In a local memory care unit not long ago, I walked into a community room where ten dementia patients were up in recliner chairs or sitting in chairs around tables. Eight of those were women. The two at tables were men working on activities. All of the women were in recliner chairs with vacant looks in their eyes. The significance didn’t really hit me until I read a recent article in JAMA Neurology.
The authors looked at five studies and found gender differences in the degree of amyloid plaque build up on imaging, tau protein blood levels, and rate of cognitive decline. Women showed tau tangle pathology in more regions of their brains than men, and faster cognitive decline when tau blood levels are high.
All of the information gathered was to look at implications for early detection, monitoring and treatment that could lead to gender-specific biomarker thresholds. This is all in the backdrop of several tau blood tests that measure different subcategories of proteins (e.g. ALZpath, Lilly, Janssen or C2N) which causes confusion when categorizing what is actually a worrisome number.
I found a general “three zone” approach to categorizing tau blood levels
Positive: Highly likely to have amyloid plaques; may not need a PET scan.
Indeterminate: The result is unclear. Doctors may order an Amyloid PET scan or a cerebrospinal fluid sample to confirm.
Negative: Highly likely to not have Alzheimer’s pathology at this time.
Researchers suggests that once tau protein blood levels hit a"positive" threshold, symptoms will likely begin within 8 to 15 years if left untreated.
I was in the memory care unit assessing several of those folks as a hospice nurse. In my role as a writer of all things dementia and a female, as well as an APOE4 carrier, I have sooo many questions. It makes me recall that heart disease research was focused on men for so many years until we finally understood not long ago that heart attacks look different in women.
Sigh.
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