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Beyond Statistics: The impact of neurodegenerative diseases on women

<blockquote>
In this article, we will cover:
<ul>
<li><a href="#What-NDs">What are neurodegenerative diseases?</a></li>
<li><a href="#Why-NDs">Why study sex and gender differences in neurodegenerative diseases?</a></li>
<li>How are women affected by:
<ul>
<li><a href="#AD">Alzheimer&rsquo;s disease</a></li>
<li><a href="#PD-NDs">Parkinson&rsquo;s disease</a></li>
<li><a href="#ALS">Amyotrophic lateral sclerosis (ALS)</a></li>
<li><a href="#MS-NDs">Multiple sclerosis (MS)</a></li>
</ul>
</li>
<li><a href="#Resources">Where to get more information on neurodegenerative diseases in women</a></li>
</ul>
</blockquote>
The first person diagnosed with&nbsp;<a target="_blank" href="https://wmnhealth.org/blog/a-short-guide-to-alzheimers-disease-in-women/" class="editor-rtfLink" rel="noopener">Alzheimer&rsquo;s disease</a>&nbsp;(AD), the most common form of dementia, was a woman. It wasn&rsquo;t just chance. Females are disproportionately affected by the disease, so much so that today, it is widely recognized that about&nbsp;<a target="_blank" href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00249-8/fulltext" class="editor-rtfLink" rel="noopener">two-thirds of people with Alzheimer&rsquo;s disease worldwide are female</a>.&nbsp;
AD is a neurodegenerative disease &mdash; a condition characterized by the progressive degeneration or death of nerve cells in the brain or peripheral nervous system. Other common examples are&nbsp;<a target="_blank" href="https://wmnhealth.org/blog/what-is-parkinsons-disease/" class="editor-rtfLink" rel="noopener">Parkinson&rsquo;s disease</a>, amyotrophic lateral sclerosis (ALS), Huntington&rsquo;s disease, and&nbsp;<a target="_blank" href="https://wmnhealth.org/blog/what-is-multiple-sclerosis/" class="editor-rtfLink" rel="noopener">multiple sclerosis (MS)</a>. These debilitating diseases result in the gradual loss of cognitive function, motor skills, or both. Specific treatments can relieve some of the physical or psychological symptoms associated with neurodegenerative diseases. But they are currently irreversible, incurable, and far too often a death sentence.&nbsp;
Scientists don&rsquo;t understand why Alzheimer&rsquo;s affects more females than males. The same is true for MS, where&nbsp;<a target="_blank" href="https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Women-with-MS#:~:text=MS%20is%203%20times%20more,it%20means%20for%20your%20fertility." class="editor-rtfLink" rel="noopener">females with the disease outnumber males approximately three to one</a>. In Huntington&rsquo;s, where females and males have an equal risk of developing the disease,&nbsp;<a target="_blank" href="https://wmnhealth.org/blog/the-neglected-science-of-huntingtons-disease-in-women/" class="editor-rtfLink" rel="noopener">symptoms appear more severe in females than males</a>. The question is, why?&nbsp;
The answers aren't clear-cut. These conditions are complex and multifactorial. For example, the likelihood of developing a neurodegenerative disease increases dramatically with age &mdash; and globally,&nbsp;<a target="_blank" href="https://ourworldindata.org/why-do-women-live-longer-than-men#:~:text=Women%20tend%20to%20live%20longer,expectancy%20is%20not%20a%20constant.&amp;text=Women%20tend%20to%20live%20longer%20than%20men.,versus%2068.4%20years%20for%20men." class="editor-rtfLink" rel="noopener">females outlive males by about 5 years</a>. Genetic, hormonal, lifestyle factors, and even&nbsp;<a target="_blank" href="https://wmnhealth.org/blog/why-gender-inequality-is-a-hidden-driver-of-dementia/" class="editor-rtfLink" rel="noopener">gender inequality</a>&nbsp;likely also play a role in neurodegenerative diseases and how they affect men and women. Also, most brain researchers don't study sex and gender differences. They can't answer questions they aren't asking.
That is beginning to change &mdash; and not a moment too soon. According to the WHO, the number of people living with dementia is expected to rise from 55 million in 2019 to 139 million in 2050 as the population ages. Parkinson&rsquo;s and MS are also on the rise globally, meaning millions more men and women will be living with neurodegenerative diseases. Research is urgently needed to understand how sex and gender influence disease risk, symptoms, and trajectories &mdash; and to develop therapies that are effective for everyone.&nbsp;
In this article, we delve into neurodegenerative diseases, explore their effects on women, and why understanding these nuances is crucial.

<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/0b17c5a8_4335_4c6b_bb8f_1c268084f0ad_5457522b94.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2><a id="What-NDs"></a>What are neurodegenerative diseases?</h2>
Neurodegenerative diseases involve the progressive degeneration of nerve cells, leading to cognitive decline and motor dysfunction. Some, like Alzheimer's, primarily affect nerve cells in the brain responsible for cognition, including memory and reasoning. Others, like ALS, primarily cause movement difficulties due to the progressive loss of motor neurons controlling voluntary muscles. Demyelinating diseases like multiple sclerosis are caused by the loss of cells that act like insulation and facilitate the transmission of signals within the nervous system.&nbsp;
Common neurodegenerative diseases include:
<ul>
<li>Alzheimer&rsquo;s disease</li>
<li>Parkinson&rsquo;s disease</li>
<li>Amyotrophic lateral sclerosis (ALS)</li>
<li>Huntington&rsquo;s disease</li>
<li>Multiple sclerosis (MS)</li>
</ul>
Some of the other neurodegenerative <a href="https://www.mda.org/disease/spinal-muscular-atrophy" target="_blank" rel="noopener">spinal muscular atrophy</a>,&nbsp;<a href="https://www.mda.org/disease/friedreichs-ataxia" target="_blank" rel="noopener">Friedreich's ataxia</a>, <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/frontotemporal-dementia" target="_blank" rel="noopener">Frontotemporal dementia</a>, <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/creutzfeldt-jakob-disease" target="_blank" rel="noopener">prion diseases</a>, and <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies" target="_blank" rel="noopener">Lewy body dementia</a>.
<blockquote>
A note from wmnHealth: Most research has focused on differences related to biological sex (assigned sex) in neurodegenerative diseases and the male-female binary. As a result, little is known about the experiences of transgender, gender-diverse, and non-binary individuals. The terms "men" and "women" are also commonly used in place of "males" and "females," even though the former refers to gender rather than biological sex. This can make it difficult to interpret the results. It also underscores the need for careful design and analysis of research on sex and gender differences.
</blockquote>

<h2><a id="Why-NDs"></a>Why study neurodegenerative disease in women?</h2>
Understanding how neurodegenerative diseases manifest differently in women is crucial for effective diagnosis, treatment, and care. Factors such as hormonal influences, genetic predispositions, and societal roles contribute to unique experiences, making sex- and gender-specific research essential.
<h2><a id="AD"></a><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/9b9b8191_7069_48d5_a91d_c74cc49e2bd7_97d0f7ac81.jpeg" alt="" width="800" height="148" /></h2>
That first Alzheimer&rsquo;s patient was Auguste Deter, who lived near Frankfurt, Germany. She wasn&rsquo;t quite 50 when her dementia symptoms emerged. When Dr. Alois Alzheimer examined her brain after death, he noted it had shrunk in specific areas and contained abnormal deposits. We now know that as neurons are injured and die in Alzheimer&rsquo;s, certain brain regions shrink. Those deposits, called plaques and tangles, are caused by molecular and cellular changes that disrupt brain circuits and ultimately prove toxic to cells. 
<h3>Who&nbsp;gets Alzheimer's?&nbsp;</h3>
Alzheimer&rsquo;s is the most common neurodegenerative disease in the world, affecting <a href="https://www.alz.org/alzheimers-dementia/facts-figures#:~:text=More%20than%206%20million%20Americans%20of%20all%20ages%20have%20Alzheimer%27s,older%20(10.7%25)%20has%20Alzheimer%27s." target="_blank" rel="noopener">1 in 9 people age 65 and older</a>. In the US, about two-thirds of people with AD are female. Older Black Americans and Hispanics are <a href="https://www.alz.org/alzheimers-dementia/facts-figures#:~:text=More%20than%206%20million%20Americans%20of%20all%20ages%20have%20Alzheimer%27s,older%20(10.7%25)%20has%20Alzheimer%27s." target="_blank" rel="noopener">more likely</a> than older White Americans to develop the disease.
<blockquote>
In the United States, about two-thirds of people with AD are female. 
</blockquote>
<h3>What are the common symptoms and early signs? </h3>
The most common early symptom of AD is short-memory memory impairment caused by damage to the circuits that help lay down memories in the brain's hippocampal region. As the disease progresses, other forms of memory become impaired, as well as executive functions &mdash; higher-order mental processes that enable individuals to plan, organize, initiate, and regulate their actions &mdash; and problem-solving. People with the disease may &nbsp;have difficulty finding the right words or understanding what other people are saying, difficulty performing previously routine tasks, as well as personality and mood changes. 
<h3>What do we know about Alzheimer's in women?</h3>
Symptoms: Females&nbsp;with Alzheimer's are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390276/#:~:text=In%20a%20study%20of%20newly,anxiety%2C%20and%20for%20total%20NPS.&amp;text=Several%20other%20studies%20have%20also,AD%20dementia%20compared%20to%20men." target="_blank" rel="noopener">more likely to experience depression and anxiety</a> than males, according to some studies.
Risk factors:&nbsp;Age is a major reason females more than males have Alzheimer's. However, longevity doesn't explain everything. Genetic, biological, and social reasons are also likely to be at play. For example, various forms of the Apolipoprotein E gene, known as APOE, are associated with Alzheimer's. The <a href="https://pubmed.ncbi.nlm.nih.gov/9343467/" target="_blank" rel="noopener">APOE4 form appears to affect females differently</a> than males. Perimenopause and the drop in estrogen levels that accompanies it may also raise the risk of Alzheimer's. On the flip side, the use of hormone replacement therapy during the menopausal transition may <a href="https://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=&amp;ved=2ahUKEwiLhpq2kuqCAxUHkIkEHfxzAxcQFnoECCIQAQ&amp;url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F381%2Fbmj-2022-072770&amp;usg=AOvVaw11-whzzOVE-WhygOU52D-g&amp;opi=89978449" target="_blank" rel="noopener">protect against dementia</a>.
Researchers are beginning to study how the experiences of males and females over a lifetime impact their dementia risk. Some interesting associations have arisen. For example, research has associated work and education with higher cognitive engagement and <a href="https://wmnhealth.org/blog/ask-wmnhealth-what-is-cognitive-reserve/" target="_blank" rel="noopener">cognitive reserve</a>&nbsp;&mdash; a person's resilience to age- and disease-related brain changes. Historically, women have had less access to mentally stimulating jobs and higher education, which may reduce their cognitive reserve and increase their risk of dementia. &nbsp;
Treatment: There is no cure for Alzheimer's, though two disease-modifying therapies have recently been approved by the FDA. These drugs help prevent the build-up of toxic proteins in the brain and show modest benefits in preventing cognitive decline. Unfortunately, the drugs appear to be <a href="https://pubmed.ncbi.nlm.nih.gov/37676096/" target="_blank" rel="noopener">less effective</a> in females than males. More research is needed on sex differences in the response to Alzheimer&rsquo;s therapies.

<h2><a id="PD-NDs"></a><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/76c478e0_0a9c_4c00_81af_ab945966d2e0_f87549d197.jpeg" alt="" width="800" height="148" /></h2>
<h3>Who gets Parkinson's?&nbsp;</h3>
After Alzheimer&rsquo;s, Parkinson&rsquo;s is the second most common neurodegenerative disease. About <a href="https://www.parkinson.org/understanding-parkinsons/statistics">one million people in the US</a> are living with Parkinson's &mdash; a number that is expected to rise to 1.2 million by 2030. Males are at least 1.5 times more likely to have Parkinson's disease than females. However, females have a <a href="https://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=&amp;ved=2ahUKEwjkuJvKx-mCAxUqPDQIHSo1D5IQFnoECA4QAQ&amp;url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F31282427%2F&amp;usg=AOvVaw1ketabJRHAfYYL9-ddkkKK&amp;opi=89978449" target="_blank" rel="noopener">higher mortality and faster progression</a> of the disease. Males also have earlier disease onset than females.
<blockquote>
Females with Parkinson's disease have a higher mortality and faster progression. 
</blockquote>
<h3>What are the common symptoms and early signs?&nbsp;</h3>
PD is a progressive disorder that leads to tremors, muscle stiffness, an unsteady gait, and balance and coordination difficulties. There is also an array of non-motor symptoms associated with PD, including depression, apathy, and sleep disorders, which <a href="https://pubmed.ncbi.nlm.nih.gov/19375664/" target="_blank" rel="noopener">often go unrecognized and untreated</a>, seriously undermining a person&rsquo;s quality of life. As PD progresses, dopamine-producing neurons die, mainly in a brain region called the striatum. The striatum is involved in motor functions like the initiation of movement and cognitive functions like decision-making and emotional processing, and is responsible for many of the cardinal features of PD.&nbsp;Nerve cell loss also occurs in other parts of the brain.
<h3>What do we know about Parkinson's in females?</h3>
"Current literature is scarce and conflicting with how this disease affects women. There are currently no expert opinion guidelines on how to manage PD symptoms in [women]," write Dr. Soania Mathur, Kat Hill, and Dr. Kristi LaMonica in a <a href="https://content.iospress.com/articles/journal-of-parkinsons-disease/jpd230017?resultNumber=0&amp;totalResults=9881&amp;start=0&amp;q=self+image&amp;resultsPageSize=10&amp;rows=10" target="_blank" rel="noopener">commentary</a> about a research initiative focused on women with PD. 
Symptoms: Research suggests females with Parkinson's experience different symptoms, especially non-motor symptoms, and report more side effects and fluctuations in their symptoms than males. Here is a summary.
<img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/3f6cbeca_8146_4e0c_8b64_6c3768683be7_f9c5d4a302.jpeg" alt="" width="800" height="446" />
Risk factors: Estrogen is considered to be a protective factor in the development of PD.
Disease severity and progression: There are sex differences in the severity and progression of Parkinson's. A recent study explored the health factors that may influence PD severity in females. It found that <a href="/are%20associated%20with%20increased%20severity" target="_blank" rel="noopener">sex-specific experiences are associated with increased severity,</a> including depression, perinatal depression, natural childbirth, vitamin B12 deficiency, and hysterectomy, though further research is needed.
Treatment: There is no cure for PD. Current treatments help manage PD symptoms rather than slow or stop disease progression. There is some evidence that <a href="https://www.parkinson.org/library/fact-sheets/women#:~:text=Women%20have%20a%20lower%20risk,most%20frequently%20reported%20side%20effect." target="_blank" rel="noopener">females respond differently to Parkinson's medications and experience more fluctuation </a>in symptoms under treatment than males with the disease.

<h2><a id="ALS"></a><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/db5642e3_1427_4b5b_9193_f4794679db06_07c34cc38a.jpeg" alt="" width="800" height="148" /></h2>
<h3>Who&nbsp;gets ALS?&nbsp;</h3>
ALS, also referred to as Lou Gehrig&rsquo;s disease, is considered a rare disorder, developing in <a href="https://rarediseases.org/rare-diseases/amyotrophic-lateral-sclerosis/#affected">1.5 to 3 per 100,000 people every year</a> in North America and Europe, though some estimates are now as high as 5 per 100,000. Approximately 80 percent of&nbsp;people&nbsp;die within two to five years of being diagnosed.&nbsp;
It is approximately <a href="https://www.als.org/understanding-als/who-gets-als" target="_blank" rel="noopener">20 percent more common in males than females.</a>&nbsp;However, with increasing age, the incidence of ALS (the number of new diagnoses in a year) becomes more equal between men and women.
The onset of ALS tends to be <a href="https://www.mdpi.com/1422-0067/24/7/6354" target="_blank" rel="noopener">earlier in males compared with females</a>. This may be due to the neuroprotective effects of estrogen.
<h3>What are the common symptoms and early signs? </h3>
In ALS, the motor neurons carrying signals from the brain and spinal cord to voluntary muscles &mdash; those that are under conscious control &mdash; gradually deteriorate and die, leading to weakness, atrophy, difficulty with movement and coordination, and paralysis. As the disease progresses, people with ALS lose the ability to walk, talk, eat, swallow, and breathe. Early symptoms include weakness, fatigue, muscle cramping or twitching, stiffness or rigidity. 
<h3>What do we know about ALS in females?</h3>
There has been very little research on sex differences in ALS. However, researchers are evaluating the impact of sex hormones on the immune system in ALS, progression of the disease, and survival.
Symptoms: One study found that&nbsp;<a href="https://www.researchgate.net/publication/49718437_Effects_of_Gender_in_Amyotrophic_Lateral_Sclerosis" target="_blank" rel="noopener">females more often complain of bulbar-onset ALS</a>, a form of the disease that affects neurons in the bulbar region of the brainstem and leads to speech, breathing, and swallowing problems. In contrast, males experience onset in the spinal and limb region. Another study on cognitive impairment in ALS &mdash; which is experienced by about half of people with the disease &mdash; suggested that female patients have <a href="https://jnnp.bmj.com/content/86/5/574" target="_blank" rel="noopener">twice the risk for developing cognitive dysfunction, specifically problems with executive function,</a>&nbsp;than males.&nbsp;
Risk factors: Age is a major risk factor for ALS, with peak incidence occurring between ages 60 and 75. Sex hormones likely influence ALS risk, too. Specifically, females under 60 account for about five percent of ALS patients, but at menopause and 60 years of age, the number of females with the disease jumps to about 30 percent, according to the <a href="https://www.cdc.gov/als/Default.html">U.S. National ALS Registry</a>.

<h2><a id="MS-NDs"></a><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/baa6c91b_68c6_499b_8a46_60da1ef0391a_2018201342.jpeg" alt="" width="800" height="148" /></h2>
<h3>Who gets multiple sclerosis (MS)?</h3>
MS is <a href="https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS#:~:text=The%20recent%20prevalence%20study%20shows,in%20determining%20susceptibility%20to%20MS." target="_blank" rel="noopener">three times more common in females than males</a>, and the typical age of onset is between 20 and 50 years old. Certain types of MS (relapsing MS) are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537319/" target="_blank" rel="noopener">increasing in females</a>. Rates of MS vary geographically, with higher rates observed in regions farther from the equator, including Canada. Its prevalence is increasing globally.
<h3>What are the common symptoms and early signs? </h3>
MS is a chronic autoimmune condition where the immune system mistakenly attacks the myelin &mdash; an insulating layer, or sheath, that forms around nerve cells &mdash; in the central nervous system. This leads to scar tissue formation (sclerosis) and disrupts communication between the brain and the rest of the body.&nbsp;Symptoms vary widely. The most common are fatigue, visual disturbances, difficulty walking, numbness, and problems with coordination. MS can affect cognitive function, leading to problems with memory, attention, and problem-solving, as well as mood swings, depression, or anxiety, though <a href="https://wmnhealth.org/blog/the-overlooked-symptoms-of-multiple-sclerosis/" target="_blank" rel="noopener">these symptoms are often overlooked</a>. Unlike Alzheimer's, Parkinson's, and ALS, MS symptoms can vary in severity and may come and go. People with MS often experience periods of relapse (exacerbations or flare-ups) followed by periods of remission, where symptoms improve or stabilize. MS is also rarely fatal. People with the disease have a slightly shorter life expectancy, but the gap is shrinking.
<h3>What do we know about MS in females?</h3>
Symptoms: Research suggests the symptoms of MS in females and males are similar. However,&nbsp;<a href="https://www.msard-journal.com/article/S2211-0348(23)00366-8/fulltext" target="_blank" rel="noopener">symptoms may worsen during menstruation</a>&nbsp;as sex hormone levels fluctuate, though results have been inconsistent. More research is needed on the relationship between MS and the menstrual cycle, including on the <a href="https://www.msard-journal.com/article/S2211-0348(23)00366-8/fulltext" target="_blank" rel="noopener">impact of oral contraceptives</a> on MS symptoms and disease progression.
Research shows that MS seems to be less active during pregnancy, leading to fewer symptoms, followed by a temporary relapse after delivery.&nbsp;
The relationship between MS symptoms and menopause is complex. Studies suggest females may experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884461/#:~:text=HRT%20Use%20in%20MS&amp;text=Improvement%20in%20MS%20symptoms%20and,postmenopausal%20MS%20patients%20receiving%20HRT.&amp;text=In%20particular%2C%20HRT%20is%20effective,of%20vulvar%20and%20vaginal%20atrophy." target="_blank" rel="noopener">less inflammation during menopause but increased disability after menopause</a>, suggesting it may be a turning point in the disease. Little is known about how hormone replacement therapy affects MS.
Risk factors:&nbsp;Scientists do not know what causes MS, though it is likely a combination of genetic and environmental factors. Why MS is more common in females than males is also unclear. Research suggests female sex hormones, vitamin D, inflammatory processes, and obesity may play a role.&nbsp;
Treatment: There is no cure for MS, but there are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537319/" target="_blank" rel="noopener">numerous disease-modifying therapies</a> that reduce future relapse, disability, and damage to the nervous system in the form of scar tissue. Research suggests MS therapies are <a href="https://pdf.sciencedirectassets.com/280683/1-s2.0-S2211034816X00089/1-s2.0-S2211034817300019/am.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEIL%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJGMEQCIAETNDY0PR1iLHI0IQLCc9FpjM5PHs7HndaWq6CWT6NSAiAN7dMn9lAWRWO2e6G%2BShTVyuqhgBliZYaVnNUkT9IVZiq8BQjb%2F%2F%2F%2F%2F%2F%2F%2F%2F%2F8BEAUaDDA1OTAwMzU0Njg2NSIMm1lbxqoS3jt4%2FzyeKpAFwsHKMzWjKv1ss0jRQHhG56H9occEgeRD%2BRim%2B%2FsiyyhJLboz8CX%2FYZtP0aPEXDG8ldIzWciA%2F0KgLMp06IDgjvWA%2B50je24I6ruKCkreuvSlqlQGwClJLJACrvYMcarGWomCDHo7V6JFd5eejiLrvi4sWRRxcHmbGA%2B4xvHx9xf%2F8HWJZ7xxDKoDfosSPm%2F81bhMikluej1AxDqhaHrZNPLW25ngAmUr5Z%2F9jLHoZ7yPfD1yU%2BJSJCHN9UCWs9FvqptuYz8SK8Cct2ANPfc3msNiKDuvdqvwFRFlcXrrSa0OecqBM5n9F%2FNyfpMAe0hcglgZ4LLEZoeVVDCv%2B7rIkDyBitbztGGuVS12PGCbzfMnp2yLnF3Ai2nXuGA%2BrZJFD%2BbHItxfOPNBAA%2FIbIc3yZTxo%2BNI2bJmXYTQSgKgQitKBrzi8JPR0180HRglkYi2oVqXrj4k2AFYMdZ7Fm7Y9cWku1KTEbQwa8P3ZvFgIBNkp1xnaseWh%2B1gwG0TLokD8vRaG0nNpB0TvwWEVPcwaaGDNSGYfVSjBqp5A%2FKS72qdwgEZoY%2FhYzHOPpoF%2FyxTxFcETIv3jTOFuIs0OSfa09MAd7MORtbFlPqLzbcHRZmVczc8IseAc4sfKRRU97QCoRRfJzHtZnFUqP%2F28Kxpw6hwVlEEr3bWQ8hOYtLtRvFfwhfMYU11Vev7PIzNcv9BJ7mjiFKj%2BcDvIF1ixmv5BpxeQdohyU8b0Ed17PdUd4LGvfMKTIlI46bb4bE3aOM%2Fx4SSRcfyuSJgfQqWowiIvPGeK0mZ%2BTC5CGw6b5sIRT8l5%2BVofw4eI%2FMsyzLKxbqoafWh93yz2gwYyPI0el21j4t%2F4snUvrestK1KDek%2FdkUwvvOdqwY6sgHWC292FAJ1PKYPduFBNYOd0sFUfhMM37L6bico88UySAsb%2F%2B7Q9mopBvcxFQ%2FxPOlf4Ban8ACoY%2FmKg%2BOChud4t7KaOek7%2BNcQnLsoJ%2FLzG6kzGOwapWUXXdVJtRieal6iN29fYxXISM0IMcZqQ20Ix6c0g7RZ4PPtXNHX8PfOg%2FerKGmRlhc0K4%2B%2F%2BqdHtcawI2L2CqAw%2B0iRP62Jjga8kXFm0VPRfUMBEfwYMg59%2BVHK&amp;X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20231129T191650Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=300&amp;X-Amz-Credential=ASIAQ3PHCVTY56NNNDH5%2F20231129%2Fus-east-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=1ecbe71649512f43775b462904ac6c0ad631b72c0f572e37b226f4fe3ae90596&amp;hash=f1ccdcaf67209b0d84369b7ae1980c60aa6e10414ccc6c0d2a09a78e144f4736&amp;host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&amp;pii=S2211034817300019&amp;tid=pdf-7e4e40da-5a63-46db-ad94-85dcce85414c&amp;sid=34efe27c6efbd944df0995b2a4704091bfacgxrqa&amp;type=client" target="_blank" rel="noopener">equally effective in males and females</a>.

<h2><a id="Resources"></a>Where can women with neurodegenerative diseases get more information?</h2>
<h3>Alzheimer's disease</h3>
<ul>
<li><a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s" target="_blank" rel="noopener">Women and Alzheimer's</a> (Alzheimer's Association)</li>
<li><a href="https://thewomensalzheimersmovement.org" target="_blank" rel="noopener">The Women's Alzheimer's Movement</a></li>
<li><a href="https://www.usagainstalzheimers.org/networks/women" target="_blank" rel="noopener">Women Against Alzheimer's</a> (Us Against Alzheimer's)</li>
<li><a href="https://womensbrainhealth.org" target="_blank" rel="noopener">Women's Brain Health Initiative</a>&nbsp;</li>
</ul>
<h3>Parkinson's disease</h3>
<ul>
<li><a class="Hyperlink SCXW84223648 BCX4" href="https://www.pdavengers.com/women" target="_blank" rel="noopener">Women and Parkinson&rsquo;s Initiative</a> (PD Avengers)</li>
<li><a href="https://www.parkinson.org/library/fact-sheets/women#:~:text=Women%20have%20a%20lower%20risk,most%20frequently%20reported%20side%20effect." target="_blank" rel="noopener">Women and PD</a> (Parkinson's Foundation)</li>
<li><a href="https://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=&amp;ved=2ahUKEwjI9cCig-qCAxV9v4kEHdCMCUQQFnoECAcQAQ&amp;url=https%3A%2F%2Fwww.unshakeablemd.com%2F&amp;usg=AOvVaw17Jk0g0F4Vbpyapfn4vEMr&amp;opi=89978449" target="_blank" rel="noopener">Unshakeable MD</a></li>
</ul>
<h3>Amyotrophic lateral sclerosis</h3>
<ul>
<li><a href="https://heralsstory.org" target="_blank" rel="noopener">Her ALS Story</a></li>
<li><a href="https://www.cdc.gov/als/Default.html" target="_blank" rel="noopener">U.S. National ALS Registry</a></li>
</ul>
<h3>Multiple sclerosis</h3>
<ul>
<li><a href="https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Women-with-MS" target="_blank" rel="noopener">Women Living with MS</a> (National Multiple Sclerosis Society)</li>
<li><a href="https://mscanada.ca/womens-health" target="_blank" rel="noopener">Women's Health and MS</a> (MS Canada)</li>
</ul>

<h2>Infographic References</h2>
<ol>
<li>Feigen, VL et al. <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30411-9/fulltext" target="_blank" rel="noopener">The global burden of neurological disorders: translating evidence into policy</a>. Lancet Neuro. 2020;19(3):255-265.</li>
<li><a href="https://www.nature.com/immersive/d41586-023-01475-2/index.html" target="_blank" rel="noopener">Women's health research lacks funding - these charts show how.</a> Nature News. (Accessed November 20, 2023.&nbsp;</li>
<li>GBD 2017 U.S. Neurological Disorders Collaborators. <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2772579">Burden of Neurological Disorders Across the U.S. From 1990-2017: A Global Burden of Disease Study.</a>&nbsp;JAMA Neurol. 2021;78(2):165&ndash;176.<a href="https://www.uclahealth.org/news/ucla-health-researcher-says-brain-health-equity-requires" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.uclahealth.org/news/ucla-health-researcher-says-brain-health-equity-requires&amp;source=gmail&amp;ust=1701352950644000&amp;usg=AOvVaw2dq39UtLdvn-7lhU8oAPas" rel="noopener"></a></li>
<li class="leading-tight font-serif text-white text-3xl lg:text-5xl"><a href="https://www.uclahealth.org/news/ucla-health-researcher-says-brain-health-equity-requires" target="_blank" rel="noopener">UCLA Health researcher says brain health equity requires &lsquo;paradigm shift&rsquo; in research practices.</a> UCLAHealth.org (Accessed November 20, 2023)</li>
<li><a href="https://www.uclahealth.org/news/ucla-health-researcher-says-brain-health-equity-requires" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.uclahealth.org/news/ucla-health-researcher-says-brain-health-equity-requires&amp;source=gmail&amp;ust=1701352950644000&amp;usg=AOvVaw2dq39UtLdvn-7lhU8oAPas" rel="noopener"></a><a href="https://www.politico.eu/sponsored-content/a-united-front-against-the-global-brain-health-emergency/" target="_blank" rel="noopener">A united front against the global brain health emergency.</a> Politico. (Accessed November 20, 2023)</li>
<li>Remme M, Vassall A, Fernando G, Bloom D E. <a href="https://www.bmj.com/content/369/bmj.m1175" target="_blank" rel="noopener">Investing in the health of girls and women: a best buy for sustainable development.</a>&nbsp;BMJ 2020;369:m1175</li>
</ol>
&nbsp;

pexels-cottonbro-studio-5493783.jpg

The neglected science of Huntington’s disease in females

<blockquote>
This article covers:
<ul>
<li><a href="#What">What is Huntington's disease (HD)?</a></li>
<li><a href="#symptoms">What are the symptoms of Huntington's disease?</a></li>
<li><a href="#sex-differences">What are the sex differences in Huntington&rsquo;s disease?</a>&nbsp;</li>
<li><a href="#sex-differences">Why do sex differences in Huntington's matter?</a></li>
</ul>
</blockquote>
Huntington&rsquo;s disease (HD) is like a life-or-death coin toss &mdash; every child of an affected parent has a 50% chance of inheriting the genetic mutation that leads to the neurodegenerative disease and progressive breakdown of nerve cells in the brain. &nbsp;
In the U.S., approximately 30,000 people live with the condition, with many more at risk of developing it. And while both males and females experience worsening symptoms with time, <a href="https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.13178" target="_blank" rel="noopener">women report more severe motor, cognitive, and mood symptoms overall</a>. &nbsp;
This stark disparity in how the two sexes experience Huntington&rsquo;s hasn&rsquo;t received much attention in the history of the disease, according to <a href="https://med.uth.edu/neurology/2022/10/31/natalia-pessoa-rocha-pharmd-msc-phd/" target="_blank" rel="noopener">Natalia Pessoa Rocha</a>, assistant professor of neurology at McGovern Medical School at University of Texas Health Science Center in Houston.&nbsp;
&ldquo;In Huntington's studies, researchers often control for sex when what we need to be doing is assessing how it plays a role in the way the condition develops and progresses,&rdquo; she says. &nbsp;
These sex differences &mdash; neglected, ironically, as scientists sought a more complete understanding of the disease &mdash; may help brain experts get answers about Huntington&rsquo;s they've been seeking all along.&nbsp;

<h2><a id="What"></a>What is Huntington&rsquo;s Disease?&nbsp;</h2>
&ldquo;Someone once described Huntington's disease as an illness of mourning, which seems very apt,&rdquo; writes British author Charlotte Raven in her self-portrait <a href="https://www.penguin.co.uk/books/441338/patient-1-by-wild-charlotte-raven-with-dr-ed/9781529112801">Patient 1: Forgetting and Finding Myself</a>. &ldquo;You lose your identity, and some of your humanity, while remaining aware enough to keep a tally of every loss.&rdquo;
This brain-ravaging condition starts off with the accumulation of toxic huntingtin protein in the brain. A genetic mutation in the Huntingtin gene causes this protein to develop an abnormally long string of a single amino acid called glutamine. As a result, Huntingtin proteins begin to stick together, and form tangled strands that slowly build up within cells&nbsp;and spread from neuron to neuron, killing them in huge numbers. One area of the brain that is acutely impacted by this loss of neurons is the striatal part of the basal ganglia.&nbsp;
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/a8677ab3_a027_46af_a545_787bd93b74ab_ba6b8d118c.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>
<span class="NormalTextRun SCXW232001769 BCX4" data-ccp-parastyle="paragraph" data-ccp-parastyle-defn="{&quot;ObjectId&quot;:&quot;e1d13d89-346b-4340-a1a9-5c3b5d6c7596|90&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[469775450,&quot;paragraph&quot;,201340122,&quot;2&quot;,134233614,&quot;true&quot;,469778129,&quot;paragraph&quot;,335572020,&quot;1&quot;,469777841,&quot;Times New Roman&quot;,469777842,&quot;Times New Roman&quot;,469777843,&quot;Times New Roman&quot;,469777844,&quot;Times New Roman&quot;,469769226,&quot;Times New Roman&quot;,134233118,&quot;true&quot;,134233117,&quot;true&quot;,469778324,&quot;Normal&quot;]}">The basal ganglia is composed of several brain structures that help control muscle movements, are involved in forming habits, and influence executive function, such as learning, decision-making, and self-control.
The striatal part of the basal ganglia receives numerous inputs from other areas of the brain &mdash; including the cerebral cortex, substantia nigra, and thalamus &mdash; and sends outputs to other regions of the basal ganglia.
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column; float: left;"><img style="float: left;" src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/69f2777a_1169_40fd_a3e2_59e2238d4356_769b020a94.png" alt="" width="400" height="182" />The volume of the basal ganglia is reduced in people with Huntington's disease. Source: BioRender</div>
In Huntington&rsquo;s disease, these brain circuits appear to be particularly vulnerable to degeneration. In fact, the striatum is so severely damaged that it often appears like a deflated balloon. 
&nbsp;

<h2><a id="symptoms"></a>What are the symptoms of Huntington&rsquo;s disease? &nbsp;</h2>
Motor symptoms&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Slow or unusual eye movements&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Muscle problems &mdash; rigidity or muscle contracture (deformity)&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Impaired posture and balance&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="4" data-aria-level="1">Difficulty with speech&nbsp;</li>
</ul>
Cognitive symptoms&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="5" data-aria-level="1">Executive dysfunction &mdash; difficulty organizing, prioritizing or focusing on tasks&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="6" data-aria-level="1">Tendency to get stuck on a thought, behavior or action (perseveration)&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Lack of impulse control &mdash; outbursts and acting without thinking&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Lack of awareness of one's own behaviors and abilities&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Slowness in thought processing&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="33" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Difficulty in learning new information&nbsp;</li>
</ul>
Emotional-behavioral&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="36" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="4" data-aria-level="1">Feelings of irritability, sadness or apathy&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="36" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="5" data-aria-level="1">Social withdrawal&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="36" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="6" data-aria-level="1">Insomnia&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="36" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Fatigue&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="36" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}" aria-setsize="-1" data-aria-posinset="8" data-aria-level="1">Frequent thoughts of death, dying or suicide&nbsp;</li>
</ul>
Source: <a href="https://www.mayoclinic.org/diseases-conditions/huntingtons-disease/symptoms-causes/syc-20356117">Mayo Clinic</a> &nbsp;
Currently, there&rsquo;s no cure for HD but the FDA-approved medication, <a href="https://medlineplus.gov/druginfo/meds/a617023.html" target="_blank" rel="noopener">valbenazine</a>, regulates dopamine levels in the brain and can make Huntington's debilitating motor symptoms like chorea more manageable.&nbsp;(About 90 percent of people with Huntington's disease experience chorea.)
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/d8e1d684_bc62_4562_9047_26715b2fea33_f8899fd8d4.jpeg" alt="" width="800" height="587" />Huntington's is one of several neurodegenerative diseases in which proteins misfold and form clumps that damage brain cells. Preventing misfolded proteins from accumulating in the brain is a major focus of scientists developing treatments for these diseases. (Infographic by Cat Lau. References below.)</div>

<h2><a id="sex-differences"></a>What are the sex differences in Huntington&rsquo;s disease?&nbsp;</h2>
When Pessoa Rocha first started studying HD, a puzzling aspect of the disease kept coming up: While prevalence rates of HD show both sexes are equally affected by the condition, females consistently have worse motor, cognitive, and mood symptoms.
&ldquo;Clinically, we knew there was a difference in men versus women with HD, but we had to prove it with strong data,&rdquo; she says.
In 2021, Pessoa Rocha and her colleagues found a way to do this.
Using datasets from Enroll-HD, a study that follows thousands of people with the condition over many years, the researchers <a href="https://doi.org/10.1002/mdc3.13178">analyzed</a> how, over a period of four visits, motor, cognitive, and mood symptoms emerged and progressed for men and women with HD. &nbsp;
They found that while both males and females reported a worsening of symptoms over time, females presented with more severe symptoms than men to begin with. Females also experienced more depressive symptoms and performed more poorly on cognitive tests compared to males. &nbsp;
(Recently, other researchers analyzing the same dataset found Black patients with Huntington's had <a href="https://movementdisorders.onlinelibrary.wiley.com/doi/abs/10.1002/mds.29536" target="_blank" rel="noopener">worse cognitive and motor symptoms</a> at the time of diagnosis.)
The reasons for these sex differences are still unclear, but Pessoa Rocha thinks gender inequality could be playing a role.
&ldquo;Women with HD show more internalizing behaviors like depression, while men show irritability, aggression, and substance abuse,&rdquo; she says. &ldquo;I think this is related to how, as a result of cultural norms, females learn to internalize stress, while males are allowed to externalize it.&rdquo;
This pattern of gender inequality crops up again in the doctor&rsquo;s office, Pessoa Rocha adds, when males and females with HD report the same level of pain, but males with the condition are more likely to receive a prescription for painkillers compared to females with the condition. As a result, the disease progresses differently in both sexes, and females with HD are more likely to be institutionalized.
Moreover, Pessoa Rocha&rsquo;s research also suggests there may be hidden biological mechanisms that result in females with HD experiencing more severe neurodegeneration than males. This finding, according to Pessoa Rocha, underscores that sex should be an important factor in developing and interpreting biological signs, also known as biomarkers, for the condition.
&ldquo;At some point, I hope, we&rsquo;ll have a treatment that could truly make a difference in people&rsquo;s lives,&rdquo; she says. &ldquo;But until we start giving biological sex the importance it deserves in clinical trials for HD, I don&rsquo;t know if we&rsquo;re going to get there.&rdquo;&nbsp;

<h2>Infographic references</h2>
Huntington's disease:
<ol>
<li><a href="https://www.huntingtonsociety.ca/learn-about-hd/what-is-huntingtons/" target="_blank" rel="noopener">What is Huntington's?</a> Huntington's Society. (Accessed November 18, 2023)&nbsp;</li>
<li>Ferguson MW, Kennedy CJ, Palpagama TH, Waldvogel HJ, Faull RLM, Kwakowsky A. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9125092/" target="_blank" rel="noopener">Current and Possible Future Therapeutic Options for Huntington's Disease.</a> J Cent Nerv Syst Dis. 2022 May 21;14:11795735221092517.&nbsp;</li>
</ol>
Protein misfolding and neurodegenerative diseases:
<ol>
<li><a target="_blank" class="c-link" data-stringify-link="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" delay="150" data-sk="tooltip_parent" href="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" rel="noopener noreferrer">Sweeney, P., Park, H., Baumann, M. et al. Protein misfolding in neurodegenerative diseases: implications and strategies. Transl Neurodegener 6, 6 (2017).&nbsp;</a></li>
<li><a target="_blank" class="c-link" data-stringify-link="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" delay="150" data-sk="tooltip_parent" href="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" rel="noopener noreferrer"></a><a target="_blank" class="c-link" data-stringify-link="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" delay="150" data-sk="tooltip_parent" href="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" rel="noopener">What is Huntington's?</a>&nbsp;Huntington's Disease News (Accessed November 10, 2023)</li>
</ol>

pexels-edward-jenner-4031323.jpg

The "protein-misfolding problem": How some neurodegenerative disorders intersect

<blockquote>
<h3>This article covers:</h3>
<ul>
<li>Why do proteins misfold?</li>
<li>How does misfolding cause neurodegeneration? &nbsp;</li>
<li>Protein misfolding in:
<ul>
<li>Huntington's disease</li>
<li>Alzheimer's disease</li>
<li>Parkinson's disease</li>
<li>Amyotrophic lateral sclerosis (ALS)</li>
</ul>
</li>
<li>Can protein misfolding and its consequences be stopped?</li>
</ul>
</blockquote>
There are anywhere from 20,000 to 100,000 different proteins within a human cell, each one designated a specialized task. These complex molecules begin as long chains of amino acids that need to be arranged in a particular sequence to form functional structures. &nbsp;
Sometimes, however, proteins fail to fold into three-dimensional structures that work &mdash; instead turning into clumps or aggregates that cause cell damage. Protein-folding errors have been linked with a number of common neurodegenerative conditions, including Alzheimer&rsquo;s disease, Parkinson&rsquo;s disease, Huntington&rsquo;s disease, and amyotrophic lateral sclerosis  (ALS). &nbsp; &nbsp; The misfolding proteins implicated in each of these conditions are different. However, experts believe understanding why these proteins fold into abnormal shapes and how they spread from cell to cell, often perpetuating disease, could help them develop strategies to slow down or halt the progression of these neurodegenerative diseases. &nbsp;

<h2>Why do proteins misfold, and how does that cause neurodegeneration?&nbsp;&nbsp;</h2>
Protein folding is a complex, haphazard process that is prone to error. A&nbsp;<a href="https://www.cell.com/trends/plant-science/fulltext/S1360-1385(23)00031-6" target="_blank" rel="noopener">third of all newly synthesized proteins</a> never make it to the final stage&nbsp;and are degraded and discarded by a cell&rsquo;s quality control system. Sometimes, mutant proteins contort into unfavorable shapes and clump together like a messy ball of yarn, disrupting a cell&rsquo;s ability to function. This accumulation of toxic protein clumps, experts believe, is at the heart of several common neurodegenerative disorders. &nbsp;
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/f381b59d_235a_46fa_93b4_0f520fccaac2_3244ccf84f.jpeg" alt="Infographic on protein folding and misfolding in neurodegenerative diseases like Alzheimer's" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2>Huntington&rsquo;s disease&nbsp;&nbsp;</h2>
Huntington&rsquo;s disease is caused by the mutant huntingtin protein, which has an abnormally long string of a single amino acid called glutamine. A normal huntingtin protein contains anywhere from 10 to 34 glutamine repeats. However, when the repeats exceed 37, huntingtin molecules stick to one another and form tangled, rigid strands, says <a href="https://mcgovern.mit.edu/tile/jill-crittenden-2/" target="_blank" rel="noopener">Jill Crittenden</a>, molecular neurologist and scientific advisor at McGovern Institute for Brain Research at the Massachusetts Institute of Technology.&nbsp;
These strands, also known as fibrous protein aggregates, slowly accumulate within cells and disrupt their function. <a href="https://doi.org/10.1146/annurev-cellbio-100617-062636" target="_blank" rel="noopener">Studies</a> have shown that huntington protein aggregates can also pass from one neuron to the next, spreading the disease and leading to its progression. &nbsp;
<blockquote>
Huntington&rsquo;s disease in females&nbsp; 
Females with Huntington&rsquo;s disease experience worse motor, cognitive, and depressive symptoms compared to men with the condition.&nbsp;These symptoms include:&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Muscle problems&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Slower eye movements&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Difficulty with speech&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Difficulty organizing tasks&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Slower thought processing</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Insomnia</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Social withdrawal</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Frequent thoughts of death&nbsp;&nbsp;</li>
</ul>
Source: &ldquo;<a href="https://doi.org/10.1002/mdc3.13178" target="_blank" rel="noopener">Sex Differences in Huntington's Disease: Evaluating the Enroll-HD Database</a>&rdquo; and <a href="https://www.mayoclinic.org/diseases-conditions/huntingtons-disease/symptoms-causes/syc-20356117" target="_blank" rel="noopener">Mayo Clinic</a>.&nbsp;
</blockquote>

<h2>Alzheimer&rsquo;s and other dementias&nbsp;</h2>
<a href="https://wmnhealth.org/blog/a-short-guide-to-alzheimers-disease-in-women/" target="_blank" rel="noopener">Alzheimer&rsquo;s disease</a> is caused by a combination of proteins &mdash; amyloid beta and tau. Normally, tau is found inside a neuron&rsquo;s axon, the hair-like cable that transmits signals from one neuron to the next. In Alzheimer&rsquo;s and some other forms of dementia, tau proteins become damaged and clump together to form neurofibrillary tangles. These tangles disrupt communication between neurons and impair cognition, including memory and thought processing, which are the hallmarks of Alzheimer's.&nbsp; &nbsp; On the other hand, the amyloid beta (or beta-amyloid) protein is normally found within the fatty membrane surrounding nerve cells and is important for neuronal growth and repair. But, when this naturally sticky protein is overproduced, it begins to form small clusters, called amyloid plaques, between brain cells. The plaques trigger an immune response that eventually leads to cell death. &nbsp;
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/7bbaad66_d1bc_4a86_a700_27441504c685_5fd493916d.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2>Parkinson&rsquo;s disease&nbsp;</h2>
<a href="https://wmnhealth.org/blog/what-is-parkinsons-disease/" target="_blank" rel="noopener">Parkinson&rsquo;s disease</a> is characterized by deposits of alpha-synuclein protein in the nervous system. When this protein that promotes crosstalk between brain cells misfolds, it forms clusters, also known as Lewy bodies, in the brain&rsquo;s motor control areas/ The accumulation of Lewy bodies eventually kills off dopamine-producing neurons. The resulting dopamine deficiency gives rise to symptoms of Parkinson&rsquo;s, like difficulty with movement and coordination, shaking, memory loss, and depression. &nbsp;&nbsp;
A recent <a href="https://doi.org/10.1016/j.neuron.2019.05.035" target="_blank" rel="noopener">study</a> in mice suggests alpha-synuclein clumps can also accumulate in the gut&nbsp;and cause nearby proteins to misfold. These clumps then travel from the gut to the brain through the <a href="https://wmnhealth.org/blog/the-vagus-nerve-what-it-is-and-how-to-harness-it-for-your-mental-health/" target="_blank" rel="noopener">vagus nerve</a>, a major signaling pathway between the brain and body.
<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/397bbe33_048c_463a_af93_d88104017afd_cc49dcbe35.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2><span class="NormalTextRun SCXW96370409 BCX4" data-ccp-parastyle="paragraph" data-ccp-parastyle-defn="{&quot;ObjectId&quot;:&quot;53bda16c-e804-4a80-b8a7-26c8cc484e80|5&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[469775450,&quot;paragraph&quot;,201340122,&quot;2&quot;,134233614,&quot;true&quot;,469778129,&quot;paragraph&quot;,335572020,&quot;1&quot;,469777841,&quot;Times New Roman&quot;,469777842,&quot;Times New Roman&quot;,469777843,&quot;Times New Roman&quot;,469777844,&quot;Times New Roman&quot;,469769226,&quot;Times New Roman&quot;,134233118,&quot;true&quot;,134233117,&quot;true&quot;,469778324,&quot;Normal&quot;]}">Amyotrophic lateral sclerosis (ALS)</h2>
A number of misfolded proteins are linked to ALS, also known as Lou Gehrig&rsquo;s disease, a progressive and debilitating disorder that&nbsp;leads to loss of muscle control and eventually death. These proteins include superoxide dismutase 1 (SOD1), TAR DNA-binding protein 43 (TDP-43), and FUsed in Sarcoma (FUS). These misfolded proteins can form aggregates in the brain&rsquo;s motor cortex and spinal cord and spread to other regions over time.

<h2><span class="NormalTextRun SCXW49903546 BCX4" data-ccp-parastyle="paragraph" data-ccp-parastyle-defn="{&quot;ObjectId&quot;:&quot;53bda16c-e804-4a80-b8a7-26c8cc484e80|5&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[469775450,&quot;paragraph&quot;,201340122,&quot;2&quot;,134233614,&quot;true&quot;,469778129,&quot;paragraph&quot;,335572020,&quot;1&quot;,469777841,&quot;Times New Roman&quot;,469777842,&quot;Times New Roman&quot;,469777843,&quot;Times New Roman&quot;,469777844,&quot;Times New Roman&quot;,469769226,&quot;Times New Roman&quot;,134233118,&quot;true&quot;,134233117,&quot;true&quot;,469778324,&quot;Normal&quot;]}">Can rogue proteins be stopped?</h2>
Targeting misfolding proteins early enough in neurodegenerative diseases is critical for slowing their&nbsp;progression. Researchers have been honing in on the specific event, called&nbsp;<a class="Hyperlink SCXW49903546 BCX4" href="https://doi.org/10.1038/nchembio0606-297" target="_blank" rel="noopener">nucleation</a>, that starts off this chain reaction of protein misfolding, aggregation, and proliferation in the nervous system.&nbsp; &nbsp; In a recent <a class="Hyperlink SCXW49903546 BCX4" href="https://elifesciences.org/reviewed-preprints/86939#s2" target="_blank" rel="noopener">preprint</a>, researchers at the Stowers Institute for Medical Research in Kansas City, Missouri, and their colleagues worked with yeast cells and found that if the abnormally long glutamine repeat (PolyQ) in huntingtin protein is stopped from aggregating early on, it can halt the neurodegenerative effects of Huntington&rsquo;s disease. Interestingly, these findings have implications for similar conditions, like Alzheimer&rsquo;s and Parkinson&rsquo;s, that are set ablaze by misfolding and clumping of proteins. &nbsp; &nbsp; Other experts are <a class="Hyperlink SCXW49903546 BCX4" href="https://doi.org/10.1038/s41586-021-03824-5" target="_blank" rel="noopener">looking</a> at the role of &ldquo;chaperones&rdquo; to stop rogue proteins from misfolding. This aptly named group of proteins assists others in folding properly and even offers misfolding proteins another chance to refold into a functional configuration. <a class="Hyperlink SCXW49903546 BCX4" href="https://doi.org/10.1126/sciadv.aax6999" target="_blank" rel="noopener">Studies</a> have shown the benefit of chaperones in helping tau &mdash; the protein implicated in Alzheimer&rsquo;s &mdash; get into its prescribed shape. &nbsp;&nbsp; &nbsp; While there&rsquo;s plenty that&rsquo;s still unknown about neurodegenerative conditions and their progression, focusing on protein folding and misfolding mechanisms offers an interconnected path forward, where a piece in the puzzle of one neurodegenerative condition can help solve the mystery of the next. &nbsp;<span class="EOP SCXW49903546 BCX4" data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559685&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:259}">&nbsp;

<h2>Infographic references</h2>
Protein misfolding:
<ol>
<li><a target="_blank" class="c-link" data-stringify-link="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" delay="150" data-sk="tooltip_parent" href="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" rel="noopener noreferrer">Sweeney, P., Park, H., Baumann, M. et al. Protein misfolding in neurodegenerative diseases: implications and strategies. Transl Neurodegener 6, 6 (2017).&nbsp;</a></li>
<li><a target="_blank" class="c-link" data-stringify-link="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" delay="150" data-sk="tooltip_parent" href="https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0077-5" rel="noopener noreferrer"></a><a target="_blank" class="c-link" data-stringify-link="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" delay="150" data-sk="tooltip_parent" href="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" rel="noopener">What is Huntington's?</a>&nbsp;Huntington's Disease News (Accessed November 10, 2023)<a target="_blank" class="c-link" data-stringify-link="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" delay="150" data-sk="tooltip_parent" href="https://huntingtonsdiseasenews.com/what-is-huntingtons-disease" rel="noopener"></a></li>
</ol>
Alzheimer's
<ol>
<li><a href="https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf" target="_blank" rel="noopener">2023 Alzheimer's Facts and Figures: Special Report</a>, Alzheimer's Association (Accessed June 20, 2023)&nbsp;</li>
<li>Castro-Aldrete L, Moser MV, Putignano G, Ferretti MT, Schumacher Dimech A and Santuccione Chadha A (2023) <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2023.1105620/full%20" target="_blank" rel="noopener">Sex and gender considerations in Alzheimer&rsquo;s disease: The Women&rsquo;s Brain Project contribution</a>. Front. Aging Neurosci. 15:1105620.</li>
</ol>
Parkinson's
<ol>
<li><a href="https://www.nia.nih.gov/health/parkinsons-disease">Parkinson's Disease</a>, National Institutes of Health (Accessed June 9, 2023)</li>
<li><a href="https://www.parkinson.org/library/fact-sheets/women" target="_blank" rel="noopener">Women and PD</a>, Parkinsons.org (Accessed June 9, 2023)</li>
<li>Subramanian, I., et al. <a href="https://movementdisorders.onlinelibrary.wiley.com/doi/epdf/10.1002/mds.28921" target="_blank" rel="noopener">Unmet Needs of Women Living with Parkinson's Disease: Gaps and Controversies</a>. Movement Disorders, Vol. 37, No. 3, 2022</li>
</ol>

pexels-los-muertos-crew-7260776.jpg

The Vagus Nerve: How to harness it for your mental health

<blockquote>
This article covers:
<ul>
<li>What is the mind-body connection, and how does it factor into anxiety?</li>
<li>The gut-brain connection</li>
<li>What is the vagus nerve?</li>
<li>What is vagus nerve's role in stress and anxiety?</li>
<li>How can you activate the vagus nerve using mind-body practices?
<ul>
<li>Deep breathing</li>
<li>Mindfulness and meditation</li>
<li>Yoga</li>
</ul>
</li>
</ul>
</blockquote>
There is a surge in research on the vagus nerve &mdash; the longest of the 12 cranial nerves in the body. This growing interest reflects a recognition that the vagus is a vital connector between mind and body that profoundly impacts mood, emotions, and overall mental health. It also reflects the fact that the vagus can be targeted through an array of mind-body practices like breathing, meditation, and yoga that help reduce stress, regulate mood, and manage <a href="https://wmnhealth.org/blog/anxiety-disorders-in-women/">anxiety disorders</a> &mdash; the most common mental condition in the world.
<blockquote>
Anxiety diorders affect twice as many women as men during their lifetimes.&nbsp;
</blockquote>
"There are all kinds of relaxation techniques out there,&rdquo; says Bruce Friedman, PhD, Associate Professor in the Department of Psychology at Virginia Tech, where he studies the relationships between emotions, personality, and the autonomic nervous system in the Mind-Body Lab.&nbsp;
&ldquo;But like any kind of exercise, you have to train,&rdquo; he adds.
In addition to relaxation techniques, medical devices called vagal nerve stimulators, implanted in the body and approved for the treatment of epilepsy and severe depression, target the vagus nerve. Researchers are now experimenting with using <a href="https://www.frontiersin.org/articles/10.3389/fnins.2020.00284/full">non-invasive techniques</a> like transcutaneous vagal nerve stimulation for the management of other mental and physical health conditions, <a href="https://pubmed.ncbi.nlm.nih.gov/30710565/">including anxiety disorders</a>.
In this article, we will delve into the intricacies of the vagus nerve, explore its link to anxiety, and discuss several mind-body methods to stimulate this vital nerve, such as deep breathing exercises, meditation, and yoga.

<h2>What is the mind-body connection, and how does it factor into anxiety?</h2>
The mind-body connection is the intricate relationship between our thoughts, emotions, and bodily responses.
For better or for worse, anxiety and anxiety disorders illustrate this intimate connection between our mental and physical states. Excessive and irrational fear and worry are signs of anxiety. But anxiety is more than just a feeling. It can trigger a cascade of physiological changes in the body, including heart palpitations, sweating, and shortness of breath.
Just as the emotions and thoughts associated with anxiety influence our bodily responses, bodily sensations can, in turn, impact our mental and emotional well-being. This bidirectional crosstalk between the mind and the brain is mediated by the autonomic nervous system, which is made up of two branches: the sympathetic and parasympathetic.
Stress and anxiety activate the sympathetic nervous system, commonly known as the "fight or flight" response. While this response is essential in times of danger, chronic activation can lead to adverse health consequences, including increased anxiety and even the development of anxiety disorders.
Conversely, the parasympathetic nervous system, responsible for calming the body and promoting relaxation, counteracts the sympathetic response. It is often thought of as the "rest and digest" response. The vagus nerve is the main component of the parasympathetic nervous system.

<div class="wysiwyg-img-caption-wrapper" style="display: inline-flex; flex-direction: column;"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/Gut_brain_v3_714a2c362f.jpg" alt="/" width="800" height="587" />One of the most exciting areas of research on the mind-brain connection involves the gut and the gut microbiome&mdash;the vast colonies of microbes that inhabit the digestive system. Neuroscientists are discovering how the gut microbiome is involved in both our mental and neurological health and &nbsp;disease. Infographic by Cat Lau. (References below.)</div>

<h2>What is the vagus nerve?</h2>
The word &ldquo;vagus&rdquo; means &ldquo;wanderer&rdquo; in Latin, a reference to the ways the vagus nerve extends to most organ systems in the body.&nbsp;It acts as an information superhighway, extending from the brain to various organs in the chest and abdomen. In addition to regulating bodily functions, from the heart's beating to the movement of food to inflammation and the immune system, it serves as the principal communication pathway between the brain and the body.
Despite growing interest in the vagus nerve and efforts to develop ways to stimulate it, the nerve&rsquo;s basic anatomy and how it encodes the information it relays to the brain is still a mystery. As a result, an effort is underway to <a href="https://feinstein.northwell.edu/news/the-latest/mapping-vagus-nerve-feinstein-institutes-report">map more than 100,000 individual nerve fibers that make up the vagus nerve</a> and their connections throughout the body. Researchers are also looking at how the brain interprets signals from the vagus nerve and what those signals convey about the function of different body parts. Just this year, researchers <a href="https://medicine.yale.edu/news-article/revealing-communications-between-brain-and-body/">found</a> that individual nerve cells in the vagus encode three key features that the brain interprets: the organ, the tissue layer within the organ, and the type of stimulus, such as stretching of the lung or stomach.
This emerging understanding of the vagus nerve and the nature of mind-body signals may help scientists design ways to target specific pathways in the nervous system to treat health conditions.
<a href="https://wmnhealth.org/blog/this-medical-student-built-a-thriving-instagram-community-about-anxiety/" target="_blank" rel="noopener"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/0ac123c1_515c_4ef3_8a53_edf17c18054f_3271fa8dc9.jpeg" alt="" width="800" height="200" /></a>

<h2>What is vagus nerve's role in stress and anxiety?</h2>
Anxiety disorders involve dysregulation of the autonomic nervous system. This is often characterized as an &ldquo;imbalance&rdquo; between the parasympathetic and sympathetic branches. But Friedman says that idea needs to be updated.
This is often characterized as an "imbalance" between the parasympathetic and sympathetic branches of the autonomic nervous system. But Friedman says that idea needs to be updated.
"We used to use the term "autonomic imbalance." It came out around the turn of the 18th to 19th century," he says.&nbsp;
"The problem with that term is it implies there should always be this equal [participation of the two branches], which is not true. Every organ has its own specific, complex autonomic regulation. Even in the scientific literature, especially the psychological literature, you don't always see an appreciation for that," adds Friedman.
What studies have shown is that individuals with anxiety disorders often have&nbsp;<a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/30704974/" class="editor-rtfLink" rel="noopener">reduced vagal tone</a>, which refers to the vagus nerve's activity and efficiency in regulating bodily functions.&nbsp;
Decreased vagal tone&mdash;that is, reduced activity in the vagus nerve&mdash;is associated with increased heart rate, shallow breathing, and a higher susceptibility to stress responses &mdash; hallmarks of anxiety and anxiety disorders.&nbsp;
In contrast, increased vagal tone activates the parasympathetic nervous system (the &ldquo;rest and digest&rdquo; system), which helps calm the body after stress. A higher vagal tone indicates that your body can flexibly shift from the stress response to the relaxation response, and researchers have found a <a href="https://journals.sagepub.com/doi/abs/10.1177/0956797612470827">positive feedback loop</a> between high vagal tone, positive emotions, and good physical health.
Vagal tone can&rsquo;t be measured directly. Instead, other biological processes, such as heart rate variability (HRV), are used as an indirect indicator of vagal tone.
Friedman is a pioneer in using HRV to study and understand the autonomic nervous system activity and its relationship to our emotions.&nbsp;Several decades ago, he and others hypothesized that people with severe forms of anxiety would be low in this parasympathetic regulation of the heart&mdash;and, therefore, also have a reduced HRV&mdash;making them more prone to anxiety disorders like panic attacks.&nbsp;
"We thought poor emotional regulation, which seems to be really common across psychological disorders, might be one of the manifestations of reduced heart rate variability. And, in general, over the last 30 years, this has been a fairly consistent finding in people with severe forms of anxiety like panic disorder," he says.&nbsp;
Some consumer health technologies, such as the Apple Watch and <a href="https://ouraring.com/">Oura</a>, maker of a &ldquo;smart ring&rdquo; sleep and activity tracker, monitor biometrics like heart rate, body temperature and blood oxygen. Oura monitors HRV and uses it to signal whether a person is stressed due to overtraining or other factors and to help them gauge their recovery.
These health technologies are taking HRV &mdash; and the science of the vagus nerve &mdash; mainstream. However, they aren't designed for neurofeedback training. Instead, HRV is meant to be used as an indicator of recovery status, overall health, and fitness level.

<h2>How can you activate the vagus nerve using mind-body practices?</h2>
Traditional interventions for anxiety, such as cognitive behavioral therapy, aim to help people harness the mind to reduce symptoms like intrusive thoughts and to improve emotional regulation. Those interventions are time-tested and effective.&nbsp;
However, researchers and mental health professionals are increasingly interested in using the mind-body connection to address anxiety disorders and other mental health conditions.
One way to tap into it is via the vagus nerve. Stimulating the vagus nerve through techniques like deep breathing exercises, mindfulness practices, meditation, and yoga can increase vagal tone and activate the parasympathetic nervous system to reduce the stress response, promote relaxation, and alleviate anxiety symptoms.
<h3>Deep Breathing</h3>
Deep, slow breathing techniques have long been associated with relaxation and stress reduction. Diaphragmatic breathing, also known as belly breathing, has been shown to&nbsp;<a target="_blank" href="https://www.frontiersin.org/articles/10.3389/fpsyg.2021.624254/full" class="editor-rtfLink" rel="noopener">reduce anxiety by activating the vagus nerve</a>&nbsp;and triggering the parasympathetic response.&nbsp;
To practice diaphragmatic breathing, inhale deeply through your nose, filling your lungs with air and allowing your belly to expand. Your exhale should be long and slow. Repeat this cycle several times, paying attention to the sensation of your breath.
"There's a variety of different breathing exercises a person can do. The evidence suggests that the period of inhaling needs to be shorter than the period of exhaling to produce increases in heart rate variability," says Friedman.&nbsp;
<h3>Mindfulness and Meditation</h3>
Mindfulness and meditation practices are also effective ways to manage anxiety. These practices involve focusing on the present moment, cultivating a non-judgmental attitude, and fostering a sense of calmness.&nbsp;
Research shows that mindfulness and meditation activate the vagus nerve and increase vagal tone,&nbsp;<a target="_blank" href="https://peplab.web.unc.edu/articles-and-chapters/" class="editor-rtfLink" rel="noopener">promoting positive emotions, relaxation, and reduced anxiety symptoms</a>.&nbsp;
"Meditation is a skill. It's not something that you learn overnight. But with practice, you're able to push those distracting, worrisome, anxiety-provoking, threatening thoughts out of consciousness and be in this present moment. Regular practice could certainly be beneficial in altering the mind-body part of the equation," says Friedman.
<h3>Yoga&nbsp;</h3>
<a href="https://wmnhealth.org/blog/qanda-what-yoga-can-do-for-the-brain/">Yoga, a mind-body practice that combines physical postures, breathing exercises, and meditation</a>, offers a path to vagus nerve activation. Specific yoga postures, such as backbends and inversions, stimulate the vagus nerve directly, enhancing vagal tone and promoting relaxation. The breathing and mindfulness components of yoga indirectly influence vagal tone.
Regular yoga practice can provide a holistic approach to anxiety management, addressing both the physical and mental aspects of well-being.

<h2>Infographic References</h2>
<ol>
<li>Morais, L.H., Schreiber, H.L. &amp; Mazmanian, S.K. <a href="https://www.nature.com/articles/s41579-020-00460-0" target="_blank" rel="noopener">The gut microbiota&ndash;brain axis in behaviour and brain disorders.</a> Nat Rev Microbiol 19, 241&ndash;255 (2021).</li>
<li>Flux, M.C., and C.A. Lowry.&nbsp;<a href="https://www.sciencedirect.com/science/article/pii/S0969996119302463#s0010" target="_blank" rel="noopener">Finding intestinal fortitude: Integrating the microbiome into a holistic view of depression mechanisms, treatment, and resilience,</a>&nbsp;Neurobiology of Disease,&nbsp;Volume 135,&nbsp;2020,&nbsp;104578. &nbsp;</li>
</ol>

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Adult ADHD: How a late diagnosis changed one woman's life

<blockquote>
<h4>This article covers:</h4>
<ul>
<li>What was the catalyst for pursuing an assessment for attention-deficit/hyperactivity disorder (ADHD)?</li>
<li>What was the diagnostic process?</li>
<li>How did you come to terms with your diagnosis?</li>
<li>What was the impact of treatment?</li>
<li>What role did sex and gender play in your ADHD journey?</li>
<li>Was stigma an issue for you?</li>
<li>What are your coping mechanisms?</li>
<li>What advice do you have for others who relate to your story?</li>
</ul>
</blockquote>
<h4>On average, girls with attention-deficit/hyperactivity disorder (ADHD) are <a href="https://caddac.ca/adhd-in-women-and-girls/#:~:text=Girls%20are%20diagnosed%20with%20ADHD,with%20attention%20problems%20are%20undiagnosed." target="_blank" rel="noopener">diagnosed 5 years later than boys</a>&mdash;at age 12. But those who do receive a diagnosis are in the minority: An estimated 75 percent of girls with attention problems are <a href="https://caddac.ca/adhd-in-women-and-girls/#:~:text=Girls%20are%20diagnosed%20with%20ADHD,with%20attention%20problems%20are%20undiagnosed." target="_blank" rel="noopener">never diagnosed</a>. Misconceptions about the neurodevelopmental disorder mean that females with ADHD, who tend not to display the hyperactive or impulsive behaviors associated with the condition in boys, go unrecognized&mdash;and untreated. That is especially true for gifted girls. Instead, young females are more likely to be inattentive, daydreamers, anxious, or easily overwhelmed.</h4>
<h4>Theresa Tayler, an entrepreneur based in Calgary, says despite her ADHD, she coasted through school and later thrived in the fast-paced and creative world of journalism. It wasn't until the eve of 40, in the aftermath of a series of traumatic events, that it manifested as a serious problem, likely in combination with complex post-traumatic stress disorder, a form of PTSD associated with prolonged, repeated traumatic life events. (Symptoms of the <a href="https://chadd.org/attention-article/adhd-ptsd-or-both/" target="_blank" rel="noopener">two conditions often overlap</a>.)</h4>
<h4>Here, Tayler shares what led her to a diagnosis, how she copes with the symptoms of ADHD, and how she found a path forward.</h4>
This interview has been edited for length and clarity.

<h2>The lead-up to a diagnosis</h2>
In my late 30s, I went through a whole bunch of stuff, some of it traumatic. And that, I think, is what kind of triggered it. I started trying to understand some of that, and it's almost like it opened up like a pocket in my brain. People say that when you think you understand trauma and do the work to heal, it's only the beginning. At that point, it's like the brain goes, "Holy moly, I have to process this all now."&nbsp;
And then we got into COVID. I was a contractor, and much of that gig work disappeared because we were in lockdown across the universe. During that time, I realized I had to make some changes. I didn't know what was going on&mdash;I thought it was low-grade depression, divorce, turning 40, and realizing some things about my family. I thought it was all normal midlife stuff.&nbsp;
I decided I had to get back on track, and I started the business I have now, a PR consultancy. I didn't think it would be hard. In my 20s and 30s, I was a high-performer. But when I tried to start building this, it was going slow. I couldn't get my head around it. There came a point in time when I realized something was not working, and other people were noticing. And they were. I was out for lunch with one of my clients, and she said, "Theresa, I've known you for 10 years, and this isn't like you. What is going on? I'm concerned about you."
When she said that to me, my heart just broke, in a good way, because I had seen her go about her journey, founding a not-for-profit and trying to grow it. The idea that I would bring her star down just killed me. At that moment, and through her kindness, I decided I had got to figure out what was going on.

<div class="wysiwyg-img-caption-wrapper" style="margin: 0px; width: 820px; display: inline-flex; flex-direction: column;"><img style="margin: 0px;" src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/560fd569_c645_4279_8aff_39978a029b11_fe9f0b0c00.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2>The diagnostic process</h2>
I suspected ADHD for several reasons, so I started researching it online and also talked to my psychologist about it. He said, "I don't know if it's ADHD, Theresa. I think you probably have some complex post-traumatic stress." I think he was very hesitant to encourage me to go down the road of getting on medication.&nbsp;
But I decided to get tested, so I went through the process with Alberta Health Services &mdash; all the cognitive and behavioral testing and interviews. The psychologist also talked to a few people who knew me. Ultimately, she came back to me a few weeks later and said, "I think you have it."

<h2>Coming to terms with her diagnosis</h2>
I took the assessment and sat on it for about a month because I was asking myself, "Do I want to be on pharmaceuticals? I don't want to be on anything that's gonna make me crazy or make me gain weight," or all the things that go through people's minds if they've never been on serious brain-changing pharmaceuticals. Eventually, I took it to my doctor, and I thought she was gonna say, "You don't have ADHD; I'm not giving you any drugs" because I couldn't believe it, I guess. I felt like I was like an ADHD imposter. But she gave me a prescription, and I went to the pharmacy and thought, "Eff it. I'm just going to take this."

<h2>The impact of treatment</h2>
I took my first dose, and I remember when it kicked in because it was about 10 minutes later. I was driving down the street, and I came to a light, and I stopped. And I remember looking at the road and the light, and the first thoughts that went through my head were, "That's the road. And that's a red light." And then I went, "That's it. That's all there is right now. I'm not thinking about everything else around me. It's just a road and a light, and I'm going home." Then, I got home, started working on some stuff for a client and sent it to him. He phoned or emailed me shortly after, and he was like, "Wow." So, the impact was immediate. People noticed immediately.&nbsp;
We have this stigma of what ADHD is like: It's a guy's disease, and it's behavioral. Well, for me, it is more rumination&mdash;worrying about situations, replaying traumas in my head, conversations&mdash;and anxiety, like, what if I'd messed up with people. I think that was why I couldn't concentrate. The drugs have really helped that anxiety and concentration. They have given me my life back. And they've made it easier to deal with post-traumatic stress disorder as well because I can think clearly. So I can actually feel uncomfortable feelings without going into a total panic.&nbsp;
Not having that intense anxiety and rumination&hellip; It's been a big kind of awakening for me. There's sadness, too. I have left a lot of my old social circles and dynamics behind because I'm not going back to being that person who masked and pretended I was okay, hanging out with people who didn't embrace that I was a bit of a different thinker. So there's sadness in that. But you know, from a clinical point of view, not having anxiety is good!

<h2>The role of sex and gender in ADHD</h2>
I think in a lot of women, it has gone unnoticed. After all, the roots of modern medicine come from men studying men. When everything is built for White middle-class men, how are you going to be able to get a diagnosis on anybody else?&nbsp;
Men get diagnosed as kids, so usually much earlier than I did. So, for me, it went "boom" into almost a total shutdown because it wasn't assessed, it wasn't dealt with, I wasn't dealing with it. And then I went through a whole bunch of traumatic events, we get into COVID, everybody's in trauma, and then all of a sudden, instead of a slow trickle, where you might look at a teenager and say maybe they need some treatment, it hit me like a bomb. It's almost like I just shut down. I think that might be a familiar story for a lot of women. I hate to think about how many women got diagnosed with borderline personality or put on antipsychotics because they weren't assessed earlier.&nbsp;

<h2>Struggling with stigma</h2>
There's a stigma around mental health and around ADHD. And I think the reason some people are hesitant to talk about it isn't because they are embarrassed to have it or to be neurodivergent. I'm certainly not. I think there is a superpower in that neurodivergence, and it can be threatening to people. And so it is stigmatized as a problem. I've been hesitant to talk about it because I am afraid people will use it to make me out to be the problem. So I think that's why people don't want to come out and talk about it. They don't want to become the scapegoats.

<h2>Coping with ADHD</h2>
The meds are great. But, for myself, there's that trauma stored in the body, in my hips and joints and muscles. So I do yoga weekly, I do my stretches, and I try to do cardio every day. So, I approach it holistically, as body, mind, and spirit. All of those things have been important. When I fall out of alignment with one, like if I get busy with work and I'm not exercising, stretching, or meditating, the drugs aren't as effective. It's kind of like being back in fight or flight. For me, that's where I think the PTSD comes in more than the ADHD.&nbsp;

<h2>Her advice to others</h2>
If you feel something's up with you, stick with your gut. Get a second opinion. Go to multiple sources and try to get it assessed. Maybe it's not ADHD, or depression, or whatever you've got in your mind, but it might be something else. So trust your intuition.
Eventually, you have to lean into whatever's going on with you and not worry about what people think. There are a lot of people out there who have all sorts of different things going on. We just don't talk about it. Once you can voice it and say, "I might have this going on," it takes its power away. But I'm just at that step.&nbsp;
&nbsp;

<h2>Infographic References</h2>
<ol>
<li><a href="https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women" target="_blank" rel="noopener">Cosmos Study: Number of ADHD Patients Rising, Especially Among Women</a>, Epic Research. March 30, 2023. &nbsp;</li>
<li>Young S, Adamo N, &Aacute;sgeirsd&oacute;ttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422602/" target="_blank" rel="noopener">Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.</a> BMC Psychiatry. 2020 Aug 12;20(1):404. doi: 10.1186/s12888-020-02707-9. </li>
</ol>

pexels-andrea-piacquadio-4834550-2.jpg

Cases of ADHD in women are rocketing. What's behind the trend?    

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood neurodevelopmental conditions, and it's having a moment.&nbsp;&nbsp;&nbsp;
Whether it's due to the growing number of ADHD influencers on TikTok&mdash;the <a href="https://www.tiktok.com/tag/adhd?_d=secCgYIASAHKAESPgo8/d5VBhdhZJ4N8gXPpnvfERUvY0HKq4OE2wdpfAnM8pstJpp3gOusXWJr9tgLk2alYsCmXllPPxQDmQViGgA=&amp;_r=1&amp;checksum=e95614c428aa8e4825b8c9b12029e6c9bfed47e59f76c3d600fb72624fe067eb&amp;language=en&amp;name=adhd&amp;sec_user_id=MS4wLjABAAAA0s4eRqehxLdm3hJNd-o7bfsOoplVO0rS_QZtgAvzxs8qVJJrbYBMs95bFXEZR6i8&amp;share_app_id=1233&amp;share_challenge_id=62390&amp;share_link_id=89CAF8CB-5C1D-4499-9A94-A589D9FD7AA6&amp;source=h5_m&amp;tt_from=sms&amp;u_code=dicmcjh91mg6gk&amp;user_id=6959304206259913733&amp;utm_campaign=client_share&amp;utm_medium=ios&amp;utm_source=sms" target="_blank" rel="noopener">#adhd&nbsp;</a><a href="https://www.tiktok.com/tag/adhd?_d=secCgYIASAHKAESPgo8/d5VBhdhZJ4N8gXPpnvfERUvY0HKq4OE2wdpfAnM8pstJpp3gOusXWJr9tgLk2alYsCmXllPPxQDmQViGgA=&amp;_r=1&amp;checksum=e95614c428aa8e4825b8c9b12029e6c9bfed47e59f76c3d600fb72624fe067eb&amp;language=en&amp;name=adhd&amp;sec_user_id=MS4wLjABAAAA0s4eRqehxLdm3hJNd-o7bfsOoplVO0rS_QZtgAvzxs8qVJJrbYBMs95bFXEZR6i8&amp;share_app_id=1233&amp;share_challenge_id=62390&amp;share_link_id=89CAF8CB-5C1D-4499-9A94-A589D9FD7AA6&amp;source=h5_m&amp;tt_from=sms&amp;u_code=dicmcjh91mg6gk&amp;user_id=6959304206259913733&amp;utm_campaign=client_share&amp;utm_medium=ios&amp;utm_source=sms" target="_blank" rel="noopener">hashtag</a>&nbsp;has more than 30 billion views&mdash;or the pandemic's unmasking of ADHD symptoms that have led many adults to seek a professional evaluation, the recent explosion in diagnoses is a striking new trend, especially for women.&nbsp;&nbsp;
<blockquote>
Attention-deficit/hyperactivity disorder is a chronic and debilitating mental disorder that is known to impact the individual in many aspects of their life, from academic and professional achievements and interpersonal relationships to daily functioning. Adults with ADHD typically experience poor self-worth, sensitivity toward criticism, and increased self-criticism.
&nbsp;&nbsp;&nbsp;
Source:&nbsp;<a href="https://www.psychiatry.org/patients-families/adhd/what-is-adhd" target="_blank" rel="noopener">American Psychiatric Association</a>&nbsp;&nbsp;&nbsp;
</blockquote>
Girls and women with ADHD have been slipping under the radar since doctors first started studying, diagnosing,&nbsp;and treating the condition. In fact,&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173330/" target="_blank" rel="noopener">studies show</a>&nbsp;as many as half of women with ADHD are routinely misdiagnosed with&nbsp;other behavioral and mental health conditions, such as borderline personality disorder (BPD), anxiety, and bipolar&nbsp;disorder.&nbsp;&nbsp;
But, in the post-pandemic world, the ADHD landscape is slowly shifting: The percentage of women between the ages of 23 and 49 who've been newly diagnosed with the condition has nearly <a href="https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women" target="_blank" rel="noopener">doubled</a> from 2020 to 2022. That rise may look like a cause for celebration. But getting a diagnosis &mdash; and effective treatment &mdash; early in life remains an uphill battle for many.&nbsp;&nbsp;&nbsp;
Explore the reasons behind the gender gap in ADHD diagnosis and treatment, learn how the condition manifests in women, and get the resources you need for living &mdash; and thriving &mdash; with ADHD.&nbsp;&nbsp;
<h2>Common signs &amp; symptoms of ADHD&nbsp;&nbsp;</h2>
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Difficulty paying close attention to details and staying focused&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Inability to stay organized and complete tasks&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Frequently losing or forgetting things&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="4" data-aria-level="1">Difficulty following through on instructions&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="5" data-aria-level="1">Restlessness and inability to remain seated for long periods&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="6" data-aria-level="1">Procrastination&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Brain fog Source: <a href="https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878" target="_blank" rel="noopener">Mayo Clinic</a></li>
</ul>
<h2>Risk factors for ADHD&nbsp;&nbsp;</h2>
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="8" data-aria-level="1">Genetics: Close relatives, such as a parent or a sibling, with ADHD or another mental health condition&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="9" data-aria-level="1">Poor nutrition before birth: Exposure to drugs and alcohol in the womb&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="10" data-aria-level="1">Birth complications: Being born prematurely&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="11" data-aria-level="1">Environmental toxins after birth: Childhood exposure to chemicals like lead and mercury that affect brain development&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="12" data-aria-level="1">Traumatic brain injury: Sustaining a severe head injury as a child or teenager&nbsp;&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="13" data-aria-level="1">Simultaneous mental health conditions:&nbsp;Experienced behavioral and mental health challenges like depression, anxiety disorders, and personality disorders during your lifetime&nbsp;&nbsp;&nbsp; Source: <a class="Hyperlink SCXW134169776 BCX4" href="https://www.cdc.gov/ncbddd/adhd/facts.html" target="_blank" rel="noreferrer noopener">CDC</a>&nbsp;</li>
</ul>

<h2>ADHD and&nbsp;the brain</h2>
Understanding the neurobiology of ADHD is essential for diagnosing and treating it. Like many other brain conditions, such as depression, anxiety, and even Alzheimer's, a deficiency in neurotransmitters &mdash; brain chemicals that act like messengers of the nervous system and help transmit information between neurons and to muscles &mdash; underlies ADHD.&nbsp;&nbsp;&nbsp;
Norepinephrine, the specific neurotransmitter that is deficient in the brain of individuals with ADHD, is known to play an essential role in attention, alertness, and concentration. Experts believe an imbalance in norepinephrine levels leads to many of the symptoms of ADHD in women, such as inattention and impulsivity.&nbsp;&nbsp;&nbsp;
But there are other notable differences in the brain, which contribute to its most common signs and symptoms.&nbsp;&nbsp;&nbsp;
Studies have shown structural changes in these areas of the brain are linked with ADHD:&nbsp;&nbsp;&nbsp;
Basal ganglia:&nbsp;It is involved in memory, learning, and planning&nbsp;&nbsp;
The prefrontal cortex:&nbsp;This part of the brain is vital for regulating attention, behavior, and emotions&nbsp;&nbsp;&nbsp;
The limbic regions (amygdala, hippocampus, hypothalamus):&nbsp;These areas influence motivation and decision-making

<h2><a href="https://wmnhealth.org/blog/over-40-with-adhd-how-a-late-diagnosis-changed-one-womans-life/" target="_blank" rel="noopener"><img src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/885d86a7_418a_490a_a239_dc561d7b6d99_f8e0c09a20.jpeg" alt="" width="800" height="200" /></a></h2>
<h2>Inside ADHD: What ADHD looks like in women</h2>
Historically, research on ADHD has almost exclusively focused on how the condition manifests in boys: hyperactivity, impulsive behaviour, and chronic restlessness. However, girls and women with ADHD experience a different set of symptoms that defy the "traditional" understanding of ADHD. These symptoms include distractibility, forgetfulness, poor memory, and procrastination. &nbsp;&nbsp;
<blockquote>
Girls with ADHD remain an enigma &mdash; often overlooked, misunderstood and hotly debated.  &mdash;Ellen Littman, PhD
</blockquote>
For these reasons, "girls with ADHD remain an enigma &mdash; often overlooked, misunderstood and hotly debated," according to clinical psychologist <a href="https://www.drellenlittman.com/" target="_blank" rel="noopener">Ellen Littman</a>, one of the first experts to focus on <a href="https://www.apa.org/members/content/women-adhd" target="_blank" rel="noopener">gender differences in ADHD</a>. &nbsp; 
<div class="wysiwyg-img-caption-wrapper" style="margin: 0px; width: 820px; display: inline-flex; flex-direction: column;"><img style="margin: 0px;" src="https://wmnhealthpublicfiles.blob.core.windows.net/publicfiles/MediaLibrary/cace85d4_7aa5_43e4_a17d_23ae76432829_852a53439e.jpeg" alt="" width="800" height="587" />Infographic by Cat Lau. (References below.)</div>

<h2>A New Direction: Where the science and understanding of ADHD is moving&nbsp;&nbsp;</h2>
In 2022, a longitudinal&nbsp;<a href="https://doi.org/10.1111/jcpp.13480" target="_blank" rel="noopener">study</a>&nbsp;focused on girls and women with ADHD found a higher risk of self-harm, mental health challenges, partner violence, and unplanned pregnancies among women with ADHD, underscoring the need for diagnosing and supporting them.&nbsp;&nbsp;
This study, coupled with the post-pandemic rise in ADHD diagnoses among women, has improved awareness around the condition, and countless women have come forward on social media with their experiences of living with ADHD.&nbsp;&nbsp;&nbsp;
Researchers, on the other hand, are also dedicating more resources to studying ADHD in girls and women. Duke University in North Carolina, for example, has also opened the&nbsp;<a href="https://adhdgirlsandwomen.org/" target="_blank" rel="noopener">first U.S. program</a>&nbsp;focused on advancing knowledge about ADHD in women and girls and its impacts on family members, clinicians, educators, and the broader public.&nbsp;&nbsp;&nbsp;
If you or a loved one suspects they have ADHD, here is a list of credible resources that will help you in your journey to understand and accept ADHD:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="14" data-aria-level="1"><a href="https://caddac.ca/" target="_blank" rel="noopener">Centre for ADHD Awareness</a>&nbsp;(Canada)&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="15" data-aria-level="1"><a href="https://www.add.org">Attention Deficit Disorder Association</a>&nbsp;(USA)&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="16" data-aria-level="1"><a href="https://drgabormate.com/" target="_blank" rel="noopener">Scattered Minds: The Origins and Healing of Attention Deficit Disorder by Gabor Mat&eacute;</a>&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="17" data-aria-level="1"><a href="https://adhdgirlsandwomen.org/resources/" target="_blank" rel="noopener">Duke Center for Girls &amp; Women with ADHD</a>&nbsp;&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="34" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" aria-setsize="-1" data-aria-posinset="18" data-aria-level="1"><a href="https://translatingadhd.com/" target="_blank" rel="noopener">Translating ADHD</a>&nbsp;podcast&nbsp;</li>
</ul>

<h2>Infographic References</h2>
<ol>
<li><a href="https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women" target="_blank" rel="noopener">Cosmos Study: Number of ADHD Patients Rising, Especially Among Women</a>, Epic Research. March 30, 2023. &nbsp;</li>
<li>Young S, Adamo N, &Aacute;sgeirsd&oacute;ttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422602/" target="_blank" rel="noopener">Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.</a> BMC Psychiatry. 2020 Aug 12;20(1):404. doi: 10.1186/s12888-020-02707-9.</li>
</ol>
&nbsp;

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