For Women 40-65
Brain Health
Your brain health deserves attention before there is a problem.
Get the Early Advantage™:
Your brain health deserves attention before there is a problem.
Perhaps you have watched a parent lose their memory and found yourself wondering what their history means for you.
You may already know that you carry a genetic variant associated with increased risk. Or perhaps your own memory feels less reliable, concentration takes more effort, or your mental sharpness feels different from before.
Perhaps you are asking:
“Is this going to happen to me?”
There is rarely a simple answer. Many factors need to be considered: family history, genetics, age. But none of them, alone, can tell us what will happen to you.
The biological changes associated with Alzheimer’s disease can begin years, even decades, before significant cognitive impairment becomes apparent.
Brain health does not begin with a diagnosis, or even with a symptom.
Women have a particular reason to pay attention.
Women account for almost two-thirds of Americans living with Alzheimer’s disease.
At age 45, the estimated lifetime risk of developing Alzheimer’s dementia is 20%, or approximately one in five for women, compared with 10%, or one in ten for men.
Women are not at higher risk because they live longer. Many factors are worth considering including metabolism, immune function, vascular health, hormones, environmental toxin burden, chronic infections, among others.
Menopause itself is a hugely consequential event in a woman’s brain health.
Brain energy can decline by up to 30% from pre menopause to menopause.
These positron emission tomography (PET) scans show brain metabolic activity before and after the transition to menopause. Brighter (red to yellow) colors indicate more energy, and darker (green) colors indicating less energy. The “after” scan looks “greener,” reflecting reduced brain energy levels. (Lisa Mosconi/Weill Cornell Medicine)
At midlife, the useful question is often not just, “Is this menopause?”
It is: What is happening in this woman, and what deserves our attention?
The work is figuring out what is happening in you.
There is no single test that can answer that question.
We would all prefer an elegant answer: one blood test, one scan, one genetic result that could tell us whether our brain is healthy and what the future holds.
Brain health is more complicated than that.
The brain does not exist independently of the body that supports it. Vascular health and blood pressure matter. So do glucose regulation, sleep, physical activity, hormonal health, nutrition, medications, inflammation and other aspects of health that vary considerably from one woman to another. Genetics and family history add another layer of information, as do cognitive function, medical history and environmental exposures.
Preventing Cognitive Decline: A Comprehensive Approach
This is why I think in terms of a Brain Resilience Map rather than a single brain-health score.
Not every woman needs every test. Not every risk factor applies equally to every woman. And finding an abnormal laboratory value does not automatically mean that treating it will prevent cognitive decline.
The objective is not to search until we have assembled the longest possible list of things that are “wrong.”
It is to determine which information is meaningful, which vulnerabilities are modifiable, what deserves action, what needs to be prioritized first and what comes later.
That requires more than labs and testing. It requires interpretation, implementation and iteration.
Genetics can inform the conversation without determining the conclusion.
Family history is often what first brings a woman to me.
“My mother had Alzheimer’s. What does that mean for me?”
Sometimes several relatives have been affected. Sometimes a woman has already had genetic testing and learned that she carries an APOE4 allele, the best-established common genetic risk factor for late-onset Alzheimer’s disease.
Of that genetics matter but it is just one risk factor among many.
APOE is one part of a much larger biological picture. A genetic result becomes more useful when we interpret it alongside what else we know about personal and family history.
So I am less interested in stopping at the question, “Do you have a risk gene?”
I want to know:
Given what we know about you, how does this information change what we do?
What does prevention really mean?
No responsible doctor can promise that Alzheimer’s disease can be prevented. But increasingly, the evidence shows that cognitive decline is actionable, provided you take early action using approaches that have shown meaningful results.
I am trained in ReCODE, the personalized, multifactorial approach developed by neurologist Dr. Dale Bredesen. In the recent nine-month EVANTHEA randomized controlled trial, 73 people with mild cognitive impairment or early dementia received either personalized precision-medicine care or standard care. The precision-medicine group showed significant improvement on the study’s primary computerized cognitive measure, including memory, executive function and processing speed. The results are currently in preprint and undergoing peer review.
My particular interest is in beginning even earlier—working with women in midlife to identify and address modifiable risk factors before cognitive impairment develops.
Your brain makes you who you are
You care about brain health because it is how you think and make decisions. It is how you practice your profession, manage your life, remember the people you love, learn something new, plan a trip, solve a problem, create, lead, laugh at something funny and remain recognizably yourself.
So one of the questions I care most about is not medical at all:
What do you want your brain to allow you to keep doing?
For one woman, the answer may be practicing law into her seventies. For another, it may be traveling, running a business, caring for grandchildren, writing a book, managing her own finances or continuing in live in her own home.
The common theme in all these responses is a desire for independence and living life on her own terms.
Those responses tell us that health is not an end. We protect health because of what it makes possible.
Where should you start?
If dementia runs in your family, but you don’t yet know what you need
STAY AHEAD
Early Advantage: Health Blueprint
Early Advantage gives us a first look at your broader midlife health and helps determine what deserves your attention. It also gives us an opportunity to work together before you decide whether you need more extensive care.
MENOPAUSE
Peri Menopause and Menopause Care
If your primary concerns are menopause symptoms, hormone therapy, or understanding how the menopause transition is affecting your health, begin with Menopause Care.
BRAIN HEALTH
Brain Protection: Stay Sharp
Stay Sharp is our comprehensive nine-month personalized brain-health program.
We investigate your health in depth, establish your cognitive and health baseline, build your Brain Resilience Map, identify the factors are modifiable, create a personalized plan, prioritize what deserves action first, what can come later and iterate to evolve the plan as our work deepens.
It is designed for women who want to go beyond knowing their risks and begin doing something thoughtful with what they learn.