In the United States, approximately 6 million adults aged 65 and older have Alzheimer’s disease. Nearly two-thirds of them are women — a gap that researchers have long attributed to genetics and women’s longer lifespans, among other reasons. But there is a growing consensus that menopause may also be an important risk factor for the development of dementia later in life.
Women going through the phase of life, which is clinically defined as the end of fertility, face as many changes in the brain as in the ovaries, said Dr. Lisa Mosconi, a neuroscientist and director of the Women’s Brain Initiative at Weill Cornell Medicine. Although the vast majority of women will survive these changes without long-term health consequences, approximately 20% will develop dementia in the decades that follow.
The female brain is rich in estrogen receptors, particularly in regions that control memory, mood, sleep and body temperature, all of which “work wonderfully when estrogen is high and consistent,” said Dr. Dr. Mosconi. Estrogen is also vital for the brain’s ability to defend itself against aging and damage.
The characteristic drop in estrogen during menopause not only alters the functioning of certain regions of the brain, she said, but it is also thought to change the structure of the brain; Analyzes show reduced volume in the brains of postmenopausal people compared to the brains of men of the same age and those of premenopausal women.
These neurological changes may be responsible for some menopausal symptoms, including hot flashes, mood disturbances, and a mild, usually temporary, decline in memory and cognition.
They also resemble changes in the brain that precede dementia, Dr. Mosconi said. “Some of the regions of the brain affected by menopause are also regions affected by Alzheimer’s disease,” she said, but the connection between the two is not fully understood.
Menopausal symptoms themselves, such as lack of sleep and hot flashes, have also been linked to dementia. A study published last year found that hot flashes were associated with an increased amount of tiny lesions in the brain, a sign of declining brain health, said Dr. Pauline Maki, professor of psychiatry and director of the women’s mental health research program. at the University of Illinois at Chicago and co-author of the study. A more recent study determined that hot flashes during sleep were associated with an increase in blood biomarkers of Alzheimer’s disease that serve as early indicators of the disease.
Although this research seems alarming, most women’s brains and cognitive functions stabilize after the transition to menopause, Dr. Maki said.
“Consider how many women are postmenopausal – every woman, right? And 80 percent of them will not have dementia,” she said. “We cannot catastrophize this universal transition.”
Beyond that, there are steps you can take to boost your health and cognitive function in the face of declining estrogen.
Three steps to protect your brain
Several studies have shown that up to 40 percent of dementia cases may be preventable, said Dr. Jessica Caldwell, director of the Women’s Alzheimer’s Disease Movement Prevention Center at the Cleveland Clinic in Las Vegas. And a few lifestyle changes in midlife, including quitting smoking, reducing alcohol consumption, sleeping better and staying mentally and socially active, help with prevention.
But for menopausal women, experts say three things in particular are likely to have the biggest impact in tackling both short-term symptoms and long-term risk of dementia.
Hormone therapy, at the right time
For decades, researchers have worried that hormone therapy used to treat menopausal symptoms was associated with an increased risk of developing dementia in older women. But recent studies, including one published last month that reviewed the results of more than 50 studies, take a closer look at the timing of treatment and suggest a more nuanced picture: hormone therapy started when symptoms of menopause started was associated with a reduced risk of Alzheimer’s disease and dementia. Other studies have shown that hormone therapy has no effect on dementia and Alzheimer’s risk, Dr. Maki said, but these treatments are effective in treating hot flashes and night sweats as well as to improve quality of life, all of which are “important determinants of the brain”. health,” she said.
Physical inactivity poses a higher risk of neurodegenerative diseases in women than in men, Dr. Caldwell said. “We know that physical inactivity is a risk factor for dementia. And throughout their lives, women are on average twice as likely to be physically inactive as men,” she said.
A 2018 study that followed nearly 200 middle-aged women for 44 years found that the higher their fitness level at the start of the study, the lower their risk of developing dementia later in life. And Dr. Mosconi found that brain scans of physically active middle-aged women showed fewer Alzheimer’s biomarkers than their sedentary counterparts.
A healthy diet
In recent years, researchers have found that certain diets, such as the Mediterranean diet and the somewhat similar MIND diet, which emphasize vegetables, fruits, whole grains, lean proteins and healthy fats, are associated with reduced risk. dementia in men and women. . The Mediterranean diet in particular appears to be a protective tool, even for women at genetic risk for Alzheimer’s disease, Dr. Mosconi said. And these plant-rich diets may have an additional benefit specific to women: Preliminary research suggests that certain gut bacteria — nourished by a plant-rich diet — may help balance estrogen levels in the body.
Many of these lifestyle changes take time, which many middle-aged women feel they don’t have, Dr. Caldwell said.
“Society expects us to put ourselves after everyone else, whether children, parents or spouses, and we need to keep ourselves on the priority list,” she said. “Because if we don’t engage in these types of health maintenance behaviors, we won’t have the healthy brain aging that we want.” »
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