Women who participated in the paid labor force have lower rates of memory decline

Despite a move toward precision medicine approaches to cognitive impairment and dementia, the incorporation of sex and gender differences remains limited.^1,2 Sex refers to biological differences such as chromosomal, gonadal, or hormonal differences; gender refers to a combination of environmental, social, and cultural influences on women and men.³ Gender is rooted in biology but shaped by environment and experience. Of studies in the dementia field that have incorporated sex and gender, the vast majority focus on sex differences or sex-specific factors including pregnancy, the menopausal transition and use of hormone therapy, genetics, or differences in biomarker profiles.¹ Fewer studies have focused on gender-related differences in dementia risk, with education the factor most examined.² Low education is associated with risk of dementia in both women and men, but women born in the 20th century have historically had less access to education than men; thus, this risk factor has had a proportionally greater effect on older women. There has been even less research, if any, on gender differences in occupation or workforce participation for late-life cognitive outcomes. This is particularly relevant for women because life course patterns of working, childrearing, and marriage have changed dramatically over the last century, with an increasing number of women joining the paid labor force. Studies demonstrating that lifetime occupational attainment⁴ and occupational complexity are related to cognitive decline and dementia risk have largely overlooked this historical gender discrepancy.⁵