Sex, Gender & Brain Health: why we can’t forget to factor in females
BY: Laura M. Best
If you’ve ever completed a Canadian Institutes of Health Research (CIHR) grant application, then you’re familiar with these questions: Is sex as a biological variable and is gender as a socio-cultural factor taken into account in your research? On the surface, this seems like an obvious consideration. Personally, I run a neuroimaging trial in humans, so I recruit equal numbers of men and women and then inquire about non-binary gender considerations–easy. Digging deeper, however, the concept influences how you write your protocol, how you recruit and conduct your research methods, how you interpret and communicate the data; essentially, how you are operating as a scientist.
Being mindful of sex and gender in both basic and clinical research can have critical effects on the outcomes and can also guide new research directions. Many diseases affecting the brain and mental health, for example, are more prevalent in women. Consider dementia: two-thirds of those affected in Canada are female1. Even after taking into account differences in life-span, women are at a significantly higher risk for dementia compared to men, and we now know that sex differences exist in amyloid and tau protein accumulation2. Despite these differences, however, research has historically used male subjects. This neglects the nuances that are specific to females, including differences in brain structure and function, immune system functioning, and hormones, to name a few. While modern scientific research is making strides in this area, there is still work to be done.
One charity that is making an impact in this space is Women’s Brain Health Initiative (WBHI)3, and I have had the pleasure of serving as the Vice-Chair on their Young Person’s Cabinet, a board of appointed young-achievers, for 2 years. Founded in Toronto in 2012, WBHI is solely dedicated to protecting the brain health of women. Through the motivation to help women stay connected longer to a meaningful life, WBHI has funded research and founded education programs across North America. Their advocacy work has even led to the very questions that we are all too familiar with regarding sex and gender factors on our applications. In partnership with CIHR, WBHI established and currently funds the world’s first Research Chair in Women’s Brain Health and Aging, which was awarded to Dr. Gillian Einstein, a neuroscientist investigating the effect of sex and gender in dementia and depression at the University of Toronto. The charity has also partnered with the Canadian Consortium on Neurodegeneration in Aging, a group of 350+ clinicians and researchers across Canada dedicated to advancing research in age-related neurodegenerative diseases, to support their Women, Gender, Sex and Dementia program within the affiliated 350+ research labs across Canada.
A jarring finding from recent research is that neurodegeneration and plaque accumulation can occur decades prior to the first symptoms of dementia in both men and women4. While this reality is not lost on the charity or it’s Young Person’s Cabinet, it is not common knowledge among young adults and millennials; the general population may not be aware of the connections between sex, gender and dementia, let alone how lifestyle choices during young adulthood can influence one’s risk of dementia and other diseases affecting the brain. In an effort to communicate new and reliable research discoveries such as these, WBHI hosts educational events across Canada, such as the Engaging Millennial Minds series, which pair scientists with refreshments and fun activities to facilitate an engaging, accessible learning environment.
From my involvement with the charity, and my own research, I have learned that this landscape is not barren or hopeless. Rather, we are on the cusp of exciting discoveries that can empower millennials and women to engage in neuroprotective lifestyle choices such as eating a healthy diet, scheduling regular physical activity and adequate sleep, staying socially active and reducing the effects of stress through mindfulness and yoga. But this and other reliable research needs to be conducted in such a way that it considers our entire population, specifically women. As students, young adults, young clinicians, and young scientists, we are in the perfect position to make an impact in the broader context of women’s health when we choose to take gender and sex differences into consideration on multiple levels within science, medicine and research. Oh, and be sure to take care of your brain, too.
- Public Health Agency of Canada. Dementia in Canada, including Alzheimer’s Disease: Highlights from the Canadian Chronic Disease Surveillance System. 2017.
- Buckley R, Mormino E, Rabin J, et al. Sex Differences in the Association of Global Amyloid and Regional Tau Deposition Measured by Positron Emission Tomography in Clinically Normal Older Adults. JAMA Neurol 2019; 76(5): 542-51.
- Women’s Brain Health Initiative. https://womensbrainhealth.org/.
- Younes L, Albert M, Moghekar A, Soldan A, Pettigrew C, Miller MI. Identifying Changepoints in Biomarkers During the Preclinical Phase of Alzheimer’s Disease. Frontiers in Aging Neuroscience 2019; 11