![Headshot of Dr. James Ellison](/sites/default/files/styles/1_1_320x320/public/2021-07/dr._james_ellison_new_0.jpg?h=fc4d08be&itok=14OzJmuh 320w, /sites/default/files/styles/1_1_640x640/public/2021-07/dr._james_ellison_new_0.jpg?h=fc4d08be&itok=s_Rt_Rg5 640w)
James M. Ellison, MD, MPH
James Ellison, MD received his medical degree from UCSF in 1978 and trained in psychiatry at the Massachusetts General Hospital (1979-1982).
Swank Center for Memory Care and Geriatric Consultation, ChristianaCare
Learn about the roles that one’s sex (determined by genes and chromosomes), and gender (social role and preferred orientation) play in the risk for developing Alzheimer’s in women. We examine how they may impact the course of the disease.
Elise’s husband noticed her memory problems before anyone else did.* Elise, an 82-year-old mother of 3 and a retired attorney, was skillful at covering up her memory lapses. Her supportive husband covered for her occasional lapses, and with his help, she was able to manage routine activities at home until his death from a heart attack. In the wake of his death, Elise’s children saw that their mother was having considerable trouble operating her computer, paying her bills, and eventually even keeping on top of household chores. They brought her to a memory clinic for evaluation. There, on the basis of her medical history, examination, cognitive testing, blood tests, and neuroimaging, a diagnosis of Probable Alzheimer’s disease (AD) was made. Elise was no longer able to live independently. Her son, Alan, invited her to move in with him and his wife, Ann. Ann, a busy realtor, took on the additional role of providing most of Elise’s care. In the beginning, Elise didn’t need much help, and caregiving wasn’t very stressful.
Her disease, though, progressed quickly. She remained a gentle and considerate woman with a charming social manner, but Ann found it stressful to console Elise once she developed fearful and suspicious delusions about her safety in Alan’s and Ann’s home.
*Vignettes are fictionalized to protect the confidentiality of the individuals whose stories inspired them.
AD, if we look at the evidence, is a much larger burden for women than for men. Nearly two-thirds of people diagnosed with AD are women. A similar proportion of caregivers is women. As a woman, Elise’s sex (determined by her inherited sex chromosomes) and her gender (her social role and preferred orientation) play important roles in her risk for developing AD and for the course her disease will take. Clinicians and researchers have been learning more about this issue lately, and here are some of the things they’ve found:
Rocca WA, Mielke MM, Vemuri P, et all. Sex and gender differences in the causes of dementia: a narrative review. Maturitas 2014;79:196-201.
Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer's disease: assessing sex and gender differences. Clinical Epidemiology 2014;6:37-46.
Podcasy JL, Epperson Neill. Considering sex and gender in Alzheimer disease and other dementias. Dialogues in Clinical Neuroscience 2016;18:437-446.
Nebel RA, Aggarwal NT, Barnes LL, et al. Understanding the impact of sex and gender in Alzheimer's disease: A call to action. Alzheimer's & Dementia 2018;1-13.
Kiamura T, Kitamura M, Shoryoku H, et al. Gender differences in clinical manifestations and outcomes among hospitalized patients with behavioral and psychological symptoms of dementia. J Clin Psychiatry 2012;73:1548-1554.
Canevelli M, Quarata F, Remiddi F, et al. Sex and gender differences in the treatment of Alzheimer's disease: A systematic review of randomized controlled trials. Pharmacological Research 2017;115:218- 223.
James Ellison, MD received his medical degree from UCSF in 1978 and trained in psychiatry at the Massachusetts General Hospital (1979-1982).
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