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Dr. Epperson Q & A: the relationship between women's brain health and dementia

Lifestyle factors can play a significant role in reducing the risk of developing Alzheimer's

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Written by Kristen O'Neill on September 27, 2019

As part of World Alzheimer’s Month in September, we spoke with C. Neill Epperson, MD, Chair of the CU Department of Psychiatry, to discuss the relationship between women’s brain health and dementia, in an effort to better understand why Alzheimer’s affects women more than men, and what, if any, preventative strategies women can use to protect themselves against the onset of dementia.  

For more news about research into Alzheimer’s disease, please listen to our recent podcast with Huntington Potter, PhD, director of The Rocky Mountain Alzheimer’s Disease Center.

Here is our chat with Dr. Epperson: 

Why does dementia, particularly Alzheimer’s, affect women more than men?

Many people initially thought it was because women live longer – and age is certainly one of the biggest risk factors for dementia – but when you look at epidemiologic samples and you control for age, it's pretty clear that it's more than just the length of someone’s life. 

For example, we know that health concerns such as hypertension, metabolic disease, cigarette smoking and excessive drinking increase the risk of dementia for both men and women. That said, when these factors are present in women, they may increase the risk for dementia in women to a greater degree than in men.  

Finding the answer to your question is a complicated process of trying to tease apart how much of one’s risk factor for Alzheimer’s is genetic, how much is hormones – or lack thereof – how much is lifestyle, and how much is overall health. We just don’t have a clear answer, yet. 

Are there preventative strategies women can use to decrease their risk of getting Alzheimer’s or other forms of dementia?

Obviously, you can't control whether you're at a genetic risk for Alzheimer's disease, and you can’t change your sex chromosomes. The good news is you can focus on lifestyle factors. These are the things we have the capacity to do something about. If you have diabetes, do your level best to control your blood glucose levels. Quit if you’re a smoker. Avoid excessive use of alcohol. The data is clear that exercise is good for the brain. Even if you haven’t exercised regularly, it is not too late to start. The benefits of exercise on overall health and well-being are important at any age. 

The data is clear that exercise is good for the brain. Even if you haven’t exercised regularly, it is not too late to start. The benefits of exercise on overall health and well-being are important at any age.

Speaking of exercise...are there “brain exercises” we can do to lower our dementia risk?

We know from research that people with higher levels of education appear to have slower cognitive decline if they do develop Alzheimer’s Disease or other dementias. There is something important about the process of building knowledge – creating connections between nerve cells – that enhances resilience in the face of dementia.

Diet-wise, is there anything specific we can eat to help prevent or delay the onset of dementia/Alzheimer’s? 

We know that being significantly overweight for most of one’s life can have a negative impact on brain health, but we don’t yet have the data yet to say “If you eat these specific kinds of foods or decrease your weight to a certain degree, you can reduce your risk of Alzheimer’s or other forms of dementia.”

Are there signs women can look for? Specific indicators of Alzheimer’s and dementia in general?

The typical complaint that “I’m having trouble finding the word I want to say” or “I walked into my bedroom to get something and can’t remember what it was” are not signs of dementia. These are likely examples of the slowing of information processing speed that is common with aging. Many women assume that this experience is due to their transition to menopause. However, the data suggests that aging has a greater impact on processing speed, while menopause has a unique impact on verbal memory. All of these processes – aging and menopause – are likely contributors to the normal cognitive/memory difficulties that are experienced by many middle-aged women. These experiences are “real” and should not be poo-pooed as “all in our heads”. With that said, anxiety about these memory changes can exacerbate the situation.

I encourage people not to be hypervigilant or get anxious about these signs of typical cognitive aging. Having anxiety about word finding or not remembering where you put something can wind up making it worse. As soon as you have anxiety about a memory issue, the brain is putting its resources towards fueling the anxious thoughts, leaving less energy to perform the task you are trying to accomplish – remembering whatever it is you’re trying to recall. So, try to put those concerns aside and recognize that we all go have these experiences, and they are not a precursor of dementia. 

If your family reminds you that you have told them information many times before, or you find yourself forgetting a favorite family recipe or forgetting how to travel a well-worn path to your grocery store, it would be advisable to speak to your doctor. While you may not be suffering from dementia, you may benefit from interventions meant to promote well-being and adaptive functioning.  

For menopausal women, do hormones play a role in prevention, or mitigating the symptoms of, Alzheimer’s and other forms of dementia?

While there are aspects of hormone therapy that we don’t yet fully understand, the majority of the evidence – particularly in healthy women – shows that the use of estrogen proximal to the time of menopause seems to be protective, or at least, not harmful.

Estrogen improves menopause-related symptoms like hot flashes, vaginal dryness, and mood.  Some women experience significant benefits in cognitive function. The epidemiologic studies in relatively healthy women suggests that use of estrogen during the time before or immediately after their final period appears to be associated with a decreased risk for dementia. There is difficulty interpreting the data from observational studies as women who participate in these studies are more likely to be healthy and well-educated. Whether the encouraging findings that estradiol improves well-being among this subset of the population can be generalized is not known.

Overall, it is important to talk to a doctor about your menopause symptoms, overall health, and whether estradiol could be beneficial to you. A short-term trial (less than four months) can be a good way to determine whether you feel better on or off of estradiol. If hormone therapy is beneficial for you, longer-term use may be preferred.