A Hidden Path to Alzheimer’s Disease for Women

In packed stadiums across America, researchers carefully track every hit a football player takes. Millions of dollars flow into studies documenting how repeated impacts affect athletes’ brains, and medical teams stand ready to assess cognitive function after every suspected concussion. The data are meticulous, the concern is real, and the connection to long-term brain health is now undeniable.

Meanwhile, behind closed doors in homes across the same cities, millions of women suffer concussions and traumatic brain injuries that often go completely undocumented. Worldwide, 30% of women experience intimate partner violence (IPV), and over 90% report injuries that physicians suspect cause a brain injury.

“The stigma around discussing IPV is still significant, much like the stigma around dementia and around cancer in the past,” said Cheryl Wellington, PhD, a BrightFocus Foundation Alzheimer’s Disease Research-funded scientist who has researched the link between traumatic brain injury and Alzheimer’s disease. “Many people have known someone affected by IPV, similar to the experience of dementia.”

Just as breakthroughs in cancer and dementia research accelerated when people began talking openly about these diseases, IPV-related brain injury may be poised for its own moment of recognition.

Until recently, there was little consideration given to whether these hidden brain traumas might be creating a silent path to dementia.

That began to change when compelling new data came forward on women who had survived chronic IPV. The test results were troubling, said Dr. Wellington, as multiple areas of memory and thinking showed measurable dysfunction.

When she looked at these cognitive test results from IPV survivors, she realized something striking: if a dementia specialist saw these same patterns without knowing their cause, they may suspect early Alzheimer’s disease.

The Tale of Two Brain Injuries

The contrast between how researchers study sports-related brain trauma versus IPV is staggering. Sports teams and military units provide perfect research conditions—baseline cognitive tests, witnessed injuries, willing participants, and supportive families. The funding flows accordingly, creating comprehensive research programs that have revolutionized our understanding of how repeated brain trauma leads to cognitive decline.

But IPV presents the opposite scenario. IPV-caused brain injuries are highly stigmatized and often go unreported. When women do seek medical care, providers sometimes focus on visible injuries like broken bones and bruises, missing the brain trauma entirely. There are often no witnesses except perpetrators, no baseline cognitive tests, and no systematic follow-up.

As Dr. Wellington noted, most women who experience physical assault by a partner also suffer blows to the head as well as nonfatal strangulation—both capable of causing brain injury. Yet healthcare professionals rarely recognize the potential for brain damage in these cases.

This oversight may be hiding a significant pathway to Alzheimer’s disease. Most neurologists and memory clinic specialists don’t systematically ask about histories of brain trauma, let alone IPV. As Dr. Wellington discovered through conversations with colleagues, “many believe they have never seen a patient with a history of IPV, which is statistically unlikely.”

In response, Dr. Wellington and colleagues are creating a clinical practice guideline for dementia researchers to specifically ask about IPV in clinical history.

A More Complex and Dangerous Injury

The brain injuries from IPV aren’t just understudied—they may actually be more dangerous than those seen in sports. “The major differences between IPV-related brain injuries and other types of traumatic brain injury are their complexity,” Dr. Wellington explained.

IPV-related injuries often combine repeated head impacts with nonfatal strangulation. This strangulation component sets these injuries apart from those seen on football fields. It can cause loss of consciousness, dangerous increases in brain pressure, complete loss of blood flow to the brain, and increased risk of artery damage.

This combination may create particularly problematic brain damage. While chronic traumatic encephalopathy, found in some athletes, has captured public attention, IPV cases appear to follow a different pathway. The largest study of IPV-related brain injury to date has found evidence of vascular damage, suggesting these injuries might increase dementia risk through blood vessel problems in the brain rather than the protein accumulations seen in chronic traumatic encephalopathy or typical Alzheimer’s disease.

The Alzheimer’s Connection We’re Missing

Dr. Wellington believes this vascular pathway to cognitive decline may represent an opportunity for Alzheimer’s research and prevention. We know that problems with brain blood vessels can contribute significantly to dementia, yet we may be missing millions of women whose vascular damage began decades earlier with IPV.

“The stigma around discussing IPV is still significant, much like the stigma around dementia and around cancer in the past.”

The early signs are already visible in survivors. Women who have experienced chronic IPV show cognitive dysfunction patterns that span multiple areas of memory and thinking. They also frequently experience sleep disturbances, stress, depression, and anxiety—all factors that can accelerate cognitive decline. These symptoms are often attributed to psychological trauma rather than considered potential markers of brain injury.

Dr. Wellington’s insight into what a geriatric neurologist might think when seeing these cognitive patterns is particularly striking. If the same test results appeared in a 65-year-old woman without known IPV history, they might prompt immediate concerns about early dementia and trigger comprehensive workups. But because the IPV history is hidden or ignored, the brain injury component often goes unrecognized.

A Critical Research Opportunity

Dr. Wellington believes this hidden population could represent an opportunity to understand more about the vascular contributions to dementia. While most Alzheimer’s research focuses on protein accumulations in the brain, the vascular damage patterns seen in IPV survivors could unlock new insights into how blood vessel injuries accelerate cognitive decline, knowledge that could benefit all dementia patients.

Yet the research field remains in its infancy. “There really hasn’t been enough work done on IPV-related brain injury to even think about what may be surprising versus not. We know very little about its neuropathology,” Dr. Wellington said.

Most importantly, this population could help us understand the critical timing of dementia prevention. Dr. Wellington noted that unlike studying 70-year-olds who already show cognitive symptoms, IPV survivors often experience their brain injuries in their 20s, 30s, and 40s, giving researchers a decades-long window to study how dementia risk develops and potentially intervene before symptoms appear.

The Stakes for Alzheimer’s Research

If IPV-related brain injuries do increase Alzheimer’s risk, scientists may be overlooking a preventable contributor to dementia in millions of women. Unlike genetic risk factors that can’t be changed, IPV is a social problem with solutions. But only if we recognize its connection to long-term brain health, Dr. Wellington said.

“I wish more people understood that there may be a connection between IPV, traumatic brain injury, and Alzheimer’s risk,” she said. She draws parallels to the early days of research into sports-related concussions, when the long-term consequences were similarly unknown.

Dr. Wellington and others working in this emerging field believe that many women who are experiencing cognitive problems may have a history of brain injuries from IPV that were never identified in memory clinics. Some may be diagnosed with Alzheimer’s. Others may be told their symptoms are due to stress or aging. But without asking about past violence or potential head trauma, clinicians may be missing a key piece of the puzzle.

Understanding the long-term effects of IPV-related brain injury could reshape how researchers approach Alzheimer’s risk, especially in women. It could open new avenues for prevention and intervention, decades before symptoms begin. But first, we have to acknowledge what’s been hiding in plain sight all along.