“In the next three minutes, 3 people will develop Alzheimer’s. Two of them will be women” – Dr. Lisa Mosconi, PhD.

Women are at the epi-center of Alzheimer’s disease (AD) as both persons living with the disease and as the caregivers of those with dementia. A disproportionate two thirds of seniors living with AD are women. Until recently, sex differences in the disease development have been overlooked and past explanations for the gender difference in AD development have been attributed to the fact women tend to live longer than men. However, this number is only by 4 years and while age does increase risk, this alone does not account for other factors that contribute to the significantly higher risk or the faster progression of the disease in women.

What’s further problematic is that women’s symptoms are more likely to be dismissed. Early warning signs of AD are often mistaken for depression or other physical or psychological health conditions such as depression. Furthermore, women have stronger verbal memory at baseline than men so they perform better on early cognitive screening tests even if they have some degree of cognitive impairment. Current screening tests may not be sensitive enough for women and do not account for gender differences in memory. Unfortunately, both issues delay early diagnosis and subsequent treatment of AD in women.

Mild cognitive impairment (MCI) often starts in our early thirties and begins as very subtle shifts in memory recall, focus, thinking, judgement, planning, directions, language, and our mood. Fortunately, most, if not all symptoms of MCI are reversable when efforts to address underlying health concerns contributing to AD development are taken with early dietary, lifestyle and nutraceutical interventions.

What’s perturbing is that women generally only show notable symptoms of AD with more extensive brain damage as seen in more advanced disease. PET imaging has shown the tau protein tangles, one hallmark of AD, may spread more rapidly in women due to a number of factors, including genetic, hormonal, anatomical, and social influences. Other aspects on imaging are the presence of beta-amyloid plaques and significant brain shrinkage.

Risk factors for Alzheimer’s disease for BOTH genders include:

• ApoE4 carrier
• Blood sugar dysregulation and diabetes
• High blood pressure
• Elevated LDL cholesterol
• Obesity
• Depression
• Lack of physical activity
• Smoking
• Lack of participation in mentally or socially stimulating activities

So why then the difference between men and women when it comes to AD?

ESTRADIOL, according to growing research. Hormones play a critical role in neuroprotection for women, specifically estrogen in the form of estradiol. More light is being shed on the link between Alzheimer’s disease and menopause. As estrogen levels decline during this time, it is postulated that so do its neurological protections. Menopause leads to metabolic changes in the female brain that may increase the risk of the disease development. Brain imaging studies have shown that 40-60 year old perimenopausal and postmenopausal women exhibit AD characterized by decreased metabolic activity and increased brain beta-amyloid deposition when compared to premenopausal women and to age-matched men.

The menopause transition brings with it a number of estrogen-disruptions that impact cognition, including temperature regulation, sleep and circadian rhythms, depression, and decreases in several cognitive domains. Declining estrogen has also been shown to change brain energy pathways. In particular, estrogenic regulation of brain glucose metabolism becomes dismantled during perimenopause. As brain estrogen drops, the pathways requiring estrogen to metabolize brain glucose for energy disassemble. This increases the breakdown of ketones as an alternative fuel source for the brain. Hypometabolism, mitochondria (the cell’s powerhouse) function decreases and oxidative damage promoting amyloid plaque formation and neuron damage can result.

Furthermore, brain regions crucial to learning and memory contain a substantial amount of estrogen receptors. Hysterectomy, a relatively common procedure removing the uterus, and other medical or pharmaceutical interventions also dramatically impact estradiol levels.

Of course, not all menopausal women will develop AD. However, it is important to address underlying health conditions and minimize our risk through dietary, lifestyle, and nutraceutical approaches.

Strategies in Alzheimer’s Disease Prevention

1. Physical and Mental Exercise

On average, women do not get as much physical activity as men. For middle-aged women, the benefit of exercise in AD prevention is up to 30%. Just like the body, the brain needs regular exercise to stay sharp. Try activities such as dancing, learning a new skill, puzzles, and reading. Brain training apps such as Lumosity make brain training exercises convenient in the palm of your hand.

2. Antioxidants & Balancing Blood Sugar

High blood sugar levels impact cognition and brain health by impairing oxygen supply to the brain and damaging neurons. Focusing on healthy fats and lean protein helps stabilize blood glucose levels and prevent reactive hypoglycemia. Including antioxidants is imperative for women’s brains. These include foods such as berries, nuts, seeds, leafy greens, pineapple, mango, papaya, flaxseeds.

3. Avoiding Toxins

Xenoestrogens (estrogen compounds found in our environment) are toxic and disruptive to hormonal health. Pesticides and plastics are the primary source of these. Opt for organic whenever possible. Quitting smoking or vaping is also extremely important.

4. Stay Hydrated

Water, and optimal hydration is essential. The brain is 80% water and is essential for all chemical reactions and energy production in the brain. Even a 2-4% water loss can cause neurological symptoms such as fatigue, dizziness, brain fog, etc.

5. Hormone Replacement Therapy

HRT are bioidentical hormones derived from plant sources, chemically identical to those the human body produces. HRT may be option for some women as estrogen and other hormone levels begin to fall. In addition to dementia prevention, HRT has benefits on bone, cardiovascular, adrenal, and thyroid health. However, individual risk vs benefit should always be considered before starting HRT.

More efforts to uncover the significance of gender differences in AD development is vital to tailoring proper prevention and treatment strategies based on the individual. It is never too soon to prioritize our brain health!

Always consult with your healthcare practitioner before starting any treatment regime. For more information on treatment options and for an individual protocol appropriate for you, call 604-738-1012 or email [email protected]

Book your consultation with one of our experienced Naturopathic Doctors!

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References

1. Duarte, A., Santos, M., Oliveira, C., & Moreira, P. (2018). Brain insulin signalling, glucose metabolism and females' reproductive aging: A dangerous triad in Alzheimer's disease. Neuropharmacology, 136, 223-242. doi:10.1016/j.neuropharm.2018.01.044
2. Mcgurran, H., Glenn, J., Madero, E., & Bott, N. (2020). Risk Reduction and Prevention of Alzheimer's Disease: Biological Mechanisms of Diet. Current Alzheimer Research, 17. doi:10.2174/1567205017666200624200651
3. Mosconi, L. (2020). The XX brain: The groundbreaking approach for women to prevent dementia and Alzheimer's disease and inprove brain health. Strawberry Hills, NSW: ReadHowYouWant.
4. Scheyer O, Rahman A, Hristov H, et al. Female Sex and Alzheimer's Risk: The Menopause Connection. J Prev Alzheimers Dis. 2018;5(4):225-230. doi:10.14283/jpad.2018.34