Women are at higher risk for Alzheimer's disease (AD) compared to men, influenced by biological, genetic, and psychosocial factors. The APOE4 allele is a major genetic risk factor for AD, with women carrying this allele more likely to develop mild cognitive impairment (MCI) and AD. Women with APOE4 also show increased total tau in cerebrospinal fluid, a marker of neuronal degeneration. Telomere shortening, associated with aging, is more pronounced in women, and APOE4 carriers experience accelerated telomere attrition. Estrogen may protect against telomere shortening, and hormonal therapy may modulate AD risk in vulnerable women. Pregnancy complications, such as preeclampsia and hypertensive disorders, increase the risk of vascular dementia and cognitive decline. Women with more pregnancies have a higher risk of AD, possibly due to hormonal changes or other factors. Psychiatric conditions like depression and insomnia are also linked to increased AD risk. Depression is associated with a higher risk of AD, and insomnia may accelerate cognitive decline. Educational attainment influences cognitive reserve, with women historically having fewer opportunities for higher education, which may contribute to increased AD risk. However, recent trends show a narrowing of the education gap between women and men. The sex differences in AD risk are influenced by genetics, hormonal effects, pregnancy-related factors, psychiatric conditions, and educational status. Understanding these factors is crucial for developing targeted prevention and treatment strategies for women at higher risk of AD.Women are at higher risk for Alzheimer's disease (AD) compared to men, influenced by biological, genetic, and psychosocial factors. The APOE4 allele is a major genetic risk factor for AD, with women carrying this allele more likely to develop mild cognitive impairment (MCI) and AD. Women with APOE4 also show increased total tau in cerebrospinal fluid, a marker of neuronal degeneration. Telomere shortening, associated with aging, is more pronounced in women, and APOE4 carriers experience accelerated telomere attrition. Estrogen may protect against telomere shortening, and hormonal therapy may modulate AD risk in vulnerable women. Pregnancy complications, such as preeclampsia and hypertensive disorders, increase the risk of vascular dementia and cognitive decline. Women with more pregnancies have a higher risk of AD, possibly due to hormonal changes or other factors. Psychiatric conditions like depression and insomnia are also linked to increased AD risk. Depression is associated with a higher risk of AD, and insomnia may accelerate cognitive decline. Educational attainment influences cognitive reserve, with women historically having fewer opportunities for higher education, which may contribute to increased AD risk. However, recent trends show a narrowing of the education gap between women and men. The sex differences in AD risk are influenced by genetics, hormonal effects, pregnancy-related factors, psychiatric conditions, and educational status. Understanding these factors is crucial for developing targeted prevention and treatment strategies for women at higher risk of AD.