Almost 70 percent of Americans think about it yearly. It will be the subject of more than $3.8 billion worth of research this year, has catalyzed the creation of public health campaigns stretching back decades, and is a regular fixture in popular media. Yet, for everything we think we know about Alzheimer’s disease, it continues to evade not only cures, but also broad awareness among the group it most affects: women. They comprise two-thirds of all Alzheimer’s patients and are twice as likely to develop the disease as their male counterparts, yet many don’t realize they’re at higher risk. Neuropsychologist Jessica Caldwell works to remedy that as director of the Women’s Alzheimer’s Movement at Cleveland Clinic’s Lou Ruvo Center for Brain Health, the first women-specific center of its kind in the nation. Caldwell talked with Desert Companion about why women are at higher risk of memory loss and what they can do to slow or perhaps even prevent it. An edited excerpt of the conversation follows.
Your research has focused on menopause’s role in memory loss. You say midlife hormonal changes might be an explanation for the large disparity in Alzheimer’s diagnosis rates for women and men. Why?
When women go through menopause, one of the biggest changes is that we lose estrogen, a hormone that most people think of in the context of fertility, but actually is active throughout our body as well as throughout our brain. One thing estrogen does in the brain is promote protection of neurons or cells, as well as promote plasticity or flexibility and growth of new neural pathways. So, when women go through menopause, we really have to readjust our bodies, as well as our brains, to having less estrogen. There is typically a bit of a dip in memory around that time for many, many women. But for most people, it is just a dip and (then) a recovery in memory. On the other hand, there seem to be women who don’t recover quite as well as others, and these may be the women who are experiencing Alzheimer’s disease risk related to estrogen loss.
Is avoiding that as simple as starting hormone replacement therapy?
Addressing risks related to menopause is a very complex topic. We know that if a woman is long past menopause, she should not start taking hormone replacement. And if a woman is very young when she goes through menopause — say in her 30s — it’s beneficial to take hormone replacement for brain health later on in life. But where the findings are really mixed is right around the time of the average age of menopause, which is around age 52 or 54. It’s unclear whether women should take a hormone replacement treatment, not just for things like hot flashes, but specifically for their brain health.
What can people of all genders do to stave off Alzheimer’s?
Research supports that there are 12 factors that account for about 40 percent of current Alzheimer’s disease cases. These are things like making sure you get enough exercise, not getting diabetes or high blood pressure (and treating them if you do get them), and finishing high school and continuing to stay mentally or intellectually stimulated. All those factors are important. And in addition, there is a number of factors related to better aging: People who get enough sleep age better; people who eat a nutritious diet that’s low in processed foods tend to age better. So, when we think about risk reduction and supporting healthy aging, we want women to think about both this list of things that can account for dementia, as well as the list of things that might actually support best brain health.
What do you tell women who might be at the very beginning stages of this disease and could be afraid of what the future holds?
Oftentimes, what I’m doing is giving a name to a problem that women already know is there. In addition to helping them to understand the cause of their problems, I’m also helping women to understand that there are many things that they can do, even with a disease process in the brain. … In terms of the reality that I know, this is a disease that is highly complex, and every individual will experience it somewhat differently. But there are always things that people and families could do.
