University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA.
University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA.
J Alzheimers Dis. 2024;97(1):31-74. doi: 10.3233/JAD-230527.
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
阿尔茨海默病（AD）影响的女性多于男性，而处于绝经过渡期的女性可能是研究和风险最大的群体。睡眠障碍是 AD 的一个既定风险因素，随着正常衰老，其患病率增加，而在女性绝经期间则更为严重。文献中已经确立了女性和雌性动物模型中睡眠模式中断和 AD 病理增加的性别差异，并且非常强调随着年龄增长循环性腺激素的丧失。有趣的是，促性腺激素（如卵泡刺激素）的增加似乎是 AD 发病机制的主要原因，并且可能也在睡眠中断中起作用，也许与其他研究较少的激素结合在一起。大脑中几个影响睡眠的区域似乎在 AD 进展的早期就受到了影响，并且其中一些区域可能表现出性别二态性，这可能导致女性随着年龄的增长睡眠中断增加。此外，一些最常见的睡眠障碍以及多种影响睡眠质量的健康状况在女性中更为普遍和严重。这些疾病通常与 AD 并存，并且具有协同作用的双向关系，会导致认知能力下降和神经病理学恶化。随着年龄的增长，睡眠中断和睡眠障碍增加，绝经期间和之后激素急剧变化，以及 AD 病理增加，这些因素可能相互作用并成为导致更多女性患有 AD 的因素。
