hotflash inc: dementia in women is linked to hundreds of possible causes, but lifestyle changes seem like the best shot at prevention
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brain power and cognitive function can drop significantly during perimenopause, according to brain scans. getty
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one of the most frightening things a mid-life woman can hear these days is her increased risk for dementia as she approaches menopause.
women represent two-thirds of the fast-rising alzheimer’s and dementia caseload globally. obviously everyone wants to know why and what we can do about it.
loss of estrogen, which has long been demonstrated to have protective effects in the brain, is an obvious suspect, and a flurry of closely-watched research is underway trying to pin this down how this is all connected.
the most recent study to get everyone excited was published in the journal alzheimer’s research and therapy in january. broadly speaking, it found that introducing hormone therapy in women who had the apoe4 gene, which heightens risks for later development of alzheimer’s, led to improvements in memory and cognitive function, and larger brain volumes later in life.
it’s tempting to leap on hormone therapy when you are afraid of losing your mind
according to researchers at the university of east anglia’s norwich medical school, where the research was conducted, the findings demonstrate the “potential importance” of hrt in the face of our outsized risks.
“it’s too early to say for sure that hrt reduces dementia risk in women, but our results highlight the potential importance of hrt and personalized medicine in reducing alzheimer’s risk,” uea’s norwich medical school’s professor michael hornberger told the guardian.
it’s tempting to leap on hormone therapy when you are scared of losing your mind, as many women in the throes of perimenopause are. and no wonder: our brain power and cognitive function can drop significantly during this transition, according to brain scans.
lisa mosconi is an american neuroscientist and author of the 2020 new york times bestseller the xx brain: the groundbreaking science empowering women to prevent dementia. she is also a leading researcher looking at how these supposedly temporary changes are connected to our future cognition — or lack of it. one of her studies, published in neurology in 2021, indicated middle-aged women were more likely than men to exhibit evidence of changes related to alzheimer’s disease, even when they show no outward differences in thinking and memory.
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“our results show changes in brain imaging features, or biomarkers in the brain, suggesting menopausal status may be the best predictor of alzheimer’s-related brain changes in women,” she said.
women represent two-thirds of the fast-rising alzheimer’s and dementia caseload globally. getty
all this research is challenging the previous explanation that women get dementia more than men because we live longer, that much is for sure.
but despite claims around the potential role of menopause in developing dementia and hrt as perhaps a preventive, it’s important to remember that the world’s guiding bodies have yet to recommend menopause hormone therapy as a preventive for dementia — including the latest guidelines from the north american menopause society released in 2022.
to be clear, estrogen is just one part of a very complicated story, and with so many other factors contributing to dementia, focusing on it alone seems almost irresponsible.
dementia is also linked to level of education, stress and sleep
according to the centers for disease control and other relevant bodies, minorities are also at a greater risk, as are those with “lower levels of education, higher rates of poverty, and greater exposure to adversity and discrimination.” there are many other contributing factors as well: length of our reproductive years (between first period and last), number of pregnancies or lack thereof, poor sleep, stress, depression, diabetes, poor diet, exercise, and environmental toxins.
what about the statistically significant associations found between commonly used anticholinergic drugs, which include everything from benadryl to benzodiazepines? or the new study out of johns hopkins published in the journal of the american geriatrics society that found that socially-isolated adults had a 27 per cent higher risk of developing dementia than their more connected counterparts.
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and then there’s birth control
in a package published in may 2020 called, menopause predisposes a fifth of women to alzheimer’s (originally titled the menopause connection), scientific american writer jena pincott called attention to another area: the 100 million women worldwide who take birth control. as she wrote, “shockingly little” is known about what role, if any, the pill might be playing in increasing risk factors for alzheimer’s or dementia.”
so what’s a woman worried about dementia to do?
well, keep up with research, of course. but wouldn’t the prudent thing be to reduce all your known risk factors by taking an evidence-based lifestyle approach? this would involve adopting habits that would keep the rest of your body healthy too, including walking, following a mediterranean diet, strength training, improving sleep, seeking out human connection, managing stress and continuing to challenge yourself, no matter what age you are.
ann marie mcqueen is a journalist with 25 years of experience covering health, wellness, science and more, and when she realized she was in perimenopause five years ago, she decided to make this transition her beat. she has since become a global expert on the subject through her platform hotflash inc, where she helps people navigate the gap between medical and holistic treatments with evidence and experience-based research. she will be writing regularly on all things related to menopause and mid-life.
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