Sex-Based Variations in Alzheimer’s Disease: From Susceptibility to Therapeutic Outcomes

Background: Alzheimer’s disease (AD) shows distinct differences between women and men in prevalence, disease progression, and therapeutic response. Women express a greater risk of AD onset, influenced by increased longevity and hormonal factors, and typically experience faster cognitive decline along with heightened susceptibility to AD-associated depression and anxiety. Current therapies—primarily cholinesterase inhibitors and memantine—offer only symptomatic relief without modifying disease progression. Objective: To review sex-specific differences in Alzheimer’s disease and evaluate the current understanding of therapeutic response variations between men and women, with an emphasis on identifying opportunities for sex-tailored interventions. Methods: A narrative review of the literature on AD prevalence, progression, and treatment outcomes across sexes was conducted. Particular attention was given to pharmacological therapies (cholinesterase inhibitors, memantine), lifestyle factors, and sex-specific risk determinants such as cardiovascular health and hormonal fluctuations. Results: Evidence suggests that women are more vulnerable to AD onset and progression compared to men. Limited studies indicate potential therapeutic advantages of specific medications for women, though robust, sex-stratified clinical trials remain lacking. Non-pharmacological strategies, including lifestyle adjustments in diet, exercise, and cognitive engagement, show promise in alleviating symptoms for both sexes. Conclusions: Sex differences significantly influence AD onset, clinical course, and therapeutic response. While current treatment remains largely non-disease-modifying, emerging sex-specific findings underscore the need for personalised medicine approaches. Further research is required to clarify sex specific mechanisms, optimise therapeutic strategies, and address disparities in care access, ultimately improving management of AD in both women and men.