Is it the lack of estrogen that affects women’s brains adversely at menopause? Let’s start with what we know. Dr. Lisa Mosconi’s research shows estrogen, or lack thereof, does appear to play a role in brain health. Whether that relationship is causal or correlated is a matter of debate, but the evidence is highly suggestive of the former. Women’s brains are affected by estrogen. We know that during perimenopause, women can experience depression, anxiety, brain fog, hot flashes, and sleep disturbances. Where do all these symptoms originate? You guessed it — the brain. What makes them go away? Estrogen.
Since we know that estrogen affects the brain at each stage of women’s reproductive lives, why, you might ask, don’t we definitively know the role of estrogen after menopause vis-à-vis Alzheimer’s? We don’t know because the one large-scale study that might have answered that question, the Women’s Health Initiative, was halted prematurely over 20 years ago, and no other women’s study of similar scale has been launched to replace it. Don’t even get me started on this one. Thanks to Dr. Mosconi’s recent imaging studies of the structural and metabolic changes in the brains of women at different phases of their reproductive lives, we may be inching closer to an answer. Every Alzheimer’s presentation is different and the older you are when you exhibit signs, the more quality years you have accrued. But as Dr. Mosconi’s research has suggested, by the time the cognitive changes associated with Alzheimer’s become apparent, the disease is most likely decades in the making.
Why, then, do we spend the bulk of the time, energy, and Alzheimer’s research money targeting treatments for the disease rather than focusing on its prevention? This is a fundamental flaw in most medical research (largely resulting from the fact that much of that research is funded by drug companies). We know the risks associated with vascular dementia. We know who is at risk for developing Alzheimer’s, and what we can do to minimize that risk. So, why is more not being done to educate members of high-risk communities? The number of campaigns aimed at the prevention of Alzheimer’s and vascular dementias should rival those of the antismoking campaigns in the 1970s.
Wouldn’t it be better if we could figure out how to prevent cognitive decline rather than try to fix it after the fact? As my mother would say, it’s like closing the barn door after the horse is already out. I’m not suggesting we shouldn’t be pursuing treatments, just that we should be able to do two things at the same time. Getting the word out on preventative measures will do more than save women’s lives, it will also vastly improve the quality of their lives.
Beyond Sudoku: Preventing Brain Decline and Alzheimer’s
Now that you know that women are the majority of people living with dementia and Black women are at the highest risk of all, think about what that means for the quality of your life as you age. If you think you’re too young to be concerned about this, think again. Think about your mother. It’s never too late to do better. Being of sound mind is the cornerstone upon which everything you need to do to remain independent as you age is built. Cognitive decline negatively affects your capacity to earn income, to manage your finances, and to perform self-care.
But hang on — you know this is where I slip in some good news.
No one can predict whether you will get Alzheimer’s, but we do know that, as with heart disease, you can push that propensity off further into the future. There is significant evidence that at least 30 to 50 percent of all dementia cases could be delayed or prevented through the same behaviors that heart health demands. Your brain needs exercise the same way your body needs it. And no, I’m not talking about doing Sudoku all day.
The concept known as “cognitive reserve” means that the more knowledge and varied experiences you have stored in your brain, the more you are able to compensate when, and if, cognitive decline begins. For example, if you only know one way to complete a task, be it a route home or a strategy for completing a puzzle, when that avenue is blocked, you’re stuck. This is why physical movement is so important for your brain.
You’re never too old to learn something new, and it doesn’t have to be quantum physics. Brush your teeth or learn to write with your less dominant hand. Instead of relying on directions apps, find your way around, identifying different routes to arrive at the same place. Learn a new language or musical instrument. Change careers. Adopt a new hobby. Memorize poems, song lyrics, and the birthdays and numbers of loved ones by heart (remember when we knew all of those, back in the before-cell phones times?). These aren’t just life-enhancing skills. They’re Alzheimer’s-blockers.
Dr. Sharon’s Rx for Brain Health
- Don’t smoke. (Duh. Just in case you need a reminder.)
- Alcohol is toxic to your brain. Act accordingly.
- Control and self-monitor high blood pressure and blood sugar.
- If you have an early menopause or have your ovaries removed before the age of 50, discuss menopausal hormone therapy with your doctor. And remember: Estrogen matters.
- High fiber, protein (think fish, nuts, legumes, and lean meats), with vegetables and fruits and healthy fats are the way to go to support a healthy brain.
- In addition to your usual exercise, develop new muscle skills focusing on large muscle groups and your core. Balance exercises are important. Remember that head trauma from falls is not an insignificant contributor to dementia, and women’s brains are more susceptible to trauma.
- Stay mentally engaged. Keep learning and challenging your brain.
- Maintain your village. Friends and community matter. Depression is a risk factor for dementia, and people who remain socially engaged experience less depression.
- Seek out and participate in Alzheimer’s studies, particularly if you have a family history or if you are in a high-risk group.
If you’re sensing a pattern, or it feels like I’m just blatantly repeating myself, your brain isn’t playing tricks on you. I am intentionally, even relentlessly, trying to imprint these same healthy habits onto you — mind, body, and soul — so you can’t ignore them. They may seem basic, even boring, but when consistently applied, these behaviors will have a profound effect on your long-term health, the way you age, and your ability to heal when needed.
Excerpted from Grown Woman Talk by Sharon Malone, MD. Crown Publishing Group, 2024.
