Friday, October 20, 2017

Menopause may trigger Alzheimer's disease

A new study highlights the metabolic changes that occur in the brains of menopausal and perimenopausal women, suggesting that a loss of estrogen could make these women vulnerable to developing Alzheimer's disease.

The study was carried out by researchers at Weill Cornell Medicine - the biomedical research unit and medical school of Cornell University - in New York City, NY, in collaboration with scientists at the University of Arizona Health Sciences in Tucson.

Dr. Lisa Mosconi, from Weill Cornell Medicine, is the lead author of the study. As Dr. Mosconi and her colleagues explain, after old age, being female is the second most major risk factor for developing Alzheimer's disease. In fact, two thirds of those with Alzheimer's disease in the United States are women, according to 2017 estimates.

Although the mechanisms responsible for this increased risk are not yet known, previous research has hinted at the transition to menopause as a potential key.

As the authors explain, this transition also involves neurological and metabolical changes. So, Dr. Mosconi and team decided to investigate these transformations.

Low glucose brain metabolism found

The team used positron emission tomography imaging technology to examine how the brains of 43 women metabolize glucose, which is the main source of energy for brain cells.

The earlier studies reveal that low levels of the sugar precede and may even trigger the development of Alzheimer's disease. In the current study, the women participating were aged between 40 and 60. Of them, 15 were premenopausal, 14 were perimenopausal - or transitioning to menopause - and 14 were postmenopausal.

The study found that the perimenopausal and postmenopausal women had significantly lower glucose metabolism levels than those who were premenopausal.

In addition to this so-called hypometabolism, the researchers found signs of mitochondrial dysfunction, which means that the brain cells were not as efficient at processing energy.

A key metabolic enzyme called "mitochondrial cytochrome oxidase" was found to be less abundant among menopausal and perimenopausal women. These women also scored significantly lower in memory tests.

The findings support previous research by the same team, which showed how menopause is linked with an increase in the beta-amyloid protein, a biomarker of Alzheimer's disease, in the brain.

The same study found a reduction in gray matter and white matter in brain areas affected by the neurodegenerative condition.

Estrogen and Alzheimer’s Disease

Estrogen and progesterone are steroid sex hormones that not only contribute to female fertility but also play an important role in brain functioning for both men and women. Estrogen is part of the brain’s signaling system, and it helps direct blood to parts of the brain that are more active.

Fluctuation of estrogen contributes to brain fog and mood swings that come with menopause, and explains why women going through the change are more focused and feel better on some days than others.

Estrogen is also key in the normal maintenance of brain function in the nucleus basalis of Meynert (NBM). Degeneration of the NBM is found in people with Alzheimer’s disease, and less estrogen in the brain can contribute to this degeneration.

These fluctuating hormones also contribute to insomnia, which not only impairs memory but also causes extra stress and inflammation in the body because it’s not able to fully restore and repair itself at night. Deep sleep is when the brain moves short-term memories into long-term storage. Frequent interruptions in sleep are deadly to memory.

How loss of estrogen may impact brain cells

Cognitive decline is known to be associated with menopause, and the authors suggest that the estrogen deficiency that characterizes menopause may also be responsible for the neurodegeneration that occurs in Alzheimer's.

Brain cells have estrogen receptors, they explain, and a drop-in estrogen levels may cause a "starvation reaction" in these cells. Such a metabolic state can lead to brain cell dysfunction.

"Our findings show that the loss of estrogen in menopause doesn't just diminish fertility. It also means the loss of a key neuroprotective element in the female brain and a higher vulnerability to brain aging and Alzheimer's disease." Reports Dr. Lisa Mosconi, "We urgently need to address these problems because, currently, 850 million women worldwide are entering or have entered menopause," she warns.

"Our studies demonstrate," Dr. Mosconi says, "that women need medical attention in their 40s, well in advance of any endocrine or neurological symptoms."

There may be a "critical window of opportunity when women are in their 40s and 50s, to detect metabolic signs of higher Alzheimer's risk and apply strategies to reduce that risk."

Beyond Estrogen: Other Important Hormones

It’s not all about “female hormones.” Other hormones such as insulin, leptin and amylin decrease as both men and women age, which means your body has fewer natural antioxidant and anti-inflammatory agents. This makes your body and brain more susceptible to the damaging effects of free radicals, inflammation and excess cortisol.

Research shows these hormone decreases have a direct effect on brain functioning and contribute to cognitive decline, dementia and Alzheimer’s disease.

Another important hormone is gamma-aminobutyric acid (GABA), a neurotransmitter that regulates communication between brain cells.

A study published in January 2017 in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging found that older adults who had lower levels of GABA in the frontal lobes of their brain (the part that handles complex cognitive functioning) performed worse on cognitive tests compared to those who had higher GABA levels.

However, all is not lost. There are things you can do to boost production of GABA, estrogen and other important hormones to help keep your brain healthy.

Challenges for Early Diagnosis

Women show a lifelong advantage in verbal memory compared to men. Interestingly, this advantage might make it more difficult for clinicians to detect a memory problem in women who are in the early stages of Alzheimer’s disease (AD).

Before developing AD, patients transition though a stage called amnestic mild cognitive impairment, or aMCI. At this stage, memory problems exceed what is expected for age but do not reach the level of severity seen in AD. The female advantage in verbal memory persists in the aMCI stage. Consequently, women perform better than men despite showing the same level of AD disease on brain scans. Although this could be seen as an advantage, women may be diagnosed with aMCI or AD at a later and more severe stage of the disease than men. Researchers are now exploring whether it might be useful for clinicians to use different cut-offs for memory tests in women and men, so that AD can be detected earlier in women.

How to Manage Your Hormones for Better Brain Health

Two important things you can do yourself to prevent diminishing hormones, especially diminishing estrogen, are:
(1) Keep stress under control and
(2) Maintain a healthy diet.

Excess stress contributes to a flood of cortisol in your body, which, if left untended, can essentially corrode your organs and neurotransmitters, making you vulnerable to disease and dementia.

A healthy diet of whole foods and nutrients can actually boost hormone production, increasing your body’s natural defenses. Foods said to increase estrogen specifically include alfalfa, barley, baker’s yeast, beets, cherries, chickpeas, carrots, celery, cucumbers, dates, fennel, oats, olives and olive oil, papaya, peas, plums, pomegranates, potatoes, beans, rhubarb, rice, tomatoes, wheat and yams.

A few things you can do to increase waning hormones in your body, whether you’re a woman going through menopause or not, are:
* Move every day. Not necessarily “exercise” but movement like walking or hiking outside in nature, bike riding, etc. These activities reduce stress while increasing GABA production.
* Take time for self-care. Rest, take a hot bath, do yoga, read, take a nap… These things help you manage stress, sleep better and reduce cortisol.
* Eat whole foods, healthy fats and raw organic cacao. Cacao (dark chocolate) has been shown to boost hormones and reduce cortisol.
* Practice mindfulness. Pay attention to what you’re doing when you’re doing it. Don’t let yourself be so distracted and stressed out that you can’t remember where you put your keys, whether or not the stove was left on or what you came into the room for. Be aware of your actions.

These are easy steps you can take daily to counteract the natural decrease in hormones that happen as you age. While you can’t turn back the clock, you can meet the future with a box of tools and a set of choices that will keep you healthy longer.

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