Researchers Identify Protective Factors in Alzheimer’s Disease, Analyze Influence of Gender
Article Summary
- Miller School researchers have found being female, Hispanic, highly educated or living alone protect against Alzheimer’s disease.
- The researchers also found the intersectionality of gender with primary language affected whether individuals with Alzheimer’s disease pathology would display Alzheimer’s symptoms prior to death.
- Dr. Lilah Besser and team studied 3,107 people who had brain autopsies after being clinically followed by Alzheimer’s Disease Research Centers across the country, focusing on those whose brains showed Alzheimer’s pathology at autopsy but never displayed enough symptoms to warrant a diagnosis of cognitive impairment or dementia.
Protective factors against symptomatic Alzheimer’s disease include being female, Hispanic, highly educated or living alone, according to a new study by University of Miami Miller School of Medicine researchers.
Even more, the researchers found that the intersectionality of gender with primary language affected whether individuals with Alzheimer’s disease pathology would display Alzheimer’s symptoms prior to death.
“The multiple social identities of a person – Black woman, Hispanic man – differentially affect the risk of developing Alzheimer’s disease,” said lead author Lilah Besser, Ph.D., M.S.P.H., research assistant professor of neurology at the Miller School’s Comprehensive Center for Brain Health in Boca Raton. “This study really demonstrates the importance of looking at the intersectionality of social determinants of health for future Alzheimer’s studies.”
The study was published in the Journal of Alzheimer’s Disease in October.
Social Determinants of Alzheimer’s Disease
Dr. Besser was at the forefront of researchers analyzing social determinants of health that influence the risk for Alzheimer’s disease when this area of study blossomed in the last decade. After having long focused on how the neighborhood environment influences social determinants of health and Alzheimer’s risk, Dr. Besser turned her attention to individual-level determinants and the intersectionality between them.
She and her colleagues focused on a cohort of 3,107 people who had brain autopsies after being clinically followed by Alzheimer’s disease research centers across the country, focusing on those whose brains showed Alzheimer’s pathology at autopsy but never displayed enough symptoms to warrant a diagnosis of cognitive impairment or dementia.
“What social determinants may be protective against displaying Alzheimer’s symptoms even though someone has Alzheimer’s pathology in their brain?” Dr. Besser said. “We found that as individual predictors, women, people with more years of education and people who identified as Hispanics were more likely to have asymptomatic disease.”
The Impact of Primary Language
The team then looked at gender in combination with other social determinants of health to see if they could predict who would display symptoms of Alzheimer’s disease. They found women were less likely to remain asymptomatic if their primary language was one other than English.
Why might this be the case?
“We hypothesize that women whose primary language is not English may have come from countries where educational opportunities were offered less often to women than to men or they may not have had the same quality of education given to men,” Dr. Besser said.
The multiple social identities of a person – Black woman, Hispanic man – differentially affect the risk of developing Alzheimer’s disease.
—Dr. Lilah Besser
An alternative explanation, she said, could be that the diagnostic evaluations do not account for those whose primary language is not English.
“Does having a different primary language impair someone’s ability to complete cognitive exams because of cultural or language barriers?” Dr. Besser asked. “We are calling attention to make sure we are making culturally tailored diagnostic evaluations.”
The study’s co-authors are:
• Medical students Anthony Fuentes (M.D., M.P.H. ’27) and Jessica Zhang (M.D. ’26)
• Deirdre O’Shea, Ph.D., assistant professor and clinical neuropsychologist at the Miller School
• James Galvin, M.D., M.P.H., professor of neurology, chief of the Division of Cognitive Neurology, director of the Comprehensive Center for Brain Health and director of the Lewy Body Dementia Research Center of Excellence.
Tags: Alzheimer's disease, cognitive decline, Comprehensive Center for Brain Health, Dr. James Galvin, Dr. Lilah M. Besser, lifestyle medicine, neurology, USNWR Geriatrics, USNWR Neuro