle where all the pieces are blank white

Did you know that of the 6.2 million people with Alzheimer’s disease who are age 65 or older in this country, almost two-thirds are women? This means that Alzheimer’s disease is almost twice as common in women compared to men. Why is Alzheimer’s disease more common in women?

Women live longer

The first and most important reason is that women tend to live longer than men. If you look at actuarial life tables, you can see that a baby girl born in 2019 is likely to live five years longer than a baby boy: 81 versus 76 years.

The greatest risk factor for Alzheimer’s disease is age: the older you are, the more likely you are to develop Alzheimer’s disease. For example, out of 1,000 people, the incidence (the number who develop Alzheimer’s each year) depends on age:

  • 4 out of 1,000 people ages 65 to 74 develop Alzheimer’s each year
  • 32 out of 1,000 people ages 75 to 84 develop Alzheimer’s each year
  • 76 out of 1,000 people ages 85 and older develop Alzheimer’s each year.

So, one reason that there are more women with Alzheimer’s disease than men is simply that there are more older women than older men living in our society — 5.7 million more of them — and the older you are, the more likely you are to develop Alzheimer’s disease.

But that’s not the whole answer.

The incidence of Alzheimer’s is greater in women

Your chances of developing Alzheimer’s disease late in life are somewhat greater if you are a woman than a man. One study followed 16,926 people in Sweden and found that, beginning around age 80, women were more likely to be diagnosed with Alzheimer’s disease than men of the same age. Similarly, a study based in Taiwan found that one’s chances of developing Alzheimer’s disease over seven years was greater in women compared to men. And a meta-analysis examining the incidence of Alzheimer’s disease in Europe found that approximately 13 women out of 1,000 developed Alzheimer’s each year, compared to only seven men.

So, women living longer than men cannot be the whole answer as to why women are more likely than men to develop Alzheimer’s disease, because even among individuals who are living and the same age, women are more likely to be diagnosed with Alzheimer’s than men.

The incidence of non-Alzheimer’s dementia is not greater in women

One clue to the answer to this puzzle is that your chances of developing dementia from a cause other than Alzheimer’s disease is not greater if you are a woman. For example, the study examining dementia rates in Sweden found that both women and men were equally likely to develop a non-Alzheimer’s dementia as they aged. That rates of Alzheimer’s disease differ by gender, whereas rates of non-Alzheimer’s dementias do not, suggests that there must be a specific interaction between Alzheimer’s disease and gender.

Amyloid deposition in Alzheimer’s may be fighting infections

Another clue to this puzzle comes from the work of Harvard researchers, who have suggested that amyloid, one component of Alzheimer’s disease pathology, may be deposited in order to fight off infections in the brain. If their suggestion turns out to be correct, we might think of Alzheimer’s disease as a byproduct of our brain’s immune system.

Autoimmune disorders are more common in women

The last piece of the puzzle is that women are about twice as likely to have an autoimmune disease compared to men. The reason for this difference is not entirely clear, but it is clear that the immune system is generally stronger in women than men, and many autoimmune diseases are more common during pregnancy. It may be that women’s stronger immune system developed through evolution to protect the fetus from infections. So, as part of their stronger immune systems, women may end up having more amyloid plaques than men.

Putting the pieces together

By combining all of this information, one possible explanation as to why women’s risk of Alzheimer’s disease is greater than men’s — in addition to women living longer — is:

  • The amyloid plaques that cause Alzheimer’s disease may be part of the brain’s immune system to fight against infections.
  • Women have stronger immune systems than men.
  • As part of their stronger immune systems, women may end up having more amyloid plaques than men.
  • Because they may have more amyloid plaques than men, this theory may explain why women end up having a greater risk of developing Alzheimer’s disease.

Please note the italicized words "may" that I have used. Although the ideas I have presented here are logical, coherent, and form the basis of a good theory, they have not yet been proven to be correct. More research is needed!

The bottom line

You are more likely to develop Alzheimer’s disease over your lifetime if you are a woman, because women live longer than men and, possibly, because women have stronger immune systems compared to men.

Does that mean that if you’re a woman, you’re more likely to develop Alzheimer’s disease and there’s nothing you can do about it? Not at all! You can do many things to reduce your risk of Alzheimer’s today.

  • Engage in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
  • Eat a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
  • Sleep well — and clean those Alzheimer’s plaques out of your brain.
  • Participate in social activities and novel, cognitively stimulating activities.

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Tics and TikTok: Can social media trigger illness?

A red paper plane leading and white paper planes veering to follow it

A student suddenly develops leg pain and paralysis; soon hundreds of schoolmates have similar symptoms. Nuns begin biting each other, and soon the same thing is happening at other nearby convents. Three schoolgirls begin laughing uncontrollably, sometimes going on for days. When nearly 100 classmates develop the same problem, the school is forced to close down.

Yet in each case, no medical explanation was ever found. Eventually, these came to be considered examples of mass sociogenic illness, which many of us know by different names: mass hysteria, epidemic hysteria, or mass psychogenic illness. Over the years, many possible sources for these illnesses have emerged — and today TikTok and other social media sites may be providing fertile ground.

What is sociogenic illness?

The hallmark of these conditions is that multiple people within a social group develop similar, medically inexplicable, and often bizarre symptoms. In some cases, those affected believe they have been exposed to something dangerous, such as a toxin or contagion, although thorough investigation finds none.

The suffering caused by these illnesses is quite real and profound —even in the absence of a clear cause and presence of normal test results. And no, a person with sociogenic illness is not "just looking for attention" or "doing it on purpose."

Labeling people as hypochondriacs or "crazy," or illness as "hysteria," isn’t helpful. Hysteria and hysterical — drawn from hystera, the Greek word for womb — are loaded terms, often used to diminish women as psychologically unstable or prone through biology to uncontrollable outbursts of emotion or fear. And while some researchers suggest these illnesses more commonly affect women, most of the published literature on this condition is decades old and based on a limited number of cases.

Common features of mass sociogenic illness

Past outbreaks include illnesses in which people suddenly fainted; developed nausea, headaches, or shortness of breath; or had convulsive movements, involuntary vocalizations, or paralysis. Usually, these outbreaks occurred among people in close proximity, such as at a school or workplace. Rarely, cases appear to have been spread by shows on television. Now, social media is a possible new source.

Certain features are typical:

  • experiencing symptoms that have no clear medical explanation despite extensive investigation
  • symptoms that are temporary, benign, and unusual for those affected
  • rapid onset of symptoms and rapid recovery
  • those affected are connected by membership and interaction within a social group or by physical proximity.

Generally, treatment includes:

  • ruling out medical explanations for symptoms
  • shutting down a facility where it occurred
  • removing people from the site of supposed exposure (online or not)
  • separating affected individuals from one another.

Reassurance regarding the lack of danger, and demonstrating that the outbreak stops once individuals are no longer in close contact with each other, generally reduces anxiety and fosters recovery.

Tics and TikTok: a new driver of sociogenic illness?

The first known examples of social media-induced sociogenic illness were recognized in the last year or two, a time coinciding with the pandemic. Neurologists began seeing increasing numbers of patients, especially teenage girls, with unusual, involuntary movements and vocalizations reminiscent of Tourette syndrome. After ruling out other explanations, the tics in these teenagers seemed related to many hours spent watching TikTok videos of people who report having Tourette syndrome and other movement disorders. Posted by social media influencers, these videos have billions of page views on TikTok; similar videos are available on YouTube and other sites.

What helped? Medications, counselling, and stress management, according to some reports. Avoiding social media posts about movement disorders and reassurance regarding the nature of the illness also are key.

Geographic boundaries may have become less relevant; now, the influences driving these illnesses may include social media, not just physical proximity.

Dancing plagues, mad gassers, and June bugs

Sociogenic illnesses are nothing new. If you had lived in the Middle Ages, you might recall the "dancing plague." Across Europe, scores of afflicted individuals reportedly began to involuntarily and deliriously dance until exhaustion. And let’s not forget the writing tremor epidemic of 1892, the Mad Gasser of Mattoon during the mid-1940s, and the June bug epidemic of 1962.

The anxieties and concerns of the times play a role. Before the 1900s, spiritual or religious overtones were common. When concerns were raised about tainted foods and environmental toxins in the early 1900s, unusual odors or foods sparked a rash of palpitations, hyperventilation, dizziness, or other anxiety symptoms. More recently, some residents of the West Bank who thought nearby bombings released chemical weapons reported dizziness and fainting, although no evidence of chemical weapons was found.

Closer to home, reports are swirling that Havana syndrome may represent another example of mass sociogenic illness, although no firm conclusions can yet be made. Initially described among members of the US State Department in 2016 in Havana, Cuba, individuals who experienced this suddenly developed headache, fatigue, nausea, anxiety, and memory loss.

These symptoms have been reported by hundreds of people in different parts of the world. Many are foreign service workers attached to US diplomatic missions. Soon after the first case reports, suspicion arose that a new weaponized energy source was causing the illness, such as microwaves fired from some distance. Cuba, Russia, or other adversaries have been blamed for this. Thus far, the true nature and cause of this condition is uncertain.

Nocebo, not placebo

One theory suggests that sociogenic illness is a form of the nocebo effect. A placebo — like a sugar pill or another inactive treatment — may help people feel better due to expectation of benefit. The nocebo effect describes the potential that people could have a negative experience based purely on the expectation that it would occur.

Think of it this way: you may be more likely to experience a headache from a medication if you’ve been warned of this possible side effect, compared with another person warned about a different side effect. Similarly, let’s say you see people fainting. If you believe this is caused by a substance they — and you! — were exposed to, you may faint, too, even if there’s no actual exposure to a substance that could cause fainting.

The bottom line

We don’t know why some develop sociogenic illness while others don’t. Plenty of people have lots of stress. Millions of people were stuck inside during the pandemic and turned to social media for more hours each day than they’d like to admit. Many people are prone to the power of suggestion. Yet, sociogenic illness remains relatively rare. Despite existing for hundreds of years, much about this condition remains mysterious. An open mind is important. Some cases of sociogenic illness may be due to an environmental toxin or contagion that wasn’t detected at the time.

If you or a loved one spends a lot of time on social media and has developed an illness that defies explanation, talk to your healthcare providers about the possibility of social media-induced sociogenic illness. We may soon learn that it’s not so rare after all.

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New study investigates treatment-associated regrets in prostate cancer

Men who are newly diagnosed with prostate cancer have difficult choices to make about medical therapy, and the last thing any of them want is to regret their treatment decisions later. But unfortunately, treatment-related regrets are quite common, according to a new study.

After looking into the experiences of 2,072 men diagnosed with prostate cancer between 2011 and 2012, the investigators found that more than one in 10 were unhappy with their chosen treatment.

The men were all younger than 80, with an average age of 64. Nearly half of them had slow-growing cancers with a low risk of recurrence or spread after treatment. The rest were in intermediate- or higher-risk categories.

All the men were treated in one of three different ways: surgery to remove the prostate (a procedure called radical prostatectomy); radiation therapy; or active surveillance, which entails monitoring prostate tumors with routine PSA checks and imaging, and treating only when, or if, the cancer progresses. More than half the men chose surgery regardless of their cancer risk at the time of diagnosis. Most of the others chose radiation, and about 13% of the men — the majority of them in low- or intermediate-risk categories — chose active surveillance. Then, at periodic intervals afterwards, the men filled out questionnaires asking if they felt they might have been better off with a different approach, or if the treatment they had chosen was the wrong one.

What the results showed

Results showed that after five years, 279 of the men (13% of the entire group) had regrets about what they had chosen. The surgically-treated men were most likely to voice unhappiness with their decision; 183 of them (13%) felt they would have been better off with a different approach. By contrast, regrets were expressed by 76 (11%) of the radiation-treated men and 20 (7%) of men who chose active surveillance. Men in the low-to intermediate-risk categories were more likely to regret having chosen immediate treatment with surgery or radiation instead of active surveillance. The men with high-risk cancer, however, did not regret being treated immediately.

The study was led by Dr. Christopher Wallis, a urologic oncologist at Mount Sinai Hospital in Toronto, Canada. Wallis and his team didn’t explore which specific disease outcomes or complications led to the regrets associated with particular treatments. However, the study did find that sexual dysfunction was significantly associated with treatment regrets in general. “And patients on active surveillance may develop regret if their disease progresses and they then come to believe that they may have been better suited by getting treatment earlier,” Wallis wrote in an email.

The study’s key finding, according to the investigators, is that regrets arise from discrepancies between what men expect from a particular approach and their actual experiences over time. “That’s the important take-away,” Wallis said.

In an accompanying editorial, Randy Jones, PhD., RN, a professor at the University of Virginia School of Nursing, emphasized that improved treatment counseling at the time of diagnosis can help to minimize the likelihood of regret later. This communication, he wrote, should consider the patient’s personal values, stress shared decision-making between patients and doctors, and aim for an “understanding of realistic expectations and adverse effects that are possible during treatment.”

“This study underscores the importance of not rushing into a decision, and fully understanding the time course of side effects and what can be expected from them,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Only when these consequences of treatment(s) or surveillance are fully understood is the patient able to make a truly informed decision.” All too often, newly diagnosed patients respond by “wanting to take care of this as soon as emergently possible.” But with prostate cancer, patients have the time to fully understand what is at stake. “I urge my patients to speak with members of prostate support groups and other prostate cancer patients about the issues they are likely to face, not necessarily in the immediate future, but years later. The fact that this study evaluated individuals 10+ years following their decision is an important feature in helping us better understand the time course during which regrets may be experienced.”

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When the doctor becomes the patient: A transformative experience

A colorful butterfly emerging from an injured heart, a transformation.

I grew up in India with my loving family, living in a 1,000-square-foot room. I was fearless and often experienced the bumps and bruises of an active boyhood. I always got up, dusted myself off, and walked again. I learned resilience and was a happy child.

Throughout my work as a physician, the importance of resilience has resonated. I lead research on the effects of consciousness, meditation, yoga, and spirituality on health. Little did I know my understanding of these issues was going to hit close to home.

Becoming a patient: A transformative day

It was an ordinary day. After long hours at work, I went home to enjoy dinner with my family. I did my daily exercise on the treadmill and relaxed, watching television with my son.

Suddenly, I experienced crushing pain. At first I didn’t want to take it seriously, but this pain was too much to bear and I fell on my knees. My wife quickly called 911, thinking it was a food allergy. When the EMTs arrived, I asked them to take me to the hospital where I work. There wasn’t time for that, they told me.

Those were the last words I heard.

Mindful awareness: Pain, but no suffering

I woke next to the squeaking sound of the bed wheels. I heard my best friend screaming, “I am here!” I felt a severe pain on my left shin. At that moment, I was simply aware of what was happening. The “watching myself” began. Was this a spiritual self-awareness, or the meta-awareness described by neuroscientists?

For the next few hours in the ICU, I had the range of disconcerting symptoms that accompanies a severe heart attack — the type of heart attack that only 5% of people survive. Yet it was like I was watching myself in a movie. While I was aware of profound discomforts that should have been terrifying, I felt no suffering. This experience stands out to me even today.

During my heart attack, I experienced a distance between myself, my body, and my mind. I was the witness of the event, not its victim. I believe that this is the result of a regular yoga and meditation practice that transformed my life forever. The type of yoga I practice emphasizes this distance between mind and body, but such benefits are not unique to any single type of yoga or method of meditation. My personal preference is Sadhguru yoga — you can try a simple Sadhguru meditation exercise here.

Bringing intention to illness

My experience is a powerful reminder that aligning spirituality with health not only can help you stay well, but can help you weather “dis-ease” with more intention.

Facing our own mortality can shake us into acknowledging that our time on this earth is indeed short. It serves up a strong reminder to prioritize the things that matter the most in your life. Before the heart attack, my life was driven primarily through intellectual knowledge. But now, I experientially know that there is much more to life than what my intellect perceives. I ask myself: Have I lived my life to the fullest? What impact have I had on the people around me, the city I live in, and the planet I walk on?

We have no control over what life throws at us. But we have a lot of say over what happens within us. I am grateful to the unbroken chain of resuscitation, science, and, I believe, my spiritual practices. As the new year begins, I’d encourage you to consider making spirituality — however you define it — a part of your health goals.