We’ve always known there was a higher rate of Alzheimer’s disease and other dementias in women than in men, initially attributed to the fact that women live longer and that the decline in mental function occurred with age. This turned out to be wrong. At 65, a woman has a greater than one-in-six chance of developing dementia, whereas a man’s is one-in-eleven. If the dementia worsens to Alzheimer’s, this translates to two-thirds of Alzheimer patients being women and one-third men.
What researchers have now discovered is that the first signs of mental decline in women can occur in mid-life. Importantly, though, while some women’s brain function does decline from middle age Alzheimer’s is not necessarily inevitable.
For the study, 3302 women between the ages of 42 and 52 were enrolled, with 2709 completing it several years later. They would be retested at intervals and the tests would be changed each time so that there wouldn’t be an artificial improvement due to better test-taking skills (the so-called test practice effect). Because the transition to menopause was already known to impair mental function in some women, researchers decided that the baseline test should be given at age 54, when menopause was complete. Subjects would then have three or more follow-up tests about every six and a half years.
Three factors were tested:
- Cognitive processing speed, in which participants matched numbers to symbols in a specified time period.
- Verbal episodic memory Ability to recall story elements in a paragraph read to them.
- Working memory Ability to manipulate information held in memory, assessed by giving a series of numbers and asking the participant to recite the list backwards.
In previous studies, mental decline during the menopause transition had been documented in some women. This new study, starting after menopause, showed further decline in all measurements taken when hormone levels weren’t going into free-fall, as they do during the transition to menopause.
Right up front, the researchers acknowledged two shortcomings to the project. Obviously, one was that no men were involved, even though the purpose of this project was to explore the overall higher rates of dementia in aging women. Secondly, there were no therapeutic interventions along the way, such as lifestyle changes, medications, or nutritional supplements.
Also apparently not taken into consideration were the test group’s cognition-affecting lifestyle habits—e.g., exercise, nutrition, and the brain workouts listed below. Women who had used or were taking hormone replacement were excluded from the project.
In the test group, declines were apparent from the start, with a full 5% functional impairment over a ten-year period. The authors noted: “Further research is needed to identify factors that influence decline rates and to develop interventions that slow cognitive aging.”
Given this research, it’s important to know there are many steps you can take to considerably slow mental decline.
Here’s a checklist
No, I won’t test your memory by asking you to recite this list by heart. On the other hand, keeping all this in your mind and at the ready would not be a bad idea.
- Get moving, especially aerobically. We know walking has a positive effect too.
- Starting at least in your 40s (but do start now if you’re past 40), make an extra effort to keep your brain active and challenged. Take evening courses, do different puzzles, learn a language, and stay connected with others. Here’s a resource from AARP on a variety of approaches focusing on sleep, fitness, and nutrition. And another from TIME.
- Unless you have specific contraindications (breast cancer, blood clots), strongly consider using bioidentical hormones during your transition into menopause. Low estrogen and progesterone have repeatedly been linked to poor mental functioning and most women feel sharper when their hormones are restored to a pre-menopause range.
- Get your thyroid hormone levels checked. Even minimal hypothyroidism (low thyroid) can affect the brain’s function. Ask your doctor to test T3, T4, and TSH. Don’t accept just any answer. Tell your doc you want hormone replacement to place you in “high normal” range. Remember, TSH (thyroid-stimulating hormone) rises as thyroid function goes down. Most doctors start treatment at TSH 5.0 or higher. You want your treatment to start at 2.5 or higher.
- Have your hearing checked. Even relatively mild hearing loss has been linked to decline in brain function. If you need hearing aids, wear them.
- Low levels of B vitamins (especially B-12) and D have also been linked to poor brain function, so either get these measured by your doctor or make sure you’re including D and B complex in your supplement regimen.
- Dozens of studies have proven beyond doubt that eating fish regularly slows brain decline. For those who worry about mercury, a recent study confirmed the health/brain benefits of fish well exceeded mercury issues. If you can’t stand fish, either buy a better cookbook or take a product high in DHA. While you’re at it, say goodbye to the standard American diet high in sugars and quickly metabolized carbs and start eating a Mediterranean diet. More on the components of the Mediterranean diet here.
- There are several over-the-counter nutritional supplements that have been shown in studies to enhance memory. I’ll link each of these to one research article so you can read more yourself. Acetyl-L-Carnitine. Citicholine. Turmeric (dementia is linked to brain inflammation and turmeric is an anti-inflammatory that can reach the brain). Despite last week’s Health Tip recommending a trimmed-down supplement regimen, these are important and it’s more economical to purchase them separately than to buy a combination memory supplement that may contain ingredients never clinically tested. If you’re unaware of having any particular memory issues, each of these supplements, including the fish oil, can be dosed at one capsule daily, significantly reducing your costs. If you do have memory problems, take each twice daily for three months or so, reducing to once a day thereafter.
To test the effect of your self-treatment program (not just the supplements), before you start anything try memorizing something, like a poem. Then, three months later, try your hand at a different poem.
I’m guessing you’ll have a very pleasant surprise!
David Edelberg, MD