Understanding and Preventing Alzheimer’s in Women
No matter what stage of menopause you are in, you can take steps now to lower your risk of Alzheimer’s.
Alzheimer’s is the 6th leading cause of death in the United States, with someone being diagnosed every 65 seconds. According to the Mayo Clinic, Alzheimer’s disease is the most common cause of dementia, which refers to a group of brain disorders that lead to intellectual and social skills impairment. Characterized by the accumulation of proteins called tau and amyloid-beta, this disease involves degeneration of brain cells, initially resulting in loss of short-term memory and progressing to further cognitive decline.
As women, our memory is one of our most prized possessions, allowing us to somehow manage 18 different tasks at the same time and remember what someone says years down the road. But ironically, the disease responsible for stealing human memories affects women the most.
Why does Alzheimer’s affect women more than men?
Although it was originally thought to be due to the simple fact that women live longer than men (and would, therefore, be afflicted with more diseases in their lifetime), researchers are now finding more specific factors that may play a role in why women are more likely to be affected by Alzheimer’s disease.
Approximately 1 in 6 women will develop Alzheimer's disease, compared to 1 in 11 men. Furthermore, we are most susceptible to developing this disease in the decade following menopause, highlighting the importance of conducting more research into what exactly makes us more prone to getting it.
Genetics may share some responsibility, as women are twice as likely to develop Alzheimer’s if they carry a copy of a particular form of the gene ApoE-4, an increase in risk that is not seen so dramatically among men with this same gene. Why the huge increase for women? It could have something to do with how the ApoE-4 gene interacts with the female hormone estrogen.
ApoE is a gene that instructs the body on how to make a protein that carries cholesterol through the bloodstream, and it comes in three variants: ApoE-2, ApoE-3, and ApoE-4. We all have two of these, one inherited from each of our parents, but the potential problem is seen when we inherit ApoE-4. Having this gene variant significantly increases one’s risk for both cardiovascular and Alzheimer’s disease.
Perhaps the most convincing research has to do with estrogen. A 2017 study looked at the metabolic and hormone changes that occur in women’s brains during perimenopause and menopause, suggesting that loss could increase female susceptibility to Alzheimer’s. As such, they concluded that the “optimal window of opportunity for therapeutic intervention in women is early in the endocrine aging process”. A 2018 study had similar results, stating that "estrogen deficiency could lead to anxiety development and memory impairments."
Scientists have recently been looking at other hormone changes that affect the female brain, too. A 2018 study in Neurology analyzed over 2,000 people in their 40s and found that those having the highest levels of the stress hormone cortisol performed the worst on memory, organization, and other visual tests. High cortisol levels were also associated with brain changes often seen in Alzheimer’s, and the link between cortisol and cognition was especially strong in women during midlife, a time of significant mental and physical stress.
Other studies suggest that heart health could have something to do with Alzheimer’s risk differences between the sexes. Because men have a higher risk of dying from heart disease during middle age, men who live past the age of 65 years might have stronger, healthier hearts that consequently have a protective effect on the brain. Alzheimer’s and heart disease share several similar risk factors, like obesity, diabetes, and high cholesterol.
What are the signs of Alzheimer's and when can they start?
Alzheimer’s disease starts approximately 10-20 years before symptoms appear. In fact, signs of early-onset Alzheimer’s typically appear in a person’s 30s-60s. Below are some of the most common early signs of Alzheimer’s disease that should be further evaluated by your healthcare provider.
Memory loss that interrupts daily life, especially of things you recently learned
Difficulty in problem-solving, concentrating, organizing, or planning
Trouble finishing familiar tasks that used to be second nature
Confusion around understanding time or place
Difficulty reading, judging distance, and driving
New language and word problems in speaking or writing
Unusual misplacement of items and the inability to retrace steps
Impaired judgment and decision-making
Social withdrawal from familiar groups, people, and activities
Drastic personality or mood changes in the form of acting anxious, fearfulness, paranoid, aggressive, or depressed
What are some ways to prevent Alzheimer's in women?
Like most chronic diseases, the most significant factor in Alzheimer’s prevention is lifestyle. Whether you are pre, peri, or postmenopausal, making healthy choices when it comes to diet, physical activity, and everyday behaviors are essential preventive measures.
A 2018 study by the Alzheimer’s Association found that for individuals who carry the ApoE-4 gene, engaging in at least 2.5 hours of physical activity every week was associated with a reduced risk for cognitive decline and onset of dementia symptoms. Those who exercised more had lower levels of biomarkers for Alzheimer’s disease, such as lower tau protein in their cerebrospinal fluid. Whether you’re into walking, running, swimming, or aerobics, science says that regularly incorporating these activities into your routine can make a big difference in the prevention of cognitive decline.
Like an expensive car, our body requires the highest quality fuel to perform at its best. The brain makes up only 2% of our body weight, but it utilizes 25% of the body’s energy, making it especially vulnerable to our dietary choices.
What is a high-quality diet? When it comes to Alzheimer’s disease, and many other chronic diseases, the most benefit is seen with a whole food, plant-based diet that provides a number of essential vitamins and minerals, healthy unsaturated fats, quality protein, and antioxidants - while minimizing processed foods.
Research presented at the 2018 Alzheimer’s Association International Conference found that individuals who eat a Mediterranean diet, based on whole plant foods, cut their risk of developing dementia by one-third.
Interrupted sleep is one of the most common complaints that women report during menopause, often as a result of hot flashes or insomnia. Unfortunately, inadequate sleep appears to impact levels of beta-amyloid in the brain, the accumulation of which is connected to Alzheimer’s risk. So, whatever you can do to improve your sleep patterns during menopause (not napping during the day, turning the temperature down at night, dressing in light pajamas) is a good idea.
A 2018 study in the Proceedings of the National Academy of Sciences scanned the brains of 20 healthy participants, ages 20-72 years, and looked for the protein beta-amyloid, an indicator of Alzheimer’s. Researchers found that beta-amyloid increased around 5% in their brains after a night of poor sleep. The change occurred in parts of the brain that are most vulnerable to damage in early Alzheimer’s, the thalamus and the hippocampus.
Learning new things
Although not as strong, there is some evidence that learning new things might help to slow cognitive decline with age. The theory is based on the idea that learning helps protect current neural pathways in the brain while also creating new ones, slowing the process of memory deterioration.
A 2017 study published in Neuroepidemiology found a weak, but present correlation between education and protection from memory changes. A 2015 study found that cognitive activities delayed impairments at a 5-year follow up of participants, but were no longer significant at the 10-year follow up. Doing things that challenge the brain, like solving crossword puzzles, meeting new people, or learning a language, might help - and at the very least, won’t hurt - your brain.
Can Alzheimer’s disease be reversed?
There are currently no effective treatments for Alzheimer’s disease, but researchers are working hard to find potential interventions. Prevention is at the forefront. The Center for Alzheimer’s Research and Treatment, associated with Brigham and Women’s Hospital and Harvard Medical School, conducts clinical trials to help find treatments and improve early diagnosis.
One idea is that memory loss may be able to be reversed through the targeting of a specific enzyme involved in communication between brain cells. There are also theories that, because of the strong link between gut health and brain health, interventions targeting gut bacteria could be therapeutic for the brain.
Until a promising treatment is discovered, the best approach to protecting the brain is prevention, by taking the initiative to make healthy lifestyle choices as much as possible.
For more information on women’s brain health and tips for staying sharp, come join us over at Lisa Health!
Dr. Hemalee Patel, DO, is board certified in internal medicine and currently practices at One Medical, California Pacific Medical Center, Stanford University Hospital & Clinics, and Crossover Health-Facebook Headquarters. Known as a thought leader in the lifestyle medicine movement, Dr. Patel is a frequent speaker and advisor on topics related to empowering and educating individuals using the latest advances in health and wellness so they can prevent and control the development of chronic diseases and achieve balanced lifestyles. Dr. Patel received her BA in Economics and English from UC Berkeley with an emphasis in Preventative Medicine and Nutrition. She completed her medical degree at Touro University and residency at Santa Clara Valley Medical Center.