Alzheimer’s in women remains dangerously underdiagnosed despite major breakthroughs in research and care, experts have told The National.
While science is transforming how the disease is managed, caregiver support and sex-specific diagnosis are still lagging behind – especially for women, who make up the majority of patients. Now a movement is building in Abu Dhabi to change that.
Hanan Sheikh Ibrahim, a staff physician in neurology at the Cleveland Clinic Abu Dhabi Neurological Institute, said evolving science is transforming the way the illness is viewed.
“There is a revolution now in Alzheimer’s management,” she said. “It is no longer a terminal illness. It is a disease we can manage – and you can reduce the risk. Alzheimer’s is now detectable and up to 40 per cent preventable and manageable, but only if we detect it early.”
Her comments about the need to raise awareness on the issuewere made against the backdrop of World Alzheimer's Day, taking place on Sunday, September 21.
Women at the epicentre – but often overlooked
Worldwide, at least 55 million people are believed to be living with Alzheimer's disease or other forms of dementia.
Dr Ibrahim said women are both more vulnerable and more likely to be overlooked for testing.
“For every three people with Alzheimer’s, two are women,” she said. “Yet women are diagnosed, on average, three years later than men. Millions are being missed worldwide because their early symptoms are dismissed as menopause or stress.”
This is not just a clinical gap – it is a structural blind spot, she said.
Why gender specific tools matter
Globally, the majority of Alzheimer’s research over the past century has been conducted in male animals or male-predominant cohorts.
As a result, the distinctive trajectories of women’s cognitive ageing have remained obscured – until now.
Women are at the epicentre of Alzheimer’s as patients, caregivers, and advocates. More than 60 per cent of family caregivers for dementia are women, and yet, they are also the ones most at risk for developing cognitive decline themselves.
Dr Ibrahim said that falling oestrogen levels during midlife create a “neuroendocrine inflection point” that affects the hippocampus and prefrontal cortex – regions critical for memory and multitasking.
“Menopause is not only about the ovaries,” she said. “It is a brain event. We now call it the ‘menopause brain’ because the changes extend to mood, sleep, memory and metabolism.”
Women often present with brain fog, slowed task-processing or difficulty multitasking, which can be confused with normal menopause.
“They feel ashamed, they think it is hormonal, and they delay getting checked,” she said. “Some are told ‘it’s all in your head’– and during those lost years, mild cognitive impairment can silently progress.”
Different biology, different tools
Dr Ibrahim said standard unisex memory tests can fail to pick up early disease in women.
“Women naturally have stronger verbal memory, so they outperform men and pass the test even when disease is present,” she said. “We now use female-specific questionnaires, blood biomarkers and imaging pathways to distinguish temporary menopausal brain fog from mild cognitive impairment, which is the reversible stage before dementia.
“For decades, animal and human studies were built on male models. Only in 2016 did the US National Institutes of Health mandate sex as a biological variable. When you research the wrong model, you get the wrong results.”
In response to these gaps, Abu Dhabi has become a pioneer.
At Cleveland Clinic Abu Dhabi, clinicians are piloting the use of Female-Enhanced MCI Detection Tool (FEMCI) and Functional-Adjusted MCI Index (FAMCI), as part of a broader movement towards precision brain health for women.
Hormones and prevention
Oestrogen, she stated, acts as a buffer against memory loss, mood disorders, inflammation and even the way the brain uses energy.
“Oestrogen receptors are concentrated in the hippocampus, where memory is formed,” she said.
“When oestrogen drops suddenly, some women develop symptoms and some progress to disease, depending on their genes and other risk factors.”
Hormone-replacement therapy (HRT) can help some women if prescribed within a “window of opportunity” – about five to 10 years after menopause but must be carefully stratified.
“It is not a one-size-fits-all treatment,” Dr Ibrahim said. “A good menopause doctor must weigh the benefits for brain health against the risks for cancer or blood clots. Used correctly, oestrogen can support memory, multitasking and even metabolic health.”
Trials have shown that HRT may preserve brain volume and verbal memory if started early. Abu Dhabi’s clinicians are applying these findings in real-world care.
The bigger picture
She believes the UAE should launch a women’s brain health campaign as ambitious as its breast-cancer awareness drives.
“Alzheimer’s kills more women than breast cancer,” she said. “We have done a great job in preventing breast cancer and osteoporosis. Now we need the same urgency for women’s brain prevention. The earlier we intervene, the more lives we can protect.”
Abu Dhabi, she said, is uniquely positioned to lead the region and the world in this space.
With access to advanced brain imaging, cutting-edge biomarker labs, and culturally tailored digital tools, the city is setting a new global standard for how women’s cognitive health should be protected.
“We are building a new clinical model here,” Dr Ibrahim said. “It’s not just about treatment – it’s about early detection, empowerment, and redefining women’s health from the neck up.”
Five tips for women in midlife to be aware of
• Know your risk factors: family history, sleep apnoea, diabetes, autoimmunity
• Track your brain symptoms: memory changes, word-finding, task-switching
• Address hormonal transitions early: discuss HRT with a qualified provider
• Exercise your mind and body: movement, learning, language, and connection
• Do not delay testing: ask for a sex-specific cognitive evaluation
Dr Nasir Alzbeidi, chairman of the Mental Health Council at Sakina (SEHA) and consultant in geriatric psychiatry and cognitive neuropsychiatry at Sheikh Shakhbout Medical City, said early diagnosis remains critical even without a cure.
“Diagnosis matters,” he said. “It helps us predict, improve quality of life and safeguard patients and families. Education alone reduces psychological symptoms.”
While scientists still do not know why the disease strikes some people and spares others, powerful risk factors are clear: diabetes, hypertension, high cholesterol, smoking, alcohol use, poor hearing or vision and low educational attainment. Controlling these can delay onset by decades.
“Getting Alzheimer’s at 60 instead of 85 is 25 extra years of quality life,” Dr Alzbeidi said.
New but limited treatments
Monoclonal antibody therapies now available in specialist centres target amyloid proteins in the brain and can slow decline by about 20 per cent. But they carry risks such as brain bleeds and must be administered by experienced teams.
Both doctors stressed that no single blood test or scan is definitive.
“A positive result on its own can be misleading,” Dr Alzbeidi said. “Reversible causes such as vitamin deficiency or thyroid problems must be ruled out meticulously before giving a life-changing label.”
Community gaps
Beyond medicine, the UAE needs to do more to support families.
“We need Alzheimer’s associations and volunteer-run support groups,” Dr Alzbeidi said. “Doctors have limitations. Families who have lived the journey can share invaluable advice. Other countries have had these networks for decades – we are a young nation and need to build them.”
