Sex-specific pathogenesis of Alzheimer’s disease in elderly women: mechanistic insights and therapeutic horizons

There are significant sex differences in the incidence rate, pathological features, and clinical progression of Alzheimer’s disease (AD) in elderly women compared with males. This review systematically summarizes recent research advances in epidemiology, pathogenesis, diagnostic approaches, and therapeutic strategies for AD in elderly women. Epidemiological data reveal higher prevalence rates and accelerated cognitive decline in women with AD, potentially associated with sex-specific effects of the APOE ε4 allele, postmenopausal estrogen depletion, and exacerbated neuroinflammatory responses. In terms of diagnosis, the application of neuroimaging techniques and fluid biomarkers has improved early detection rates, yet there remains a need to further optimize sex-specific diagnostic criteria. Therapeutically, while existing pharmacological agents and nonpharmacological interventions demonstrate some effectiveness, the observed sex differences in therapeutic efficacy necessitate the urgent development of personalized treatment strategies. Future research should integrate emerging technologies to investigate the molecular mechanisms underlying AD in women and strengthen interdisciplinary collaboration to advance the development of gender-sensitive diagnostic and therapeutic approaches. This review aims to provide a theoretical foundation for understanding the unique characteristics of AD in elderly women and optimizing clinical management strategies.