A new analysis suggests Alzheimer’s disease may be missed for longer in women because commonly used verbal memory tests can look “normal” even as brain changes accumulate. Researchers say this delay could matter for treatment timing, since medications such as
On an ordinary test day, a woman may sound fine.
In Alzheimer’s clinics, patients are often asked to learn a list of 15 words, recall them right away, then recall them again later after distraction. The simplicity is deliberate. It’s a verbal memory check built to catch early warning signs of Alzheimer’s disease.
But a new study suggests that for many women, that same pattern can mislead.
Women tend to have more robust verbal memories than men, and the researchers behind this work say that strength can mask signs of early Alzheimer’s—even when Alzheimer’s pathology is already building in the brain. The hallmark they point to is clumps of misfolded amyloid proteins.
Ralph Martins at Edith Cowan University in Perth, Australia, who was not involved in the research, frames the issue plainly: “We are starting to recognise that gender differences in Alzheimer’s is a big issue.”
The study—led by Sasha Novozhilova at McGill University in Montreal and her colleagues—pulled together data from two large, long-term studies in the US and Canada. Across both, older adults underwent regular cognitive testing and brain imaging, and some eventually developed Alzheimer’s.
In that setup, many female participants continued to pass the verbal memory test even after significant Alzheimer’s pathology had accumulated. On average, they maintained “normal” test scores for 2.7 years longer than male participants with the same pathology.
Novozhilova points to a familiar baseline difference. Across the lifespan. women tend to have better verbal memory than men. which may give them more “cognitive reserve”—a buffer the brain can draw on as early disease changes begin. She also points to the possibility that women may have stronger connectivity within the brain: “Females seem to have better connectivity within their brains. so it might be the case that if one part starts to deteriorate. there are lots of connections around it that can help to maintain normal cognition.”.
But reserve has a limit. When it runs out, her concern is that the brain’s apparent stability can flip quickly. Team member Louis Collins, also at McGill University, warns that if treatment is delayed until later stages, it may come too late to help.
New medications—lecanemab and donanemab—have been found to slightly slow the progression of Alzheimer’s. but Collins says they need to be taken at a relatively early stage in the condition to work. That timing mismatch may be part of why women have not responded as well to the drugs in clinical trials. he adds. because they receive treatment at a later stage.
Novozhilova puts the contrast in stark terms: “Women’s brains seem to be able to compensate for the accumulating pathology for longer than men’s, but at a certain point, they can no longer compensate, and instead of a slow decline, they have a rapid loss of function.”
If verbal memory tests are reading the brain too conservatively in women. she argues that the approach may need to change. To detect Alzheimer’s earlier in women. she says clinicians may have to interpret verbal memory test scores differently and use different thresholds for considering underlying pathology.
There’s another possibility, and it’s not based on memory at all. Martins says screening could shift to blood tests for all women once they reach a certain age—tests designed to pick up early Alzheimer’s disease before memory problems become apparent. If the condition is detected. he says there are also non-pharmacological ways to slow progression. including brain training tasks. exercise. and the MIND diet.
What remains uncertain is why the baseline verbal advantage exists in the first place. The researchers say it’s unclear why women have better verbal memory on average while men tend to remember spatial information better. though they suggest there could be evolutionary reasons. In the past. Novozhilova says. women may have had to hone verbal skills to communicate within their community and pass knowledge to their children. while men went out to hunt. She also points to a modern-life factor: a higher proportion of women work in jobs such as writing. editing. nursing. teaching. and office administration—roles that may further strengthen verbal memory.
Taken together, the finding is more than a statistic about test performance. For people living through early Alzheimer’s, the difference between a “normal” score and an earlier diagnosis can be measured in years—and those years can determine whether treatments arrive in time.
Alzheimer’s women verbal memory tests amyloid pathology lecanemab donanemab cognitive reserve blood screening MIND diet