Women’s Brain Health Evaluation

Personalized and Preventative Approach to Women's Brain Health

As my Psychiatric practice has evolved over the past 30 years, I have become increasingly interested in a Preventative Model for optimizing women's brain health. I have women in my own family who have been diagnosed with Alzheimer’s disease and this has become both a personal and professional journey for me. As I began to discuss my interest in women's brain health with my patients, and the women in my own circle of friends, it became evident that many women share these same concerns and are looking for answers.

Dementia prevention is top of mind for many women, especially those with us with a positive family history. However, maintaining brain health is essential for all women to protect our quality of life and optimize our health span. We do not just want to live longer but we all want to live healthy, happy, and meaningful lives with our cognitive abilities intact. 

Prevention

Unfortunately, Western medicine's approach to healthcare is to treat a disorder once it is diagnosed instead of using a preventative model. This often leads to poor outcomes as by the time the disease process can be diagnosed the damage is already done. This is especially true with dementia where brain changes can start decades before the onset of the symptoms. Therefore, early intervention and prevention are the most effective tools that we currently have to offer women and they can be powerful. It is never too early or too late to start protecting our brains so let’s get started!

Although we are all susceptible to some normative changes in cognition as we age, prevention is key to maintaining optimal brain health. Many of these Modifiable Risk Factors are related to Lifestyle: Exercise, Sleep, Nutrition, Stress Management, Mental Stimulation, Social Activity/Community.

Medical conditions including Cardiovascular risk factors or disease (hypertension, elevated lipids), Metabolic Disorders such as Type 2 Diabetes, Thyroid Disorders, Inflammation and Hormonal Imbalances can all contribute to poor brain health. Additionally Functional Medicine tests that assess  gut health, vitamin and mineral deficiencies, nutritional deficiencies, oxidative stress, mitochondrial dysfunction and toxic exposure are part of a thorough evaluation.

Alzheimer’s, the most common type of dementia, is twice as likely to occur in women versus men. Anxiety and depression are also twice as likely to be diagnosed in women versus men. However, by addressing the above mentioned Modifiable Risk Factorswomen can decrease their risk of developing dementia, even women that are genetically vulnerable. These same factors are important for all women, regardless of genetics, to maintain optimal brain health as we age.Fortunately, not all women that are genetically vulnerable to develop Alzheimer’s will go on to be diagnosed and conversely there are women without genetic vulnerability that unfortunately will develop Alzheimer’s. Genetics is not destiny and there are many factors that are under our control that we can address.

Precision Medicine

Precision medicine, otherwise known as personalized medicine, is an innovative approach to prevention. Each patient's genetics, family history, nutritional status, medical history and lifestyle factors  are carefully assessed and then an individualized plan to support optimal brain health is developed. Care is tailored to each patient rather than a one-size-fits all approach. For example vitamins, minerals, adaptogens and supplements are often recommended based on testing as not everyone requires the same support. Medications to address underlying medical conditions that affect brain health including hypertension, high cholesterol and Type 2 Diabetes may be recommended as well. 

Extensive testing is the foundation to this Preventative Model. Testing includes extensive blood work, Functional Medicine testing and genetic testing. Imaging studies may be recommended. Although there is an expense involved in obtaining laboratory testing it is essential and the foundation of the evaluation. In our society there is a tremendous amount of money spent by women on their outward appearance. In my opinion, there is no better investment of these resources than in our brain health which ultimately will allow us to age beautifully and gracefully.

Gender-Specific Care

Women’s health needs are different from men’s and therefore need to be addressed in a gender specific manner. Unfortunately, women have been excluded from medical studies for many years because of concerns regarding the prescribing of medication to women in their reproductive years. Therefore, much of the data we have on medications is based on studies in men. Fortunately this is changing thanks to researchers such as Dr. Lisa Mosconi. Dr Misconi is a neuroradiologist, director of the Cornell Weill Women’s Brain Initiative and prolific author. Her most recent book “The Menopause Brain” is a must read. Dr Misconi research has shown that menopause may be a critical window of opportunity to address “the decline in estrogen as a female specific trigger for Alzheimer's Disease.”

Most women who have gone through perimenopause and menopause are familiar with the common symptoms that occur with the decline in estrogen levels. Hot flashes, cognitive fogginess, memory losses, sleep disturbances, anxiety and depression to name a few. These symptoms result from Brain Changes secondary to the lack of estrogen. Many women may begin to experience these symptoms during the perimenopausal period, defined as the years preceding the last period. Many women that suffer with perimenopausal and postmenopausal symptoms are not offered treatment. Furthermore, the decline in estrogen with menopause may contribute to cognitive decline in the future and contributes to the risk of osteoporosis, cardiovascular disease and alterations in the gut microbiome which also affect brain health.

Although hormone replacement therapy ( HRT ) is not currently recommended for Alzheimer's prevention there is much research occurring in this vital area and evidence to support its use and safety. Unfortunately, it often takes years for these large studies to be completed, although they are underway and in time recommendations will be updated. There is much confusion about the safety of Hormone Replacement Therapy (HRT) that arose from the Women’s Health Initiative study from 2002. Fortunately, this data has been re-examined  and for most women HRT is felt to be safe with the benefits outweighing the risks. However, this is a highly individualized decision for every woman. It  is important to have this discussion with a physician familiar with the most recent trends in the field and thoroughly understand the pros and cons of hormone therapy for you as a unique individual. There is not one size fits all when it comes to hormonal therapy. Every woman deserves to have this discussion with their provider and make an informed decision.

Understanding the role hormones play in women's brain health is essential and may require collaboration with a  gynecologist well versed in hormone replacement therapy (HRT). If needed you may find a local provider at https://www.menopause.org/Menopause.org.

As you embark on this journey to support your brain health I hope that you will share all that you learn with the women you love in your life- mothers, sisters, daughters, nieces, granddaughters and friends so we can all support each other in this important work.