Structural Sexism and Memory Decline in Women

Structural sexism is linked to women’s higher rates of Alzheimer’s, among other negative health outcomes identified in recent study.

By Antarjot Kaur

New research highlights a hidden risk factor—structural sexism—that may contribute to memory decline in later life, disproportionately affecting women.

Structural sexism as a risk factor for cognitive health

Landmark research recently published in Alzheimer’s & Dementia has established an important association between systemic gender inequalities and women’s cognitive health. This study brings forward how these embedded structural inequities in societal frameworks exacerbate the cognitive aging process, especially among Black women. Such findings carry profound implications for understanding the role of social determinants in shaping the risk of Alzheimer’s disease and related dementias, which continue to escalate globally.

Alzheimer’s disease and other dementias have become a significant public health concern with the aging of the population worldwide. Women make up nearly two-thirds of the persons affected, and such a gap has prompted researchers to investigate gender-differentiated causes that influence cognitive health. This unique study positions structural sexism as an overlooked but critical contributor to disparities. The research illustrates how social inequities affect cognitive aging and points toward priority areas for intervention to tackle systemic issues, as part of broader efforts to mitigate the rising burden of neurodegenerative diseases.

RELATED: Alzheimer’s Care Access: City vs Country

This form of sexism operates at the societal level, denying women full access to resources, opportunities, and power in society. In contrast to interpersonal sexism, which is confined to discriminatory interaction between individuals, structural sexism has the whole population in its scope and permanently leaves a legacy of inequality. Structural manifestations include gender imbalance in employment, political representation, and economic security—factors that collectively shape life trajectories and health outcomes.

Designing a study on structural sexism

Justina Avila-Rieger of Columbia University teamed up with a group of researchers to analyze data from over 21,000 participants of the Washington Heights-Inwood Columbia Aging Project (an ongoing study of Manhattan, New York, residents aged 65 and older) and the Health and Retirement Study (a nationally representative cohort of U.S. adults aged 50 or older). They used this data to investigate how structural sexism related to a decline in memory. 

Key indicators of structural sexism were gauged across U.S. states, including the following:

• Male-to-female labor force participation ratios
• Women’s representation in state legislatures
• Gender disparities in poverty rates

Based on these scores, Avila-Rieger’s research team classified states into having low, moderate, and high levels of structural sexism. They assessed trajectories of change in memory using the biennial memory test. They also monitored long-term trajectories of decline in cognition.

The research team’s findings showed that women residing in states with notable structural sexism experienced a significantly more rapid decline in memory than did women in states with lower levels of sexism. This accelerated decline is comparable to a decline of almost 9 years in terms of cognitive aging. Women racialized as Black displayed the highest levels of cognitive decline among all groups. This finding illustrates the cumulative impact of structural sexism and structural racism. 

The study revealed that structural sexism affects cognitive health for both women and men, though the impact is more significant for women. While the estimates for men were not notably different from zero, the relationship between structural sexism and initial memory performance was comparable for both genders. This indicates that experiencing structural sexism, regardless of gender, could have a broadly negative effect on cognitive health, suggesting that structural sexism may lead to cognitive decline in both men and women, with a more pronounced effect on women.

Connecting social inequality to cognitive health

A growing number of studies connect social determinants of health to cognitive outcomes. Structural sexism has been shown to affect health adversely in ways such as heightened risk of cardiovascular disease and cognitive decline, especially among marginalized groups, with long-term health trajectories. Previous studies have also shown that prolonged exposure to systemic inequality produces chronic stress by raising cortisol levels. This might damage brain regions tied mainly to memory, like the hippocampus. A study by Lupien et al. in 2009, for example, showed that chronic stress associated with sustained social and environmental stressors alters the structure of the hippocampus, affecting the consolidation of memory and cognitive function. Furthermore, limited access to critical healthcare and prevention services in states with higher measured levels of sexism increases the risk for chronic diseases like hypertension and diabetes, strong risk factors for cognitive decline. 

Besides reviewing these direct health and healthcare impacts, Avila-Rieger’s team emphasizes how structural sexism contributes to reduced labor force participation rates among women and a lower presence of women in state legislatures. These structural issues mirror wider societal obstacles that hinder women’s access to education and job opportunities, both of which are crucial for their economic and social progress. Previous studies have emphasized how structural sexism affects women’s economic and social progress, pointing out obstacles to their participation in the workforce and their representation in politics. 

Structural sexism may also diminish cognitive reserve—which is the brain’s resilience to age-related wear and tear. When women are denied access to education and skilled jobs, their cognitive reserve is reduced. Avila-Rieger’s team connects lower educational attainment and limited job opportunities to reduced cognitive reserve, which accelerates cognitive decline in later life (as established in prior research studies). Black women encounter a heightened risk for this, according to the study. They are not only more likely to develop Alzheimer’s disease but also tend to reside in states with significant levels of structural sexism and racism. This overlap intensifies their health challenges, with structural sexism and racism mutually reinforcing one another, leading to worse cognitive health outcomes.

This research, in identifying systemic inequalities as modifiable risk factors, reveals new opportunities for interventions that can lessen health disparities and improve cognitive health outcomes.

RELATED: Does Brain Cholesterol Control Alzheimer’s?

Mechanisms behind the findings

The study identifies how structural sexism contributes to declining memory through various biological, psychological, and social mechanisms:

• Biological Constraints of Stress: Chronic stress may activate the hypothalamic-pituitary-adrenal (HPA) axis, resulting in increased secretion of cortisol. Chronic exposure to high levels of cortisol has been shown to impair the maintenance of neurons in the hippocampus, impair memory, and speed up cognitive aging.
• Health Behavior and Access: Women living in high-sexism states may have difficulty gaining access to preventive health and health-promoting behaviors, leading to higher probabilities of comorbidities and cognitive decline.
• Intersectional Stressors: The combined effects of structural sexism and structural racism disproportionately affect Black women, contributing to faster cognitive decline. For example, women racialized as Black in states with high sexism and racism displayed memory decline equivalent to individuals 9 years older.

Implications for public health policy and practice

These findings suggest that structural sexism is an issue of public health. The researchers call for policymakers to take action, particularly in tackling structural sexism and its impact on health disparities, especially in cognitive health. 

The researchers make several policy recommendations:

• Promote gender equity by investing in policies that reduce gender disparities in education, employment, and political representation. Such changes can empower women, enhance economic security, and mitigate the long-term health effects of systemic inequality.
• Develop interventions that are tailored to address the integrated effects of structural sexism and racism, particularly for Black women and other marginalized groups, to lessen the effects of intersectional inequalities.
• Improve access to cognitive health screenings and preventive services in states with high structural sexism, with an emphasis on early detection and intervention. 

Public awareness campaigns will propel the transformation needed at the social level. Public education about the health effects of structural sexism can generate public support for equitable policies and encourage collective action against systemic inequities.

While such a study promises interesting insight into the association of structural sexism with cognitive decline, more work would have to be done to solidify these findings. Future research could focus on neurobiological mechanisms and intervention studies.

• Neurobiological Mechanisms: Investigate the biological pathways, such as inflammation and epigenetic changes, through which systemic inequality can affect brain health.
• Intervention Studies: Develop and test community-based and policy-driven interventions that reduce the health impacts of structural sexism, focusing on improving cognitive outcomes in vulnerable populations.

Call to action

This study emphasizes the severe implications of structural sexism for women’s cognitive health and aging. By solving the apparent systemic inequalities, we are not only promoting gender equity but also improving public health outcomes on a broader scale. The findings show that social justice and health equity are intertwined and thus impact each other at a global scale.

Given the burgeoning rates of incidence of Alzheimer’s disease and related dementias, it is paramount to identify and intervene in social determinants of health. While structural sexism is a problem affecting society, it is at the same time a public health crisis. Policies and practices that insist on equity and inclusivity can lay down the foundation for a healthy, just society. 

This study was published in the peer-reviewed journal Alzheimer’s & Dementia.

References

Avila-Rieger, J. F., Adkins-Jackson, P. B., Hill-Jarrett, T. G., Robinson, W. R., Keyes, K. M., Schupf, N., Brickman, A. M., Mayeux, R. P., & Manly, J. J. (2024). Early life exposure to structural sexism and late-life memory trajectories among black and white women and men in the United States. Alzheimer’s & Dementia. https://doi.org/10.1002/alz.14410
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434–445. https://doi.org/10.1038/nrn2639