2023-12-07 08:24:51
by Cristina Marrone
Neurological changes and typical menopausal symptoms due to the decline in estrogen could be linked to dementia and Alzheimer’s in later life. What to do to protect cognitive functions
In Italy 600 thousand people over 65 suffer from Alzheimer’s. Two thirds of them are women. Researchers have attributed the reasons for this greater spread of the disease among women to their greater longevity (females live on average 5 years longer than men) and to genetic reasons. Today, more and more studies also identify menopause, and the consequent drop in estrogen, as a risk factor for dementia which becomes evident when one reaches an advanced age.
In fact, with the end of the fertile age, women’s brains also change, not just the functioning of their ovaries. The vast majority will overcome these changes without long-term health consequences; however, approx
20% will develop some form of dementia
in the years of senile age. Menopause, with its decline in estrogen and the hot flashes typical of the period, could play a role.
The role of estrogen
Estrogen, the female sexual hormones, have an important impact not only on fertility, but also on the health of the heart, bones, brain, in particular on mood and memory. The physiological decrease in estrogen, in fact, is an event that determines the greater female vulnerability to the loss of cognitive functions, because these hormones also perform a protective function against cell death and inflammation which favors the formation of Beta Amyloid plaques, whose accumulation among the causes of Alzheimer’s disease.
The impact of declining estrogen on the brain
The female brain is rich in estrogen receptors, particularly in those regions that control memory, mood, sleep and body temperature and everything works very well when the level of these hormones is high and constant. The dramatic drop in estrogen during menopause doesn’t just alter the functioning of certain regions of the brain. Scientists believe it also changes structure of the brain. Brain scans showed a
reduced brain volume
with a decrease in gray matter in the menopause period compared to the male brain of the same age and that of premenopausal women.
According to scientists, these neurological changes could be responsible for some typical symptoms of menopause, including hot flashes, mood disorders and a mild and usually temporary decline in memory and cognition. Some brain regions affected by menopause are the same as those affected by Alzheimer’s says al New York Times Dr. Lisa Mosconi, neuroscientist, director of the Women’s Brain Initiative at Weill Cornell Medicine in New York.
At the same time, some menopausal symptoms such as hot flashes or lack of sleep could be linked to dementia, as shown by one studio from a year ago which showed how hot flashes were associated with an increase in small brain lesions, a sign of worsening brain health.
Hot flashes and neurological changes
But are hot flashes causing the neurological changes or neurological changes causing the hot flashes? the estrogen deficiency that causes both answers Rossella Nappi, director of the Endocrinological Gynecology and Highly Complex Menopause Unit of the Irccs San Matteo Foundation of the University of Pavia. The lack of estrogen sensitizes the area of the brain responsible for thermoregulation to misread the temperature of the environment, no longer having that ability to adapt by about half a degree that we have when we go from a cold to a hot environment or vice versa: the woman he sweats to try to dissipate heat that doesn’t actually exist. At the same time all the neurotransmitters also change: serotonin, dopamine, acetylcholine and gaba are depressed, which are respectively neurotransmitters of good mood, pleasure, memory and stress control. The only neurotransmitters that increase are norepinephrine and adrenaline: the brain, in the absence of estrogen, becomes more “stressed” and has fewer neurological connections.
Hot flashes and Alzheimer’s
Another most recent work observed that hot flashes during sleep were associated with an increase in Alzheimer’s biomarkers that measure the level of beta amyloid in the blood.
It is not yet clear whether the association between the presence of high levels of Alzheimer’s risk biomarkers is linked in a casual manner to the presence of nocturnal hot flashes – says Rossella Nappi, who is also president of the International Menopause Society. – However, one fact that deserves great attention is the fact that women with more nocturnal hot flashes have higher levels of a biological marker of Alzheimer’s: a condition that would seem to tell us that brain cells are more degenerated. It is certainly true that the brain of a woman with hot flashes is suffering, also because she uses sugars less well. Adding up all the small alterations in your sense of well-being every day, it is clear that you will experience significant psychophysical stress.
Although some research may seem alarming, it should be noted that the brain and cognitive functions of most women stabilize after the transition to menopause. Every woman goes through menopause and 80% of them will not suffer from dementia – reassures the New York Times Dr. Pauline Maki, professor of psychiatry and director of the Women’s Mental Health Research Program at the University of Illinois at Chicago – and we must not turn such a universal transition into a catastrophe.
It should also be remembered that there are women who face menopause without symptoms and they are the ones who age better because the hormonal deficiency does not have such devastating effects on them: their body adapts because their receptor systems are capable of evolving.
The role of estrogen deficiency and hot flashes
We do not yet know whether the negative effects on the brain are caused by the hormonal deficiency or the presence of hot flashes or both. It will be possible to study the role of these two factors in future years since soon – as Rossella Nappi points out – a new class of drugs will be available that treats hot flashes with estrogen-free therapy. Today, however, much can be done to prevent dementia. Several studies have found that up to 40% of dementia cases can be prevented. Some lifestyle changes such as quitting smoking, reducing alcohol intake, getting enough sleep, doing regular physical activity and staying mentally and socially active are useful from a prevention perspective.
What to do to protect the brain
For menopausal women, however, three behaviors appear particularly helpful in both mitigating short-term symptoms and preventing long-term dementia.
Hormone replacement therapy at the right time
Everything possible must be done to avoid moderate or severe hot flashes because they bring with them a cascade of disorders such as insomnia, depression, anxiety, cognitive fog which are wearing and can also lead over time to pseudo-depressive dementia and pseudo-dementia. vascular recommends Rossella Nappi. We have hormone replacement therapy with natural hormones (TOS) available which, if administered at the right time, i.e. between 45 and 55 years of age and in any case within 10 years of the onset of menopause, as well as eliminating hot flashes and consequently improving The quality of life of women is greatly protective for bone health, lowers cardiovascular risk, improves brain health and reduces mortality by 30%.
In truth, for decades researchers have feared that hormone therapy used to treat menopausal symptoms was associated with an increased risk of developing dementia in older women (in fact, the trials were also conducted on older women, who had already suffering of the cerebral microcirculation). Recent studieseven one published last October , which a meta-analysis of around fifty works, examined in detail the timing of hormone replacement therapy, suggesting a much more nuanced picture: hormone therapy started in the period in which menopause symptoms begin seems associated with a reduced risk of Alzheimer’s and dementia. Other studies have highlighted that the Hormone therapy had no effect on dementia and on the risk of Alzheimer’s, but these treatments are still effective in combating hot flashes and night sweats, improving the quality of life of women. It is clear that by preventing hot flashes, drops in sugar, the disconnection of neurotransmitters, vasoconstriction and arterial hypertension I protect the brain, but for now we have no evidence that HRT also protects against Alzheimer’s, however it certainly improves cognitive function concludes Nappi .
Constant physical exercise
Physical inactivity is known to be a risk factor for dementia and women are twice as likely to be physically inactive as men over the course of their lives. Physical activity also strengthens the brain, making it more plastic and capable of slowing down degenerative processes. Brain strengthening occurs at every age and therefore it is never too late to abandon a sedentary lifestyle.
One 2018 study which followed nearly 200 middle-aged women for 44 years found that the higher their fitness level at the start of the study, the lower their risk of developing dementia later in life. Furthermore, brain scans of physically active middle-aged women were found to have less biomarkers of Alzheimer’s disease
compared to sedentary conscripts.
A healthy diet
In recent years, researchers have found that certain diets, such as the Mediterranean diet and the MIND diet that prioritize fruits, vegetables, whole grains, lean proteins and healthy fats are associated with a reduced risk of dementia in both men and women. Among other things, there could be a further advantage for women who follow diets rich in vegetables: one preliminary research suggests that certain gut bacteria typical of a plant-rich diet might help balance the body’s estrogen levels. And a lot is being done to study the bad pro-inflammatory intestinal bacteria, present in abundance in people suffering from Alzheimer’s, and the protective ones, which can instead defend our memory. The intestinal microbiota is highly modifiable and in the future it will probably be possible to create ad hoc probiotics to prevent or slow down the disease.
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December 7, 2023 (changed December 7, 2023 | 07:24)
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