An interview with neuroscientist Dr. Lisa Mosconi gained attention in recent months. The interview causes concern for middle-aged women because it links menopause to Alzheimer’s disease. Mosconi highlights that medical research for women often focuses on reproductive health and breast cancer. However, research on women’s brains is lacking. Dr. Mosconi aims to change that and to spread awareness about Alzheimer’s and its effect on women.

The Statistics

There are currently over five million Americans living with Alzheimer’s in the United States. Over two-thirds of those are women. Besides old age, being a female is the second risk factor for developing the disease. While women, on average, live a few years longer than men, those few years are not enough to explain the disproportionate statistics.

So, why does Alzheimer’s effect twice as many women rather than men? Dr. Mosconi set out to find the answers. 

Identifying the Link Between Menopause and Alzheimer’s

Research shows that Alzheimer’s begins in midlife, often far before other prevalent warning signs and symptoms of the disease. Dr. Mosconi simply asked, “What happens to women, but not men, in midlife that could possibly initiate Alzheimer’s?” The potential answer: menopause.

All women experience hormonal changes in various severity during menopause. For some women, these changes may be so severe they could actually trigger Alzheimer’s. Mosconi and her research team began investigating a relatively new theory: do hormonal changes during menopause increase the risk of Alzheimer’s? Through their research, the team found that there is indeed a strong association between early menopause and an increased risk of Alzheimer’s disease in women.

The Study and the Findings

To further her search for answers, Mosconi and her colleagues used a brain imaging technique called positron emission tomography, commonly called a PET scan. The scans measured neural activity and the presence of Alzheimer’s plaques in a group of healthy middle-aged women. The test showed that postmenopausal women had less brain activity and more plaques than premenopausal women. Perimenopausal women (those just starting to experience menopause symptoms) showed similar results as postmenopausal women. Additionally, the scans revealed that both peri- and postmenopausal women showed less brain activity and more Alzheimer’s plaques compared to healthy men of the same age. 

The Science Behind the Connection

While the exact cause is unknown, Alzheimer’s is likely due to compound causes, including age, genetics and lifestyle. With more recent research, the link between changing hormones and increased risk for the disease has been well established. Complex cellular process help explain why the correlation is so strong. 

Glucose Metabolism

Mosconi’s team used PET scans to examine how women’s brains metabolize glucose. Glucose, a sugar, is the main source of energy for brain cells. Mosconi’s study found that perimenopausal and postmenopausal women had reduced glucose metabolism as compared to premenopausal women. In support of her findings, previous research suggests that low levels of sugar precede and could possibly trigger the development of Alzheimer’s Disease. 

Mitochondrial Dysfunction

In addition to glucose hypometabolism, the team found signs of mitochondrial dysfunction in postmenopausal women. The mitochondria create energy for cells. Dysfunction of the cell part means that brain cells do not generate energy efficiently. Further, a critical metabolic enzyme called mitochondrial cytochrome oxidase was less abundant in menopausal and perimenopausal women. 

Estrogen and Amyloid

Dr. Mosconi isn’t the only scientist researching the link between Alzheimer’s and menopause. Neuroscientist Dr. Gillian Einstein states that estrogen is necessary for brain cells, or neurons, to grow and communicate. While menopause doesn’t always mean a drop in mental performance, a steep drop in estrogen levels may increase the risk of cognitive decline. 

Neurobiologist Dr. Ralph Martins states that the link, in simple terms, is attributed to diminishing estrogen. Decreasing estrogen levels are linked to beta-amyloid proteins in the brain. Martins’s research shows that when estrogen levels drop during menopause, amyloids build up and clump together. The protein is a biomarker of Alzheimer’s disease because they form clumps, or Alzheimer’s plaques, that disrupt brain function.

Martins’s findings align with Mosconi’s that also showed menopause’s link to an increase in the amyloid proteins. While the exact mechanism between estrogen drop and the amyloid increase is still being examined, research points strongly to the hormonal changes of menopause. 

What to do About It

Despite the strong connection between menopause and Alzheimer’s, women are not totally helpless to the unlucky hand their gender was dealt. Early detection, lifestyle changes and possible hormone therapy can help reduce their risk of developing Alzheimer’s. 

Early Detection

Dr. Mosconi believes there may be a critical window of opportunity for women in their 40s and 50s. During this time, women may be able to detect early risks of Alzheimer’s disease. A brain scan can also help identify metabolic signs of the disease.

Dr. Martins recommends women visit a specialist before the onset of perimenopause. A neuropsychologist or memory clinician can set a benchmark of brain function before hormonal changes begin. Overall, early detection of Alzheimer’s symptoms can reduce the risk of the disease’s progression. 

Lifestyle Changes 

Until middle-aged women routinely receive preventative testing and treatment for Alzheimer’s, a few lifestyle changes can help. Changes in diet can mitigate the effects of menopause and therefore possibly minimize the risk of Alzheimer’s. Certain foods such as soy, flax seeds, chickpeas, and garlic can help naturally boost estrogen production. Antioxidant-rich foods help protect the cells’ mitochondria and maintain levels of estrogen. Dr. Mosconi also advises against consuming processed foods as they have been linked to early onset menopause

Lastly, she emphasizes the importance of stress reduction during and after menopause. Consider establishing a regular habit of exercise, yoga or meditation. 

Hormone Therapy

Hormone replacement therapy (giving women supplemental estrogen) may alleviate symptoms if rendered prior to menopause. However, Dr. Mosconi is clear that further research is needed to test the efficacy and safety of hormone therapy. Overall, research is needed to weigh the risks of replacement therapy with a lessened risk of Alzheimer’s.  

Early Menopause May Increase the Risk of Alzheimer’s Disease

As with many complex diseases, the research between menopause and Alzheimer’s disease is not conclusive. Mosconi aims to continue her research with the ultimate goal of finding a cure for the disease and advocating for women’s healthcare. Women and their doctors should investigate symptoms early and manage the known risks as much as possible. Women are unique in many ways, but researchers are hoping an increased risk of memory loss doesn’t always have to be one of them.