SAN DIEGO — Two-thirds of Alzheimer's cases are women, and researchers from the University of California San Diego have received a $5.2 million grant from the National Institutes of Health to expand their study as they work to determine why. The additional funding allows researchers to include more participants for their "Women: Inflammation and Tau Study," also known as WITS.
Dr. Sarah Banks and Dr. Erin Sundermann are leading the study, as they work to determine why women are more likely to be diagnosed with Alzheimer's, and why it appears the disease is more aggressive in women, compared to men.
"I found that daunting. I did not expect that," said Julia Abremski, after learning women make up the majority of Alzheimer's cases. Her brother, Mark, is living with Alzheimer's disease, so when she learned about the UC San Diego study, she stepped up to volunteer.
"If the people coming after us can benefit from what's learned from our bodies, bring it on," Abremski said.
Researchers are looking to see how lifestyle and biological factors interrelate, including sleep, physical activity, diet, sex hormones and inflammation. They're studying how these factors could be leading to more brain changes in women versus men.
"Definitely, women live longer than men, but that's not all that's accounting for it," said Dr. Banks. "There's something else that's driving this excess of disease in women, and we're really fascinated by that." She also said they know things like exercise have more of a modifying effect on women when it comes to reducing cognitive decline. "So we kind of want to know why that is," continued Dr. Banks, adding, "We think that maybe inflammation might have something to do with it."
The researchers say women also have a greater tau burden in their brain. "This is one of Alzheimer's hallmark pathologies that occurs, and it's the pathology that's most closely related to cognitive performance," said Dr. Erin Sundermann, "and so what we're doing is trying to find out why." She explained tau is a misfolded protein in the brain that creates a tangle and then wreaks havoc on neurons and affects cognitive function.
Now, researchers are expanding WITS to include a total of 110 people, thanks to the $5.2 million grant from the National Institutes of Health. "We're definitely hoping to get more participants," said Dr. Banks. They hope to learn how they might be able to change the trajectory of the disease for people who are at risk.
Abremsky's brother was diagnosed in his late 60's. "Watching somebody that you know and love, lose themselves, just lose themselves," she said, has been difficult, which is why she wants to do what she can to help find a cure. Abremsky said she wants to "share what we're going through to help our daughters or granddaughters."
Participant Carole Franks says her mother was diagnosed at the age of 62. "It was very hard to watch, to see that happen," she reflected.
She often finds herself worrying, thinking, "Every time I forget a word, it's like, oh, is it happening to me?" Franks, a runner, is now 75 and stays active to help keep her mind sharp. "I exercise every day. It's just who I am. It makes me feel good. I like the endorphin kick. I try and eat healthy, you know, I'm at the age now where my friends are dying," she said. "So, I want to learn everything I can, and know everything I can, and whatever I can do to help others, I'm there. I'm ready."
The study is largely non-invasive but does include a spinal tap. Doctors are looking to see if inflammation might be driving that excess buildup of tau in women's brains.
"We're measuring inflammation in the central nervous system, which involves the brain and the spinal cord," said Dr. Banks. She explained, "We actually ask women in the study if we can take a little bit of their cerebrospinal fluid, which is the fluid that goes around the spinal cord and the brain. So, we're really almost directly measuring inflammation in these women's brains, which is really important. It's a big ask for these women to go through the lumbar puncture procedure to give us that CSF, but it's incredible the amount of information that we can get from that, because we're really directly measuring the inflammatory process in the brain."
The researchers are deeply appreciative of the women who have volunteered for the study. "They come in for several visits, and they go through brain scans, cognitive testing, lumbar puncture. They also wear these wearables and fill out questionnaires. So, we ask a lot from people and it's not for everyone, but if somebody is invested in Alzheimer's disease and aging, and wants to kind of give back in that way and is able to do it, we would love to hear from them," Dr. Banks said.
There is also strong evidence linking quality and quantity of sleep to the risk of Alzheimer's disease. Dr. Sundermann said they're trying to determine why. She said one theory is that during sleep, "the brain actually has a cleaning mechanism" to flush out those amyloid plaques. "And at night when we're in REM sleep," she said, "is when that those plaques tend to be cleared out."
One preliminary finding is the role sleep apnea may play in women's health. The women in the study take a sleep apnea test, and researchers say between 75 and 80 percent of the participants had some level of sleep apnea, meaning they weren't getting quality sleep, and not enough oxygen to the brain. Most weren't aware of any symptoms prior to the diagnosis. Researchers say they referred those participants for follow-up with a physician for the condition, which is known to affect brain health and is treatable. WITS is a blind study, meaning you won't get any personal information from the study, unless researchers make a significant health finding.
In order to participate in WITS, you must be at least 65 years old, commit to a 24 month period, and go through a screening process.
By studying more women and determining which factors drive changes in the brain, researchers are hoping to identify ways people can reduce the risk of Alzheimer's.
Find out more about the study and if you are interested in participating, contact WITS at 858.761.3802 or via email at: wits@health.ucsd.edu.
WATCH: Erin Sundermann, PhD - Women: Inflammation and Tau Study (WITS):