Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease

Neurotherapeutics. 2023 Jul;20(4):1019-1036. doi: 10.1007/s13311-023-01408-x. Epub 2023 Jul 25.

Abstract

It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.

Keywords: Alzheimer’s disease; Biological sex; Dementia; Ethnicity; Health disparities; Racial disparities; Vascular.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Alzheimer Disease* / epidemiology
  • Alzheimer Disease* / ethnology
  • Black or African American* / statistics & numerical data
  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Humans
  • Intersectional Framework
  • Patient Selection
  • Prevalence
  • Sex Factors
  • United States / epidemiology