Women’s Health

Cognitive and Mental Health for Women

Closing the Gaps in Care

BY Deborah Dittberner, MD

Dementia is one of the conditions where the overlap between mental health and cognitive health is most consequential. As our population ages, dementia is becoming one of the most pressing public health challenges, and it is currently the fourth leading cause of death in the state. While memory loss is often discussed as a natural part of aging, dementia is not an inevitable outcome, and its relationship to mental health is far more complex than many people realize.

Early signs of dementia are frequently subtle. In many people, especially women, changes in mood, sleep, or overall emotional well-being can emerge alongside or even before noticeable memory problems. These symptoms are commonly attributed to stress or anxiety, which can delay further evaluation. For aging women, the relationship between cognitive and mental health deserves particular attention. Women live longer than men on average, and often spend more years navigating chronic health conditions and caregiving responsibilities, while also experiencing hormonal and social factors that can increase both dementia risk and mental health strain over time. At the same time, men are more likely to delay seeking care and may present later with more advanced symptoms, underscoring that cognitive and mental health challenges affect both genders, though often in different ways.

Women face a higher lifetime risk of dementia.

There are also broader systemic challenges women face in current care systems. For decades, women’s health has largely been framed around reproductive care, leaving gaps in research, guidelines and routine screening for women as they age. Many women interact with health care regularly through OB/GYN care, yet still lack consistent longitudinal primary care as they enter midlife. Symptoms such as fatigue or mood changes are also more likely to be minimized, even when they may signal broader cardiometabolic or inflammatory conditions. Closing these gaps starts with recognizing that conditions like dementia can present early through mood, sleep and emotional changes.

Dementia Is More Than Memory Loss

Dementia is commonly associated with memory loss, but early symptoms often extend beyond cognition alone. Depression, anxiety, irritability, social withdrawal and sleep disturbances can precede noticeable memory impairment by years. In clinical settings, these symptoms are frequently addressed in isolation, particularly among women, whose concerns may be attributed to life transitions or emotional stress rather than evaluated as potential indicators of cognitive decline.

Research suggests dementia symptoms may present differently across genders. Women are more likely to experience early changes in mood, sleep or emotional regulation, while men may present later with more pronounced cognitive or functional impairment. These patterns are influenced by both biological factors and differences in how individuals engage with health care, with important implications for timely recognition and appropriate care. Men are also more likely to seek care later in the course of illness, which can shape when and how cognitive decline is identified.



These patterns are reinforced by broader gaps in mental health access for women. More than a quarter of adult women in the state report symptoms of anxiety or depression, yet only a portion of the demand for mental health services is currently met. Approximately three-quarters of Minnesota counties face shortages of mental health professionals, leading to long wait times, long travel distances, and higher costs before care is available. When mental health needs go unmet, early signs of dementia are more likely to be overlooked or dismissed.

Why Dementia Often Looks Different in Women

Women face a higher lifetime risk of dementia, yet early cognitive changes are often not addressed until they begin to interfere with daily functioning. In Minnesota, the number of adults age 65 and older living with dementia, including Alzheimer’s disease, had reached nearly 120,000 cases by the end of 2025. Women account for nearly two-thirds of Alzheimer’s cases in the state, underscoring the disproportionate impact of dementia across genders. At the same time, men face higher mortality earlier in life and are more likely to present later in the disease course, shaping differences in diagnosis and progression.

Hormonal changes during midlife may affect brain health, including how the brain responds to inflammation, vascular changes, and chronic stress, all of which are increasingly linked to dementia risk and progression. Several studies suggest women are also more likely to be diagnosed later than men, limiting opportunities for early planning, intervention, and support. A woman may seek care for sleep disruption, anxiety, or mood changes during periods of stress or transition, while also noticing more difficulty with attention, organization, or daily routines. Even when these changes are present, they may not be described as memory problems. Without integrated screening, early signs can be attributed to mental health strain alone, delaying evaluation. These biological differences, however, are only part of the story.

How Daily Strain Affects Brain Health

Social factors further shape dementia risk for women. Many women spend decades prioritizing the health of spouses, parents, and children, often delaying care for themselves. Caregiving responsibilities, which are common among Minnesota families, can lead women to downplay symptoms or postpone care while focusing on others. Across the lifespan, these caregiving roles often begin early and continue into later adulthood, contributing to chronic stress that may influence cardiometabolic and inflammatory pathways increasingly linked to cognitive health.

In Minnesota, nearly 30% of caregivers report symptoms of depression, and more than half report managing chronic health conditions themselves. A woman may be coordinating care for a spouse or parent while struggling to stay on top of her own appointments, paperwork and daily routines, which can be dismissed as stress even when it may reflect early cognitive decline.

Women are more likely to live alone later in life, particularly after the loss of a partner. Social isolation, combined with chronic stress and untreated depression, can have lasting effects on brain health. In Minnesota, long winters and  transportation barriers can further limit social engagement, making these risks especially pronounced for older women aging independently.

The intersection of dementia and mental health represents a national challenge.

When Medications Become an Early Warning Sign

Medication adherence often becomes a critical but under-recognized issue as cognitive changes begin to affect daily routines. Many older adults manage complex medication regimens for multiple chronic conditions, and even mild cognitive impairment can disrupt habits that were once automatic. In practice, early concerns often show up in medication routines first. A patient who previously managed medications independently may begin asking the same questions about instructions across multiple visits, even after counseling. Others may request early refills after taking doses twice or show gaps in refills after stopping a medication unintentionally. Struggling with a pill organizer, mixing up similar-looking bottles, or relying more on reminders can signal early difficulty with attention and organization.

For women, these challenges may be harder to detect early when medication routines are strained by caregiving responsibilities or competing demands. Symptoms such as depression, anxiety or sleep disturbance can further undermine consistency by affecting motivation, energy and daily organization. Research also suggests women may respond differently to certain medications due to differences in metabolism and hormonal influences, which can affect side effects and symptom presentation.

Because many older adults take multiple medications for chronic conditions, pharmacist-led medication therapy management and care coordination programs can play an increasingly important role in identifying adherence issues and flagging potential early signs of dementia.

Addressing Dementia and Mental Health Together

The intersection of dementia and mental health represents a national challenge, but our aging population, workforce shortages, and geographic barriers make this issue especially urgent across the state. Addressing these conditions together, rather than separately, is essential for earlier recognition and more effective care. For Minnesota, where a growing population of women are entering midlife and older age, this shift is especially important.

Routine screening that considers cognitive health alongside mental health symptoms can help clinicians identify concerning patterns even when memory complaints are not the primary reason for a visit. Brief, structured tools can support this approach without adding significant burden, particularly in busy or resource-limited settings.

Care models that prioritize prevention and long-term outcomes, including value-based care approaches, can help close these gaps by enabling earlier identification and management of risk. Clear pathways between primary care, mental health services, pharmacists and community supports are especially important in communities where care is often fragmented by distance or provider shortages. 

At Herself Health, we have built primary care intentionally for women, particularly those in midlife and beyond. That means longer visits, integrated behavioral health, proactive screening for osteoporosis and cardiovascular risk, and clinicians trained to connect the dots across systems rather than treat symptoms in isolation. When women feel heard and understood, engagement improves, and so do outcomes.

What is Next for Cognitive Care

As the population continues to age, clinicians, health systems and policymakers must prioritize integrated approaches that treat cognitive and mental health as interconnected elements. Earlier screening, better coordination across care settings and improved access to mental health services can help ensure dementia is recognized sooner and care is delivered more effectively.

Even small changes can improve early identification and support. Clinics can incorporate more brief cognitive check-ins for older adults during annual visits, particularly when patients present with new or worsening depression, anxiety, sleep disruption or functional concerns. Practices can also build in a standard step when medication issues emerge, such as missed refills, repeated questions about dosing, or increasing reliance on reminders, prompting a broader assessment rather than treating adherence challenges in isolation. These approaches help clinicians identify early risk sooner and connect patients and families to appropriate follow-up.

Looking ahead, value-based and personalized care models will be critical to meeting the growing and varied needs of all older adults. Approaches that emphasize continuity, longer visits and individualized care planning can better account for differences in how dementia presents and progresses, while supporting earlier intervention and more consistent follow-up. For women in particular, these models offer an opportunity to move beyond episodic care toward more tailored, relationship-based support that improves planning, coordination and quality of life as cognitive needs evolve with age.

Deborah Dittberner, MD, is the chief medical officer at Herself Health.