Transcription
Translator: Abdellatif ZOUMHANE
Reviewer: omar idmassaoud
Women are considered like works of art. Internally and externally. I am a neurologist, specializing in the internal aspect, specifically women's brains. There are many theories about women's brains differing from men's brains, and I have been researching brains for 20 years and can assure you that there is no such thing as sex-based brain differences. Pink and blue, Barbie and Lego, these are all inventions that have no relation to how our brains are formed. However, women's brains do differ from men's brains in some ways. And I am here to talk about these differences, because they are actually important for our health. For example, women are more prone than men to anxiety disorder or depression, not to mention headaches and migraines. Also, at the core of my research, women are more prone than men to Alzheimer's disease. Alzheimer's disease is the most common cause of dementia on planet Earth, affecting nearly six million people in the United States alone. And nearly two-thirds of these people are actually women. So for every man with Alzheimer's, there are two women. So why in general? Is it age? Is it lifespan? What else could it be? A few years ago, I launched the Women's Brain Initiative at Weill Cornell College in New York City, precisely to answer these questions. Tonight, I am here with some answers. So, apparently, our brains age differently, and menopause plays a major role in women. Now, most people see the brain as a black box, isolated from the rest of the body. But in reality, our brains are in constant interaction with the rest of our bodies. And perhaps surprisingly, interactions with the reproductive system are essential for brain aging in women. These interactions are mediated by our hormones. And we know that hormones differ between the sexes. Men have testosterone in abundance, while in women, we find estrogen. And what really matters here is that these hormones vary with age. Testosterone in men does not run out until late in life, and it is a largely slow and asymptomatic process, of course. (Laughter) Estrogen in women, on the other hand, begins to fade in middle age, during menopause, which is never an asymptomatic process. We associate menopause with the ovaries, but when women say they have hot flashes, night sweats, insomnia, memory loss, depression, and anxiety, these symptoms do not start in the ovaries. They start in the brain. These are neurological symptoms. We are just not used to seeing them as such. So why? Why is our brain affected by menopause? First and foremost, our brains and our ovaries are part of the neuroendocrine system. As part of the system, the brain talks to the ovaries, and the ovaries talk to the brain, every day of our lives as women. So ovarian health is linked to brain health. And vice versa. At the same time, hormones like estrogen are not only involved in reproduction, but also in brain function. And estrogen in particular, or estradiol, is truly key to energy production in the brain. At the cellular level, estrogen drives neurons to burn glucose to generate energy. If estrogen is high, your brain's energy is high. But when estrogen levels drop, neurons begin to slow down and age rapidly. Studies have shown that this process can lead to the formation of amyloid plaques, or Alzheimer's plaques, which are a hallmark of Alzheimer's disease. These effects are stronger in specific areas of the brain, starting with the pituitary gland, responsible for regulating body temperature. If estrogen does not properly activate the pituitary gland, the brain cannot properly regulate body temperature. So those hot flashes that women experience are the pituitary gland. Then there is the brainstem, responsible for sleep and wakefulness. When estrogen does not properly activate the brainstem, we experience sleep disturbances. Or the amygdala, the emotional center of the brain, near the hippocampus, the memory center of the brain. When estrogen levels drop in these areas, we experience mood swings perhaps and forget things. This is the anatomy of the menopausal brain, so to speak. But let me show you what a woman's brain actually looks like. This is a type of brain scan called positron emission tomography, or PET. It studies energy levels in the brain. And this is what we want our brains to look like when we are in our 40s. Nice and bright. This is the brain of a woman who was 43 years old when she was first scanned, before menopause. And this is the same brain just eight years later, after menopause. If we put them side by side, we can easily see how the bright yellow has turned orange, and almost purple. This is a 30 percent drop in brain energy levels. Now, in general, this does not happen to men of the same age. In our study of hundreds of people, it shows that middle-aged men typically have high brain energy levels. For women, brain energy is usually good before menopause, but it gradually declines during the transition. This was observed regardless of age. It does not matter if women are 40, 50, or 60. What matters more is that they were menopausal. So we need more research to confirm this, but it appears that middle-aged women's brains are more sensitive to hormonal aging than to straight chronological aging. And this is important information, because many women can feel these changes. Many of our patients have said that they feel like their minds are betraying them, in simpler terms. So I really want to validate this, because it is real. Just to clarify, if the same thing happens to you, you are not crazy. (Laughter) (Applause) Thank you. It is important. Many women worry about losing their minds. But the truth is that your brains may be going through a transition, or are going through a transition, and need time and support to adapt. Also, if anyone is concerned that middle-aged women's brains may be underperforming, I will just quickly add that we have looked at cognitive performance, God forbid, right? (Laughter) Let's not do that. But we have looked at cognitive performance, and we have found absolutely no differences between men and women before and after menopause. And other studies confirm this. So, basically, we may be tired, but we are still smart. (Laughter) We will leave that topic. Having said all that, there is something else serious that deserves our attention. If you recall, I mentioned that a drop in estrogen can contribute to the formation of amyloid plaques, or Alzheimer's plaques. But there is another type of brain scan that looks precisely at these plaques. And we have used it to show that middle-aged men have hardly any of them, which is great. But for women, there is a slight increase during the transition to menopause. And I want to be very clear here: not all women develop these plaques, and not all who have them will develop dementia. Having these plaques is a risk factor, it is not a diagnosis, especially at this stage. But nevertheless, it is an insightful idea to link Alzheimer's disease to menopause. We see that menopause is associated with middle age, and Alzheimer's is associated with aging. But in reality, many studies, including my own work, have shown that Alzheimer's disease begins with negative changes in the brain years, if not decades, before clinical symptoms. For women, this process appears to begin in middle age, during menopause. And this is important information to know, because it gives us a timeline to start looking for those changes. So regarding the timeline, most women go through menopause in their early 50s. But it can be earlier, often due to medical interventions. A common example is hysterectomy and/or oophorectomy, which is the surgical removal of the uterus and/or ovaries. And unfortunately, there is evidence that removing the uterus and, more so, removing the ovaries before menopause is associated with a significantly increased risk of dementia in women. I know this is upsetting news, and it is certainly discouraging news, but we need to talk about it because most women are not aware of this link, and it seems very important that they be aware of it. Also, no one is suggesting that women refuse these procedures if they need them. The issue here is that we need to better understand what happens to our brains during menopause, whether natural or medical, and how to protect our brains during this process. So how can we do that? How do we protect our minds? Should we take hormones? That is a good question, it is a good question. And the shortest possible answer now is that hormone therapy can be beneficial for alleviating a number of symptoms, such as hot flashes, but it is not currently recommended for dementia prevention. And many of us are working on testing different combinations, different doses, and different timelines, and hopefully all this work will lead to changes in recommendations in the future. In the meantime, there are other things we can do now to support our hormones and their impact on the brain that do not require medication but do require a serious look at our lifestyle. That is because the foods we eat, how much we exercise, whether we get enough sleep, how much stress we experience in our lives, these are all things that can really affect our hormones... for better or for worse. Food, for example. There are many diets, but studies have shown that the Mediterranean diet in particular is supportive of women's health. Women following this diet have a lower risk of cognitive decline, depression, heart disease, stroke, and cancer, and experience fewer hot flashes. What is interesting about this diet is that it is very rich in foods that contain estrogen in the form of phytoestrogens, or plant-based estrogens, which act like mild estrogen in our bodies. Some phytoestrogens have been linked to an increased risk of cancer, but not those found in this diet, which are safe, especially in flaxseeds, sesame seeds, dried apricots, legumes, and a number of fruits. Some good news, dark chocolate also contains phytoestrogens. So diet can provide estrogen, but it is important to avoid things that suppress estrogen instead, especially stress. Stress can steal estrogen, because cortisol, the main stress hormone, works in a balanced way with estrogen. So if cortisol goes up, estrogen goes down. If cortisol goes down, estrogen goes up. So reducing stress is very important. It is not just important for your day, but it also helps your brain. So these are just simple things we can do to support our minds, and there are more. But the important thing here is that changing the way we understand the female brain truly changes the way it is cared for, and the way we frame women's health. And the more women engage with this information, the more we can break taboos around menopause, and also come up with solutions that actually work, not just for Alzheimer's, but for women's brain health as a whole. Brain health is women's health. Thank you. (Applause) Thank you. Thank you.