In her groundbreaking new book The XX Brain (with a Forward by our founder Maria Shriver), WAM Scientific Advisory Council member Lisa Mosconi, Ph.D. addresses cognitive enhancement and Alzheimer’s prevention specifically in women, framing brain health as an essential component of Women’s Health.

WAM: You are the recipient of a 2019 WAM Research Grant. How will this make a difference in your research into women’s brains? How will this grant, and your previous WAM grant, further your knowledge about women’s brain (and perhaps overall) health?

LISA MOSCONI: We are indeed the lucky recipients of not one, but two WAM grants! Grants like WAM’s make a huge difference for scientists, because they allow us to test novel ideas and think outside the box, as well as collect preliminary data that we can then use to apply for larger grants from the National Institute of Health. I really can’t stress enough the importance of collecting new data and being given the opportunity to discover something new!

For example, thanks to WAM’s support, just a couple of years ago we showed for the first time that menopause is associated with long-lasting changes in brain structure and function in women, and for some women, these changes might even trigger the formation of Alzheimer’s plaques. Whenever I mention this, I see puzzled looks and raised eyebrows. Alzheimer’s and menopause? But isn’t Alzheimer’s a disease of old age, whereas menopause occurs in midlife?

Our research has shown that Alzheimer’s starts with negative changes in the brain years, if not decades, prior to the onset of clinical symptoms—and for women, this process starts in midlife, around menopause. Most women go through menopause in their early 50’s, but it can be earlier, often due to medical interventions.

Currently, as many as 1 in 9 American women undergo a hysterectomy and/or oophorectomy (the surgical removal of the uterus a/o the ovaries) in her lifetime, while another 1 in 8 American women are being treated with anti-estrogen medications that suppress estrogen production and can cause early menopause. We are now looking into whether these procedures may possibly increase risk for Alzheimer’s in even younger women.

Overall, we are testing the hypothesis that estrogen may act as a trigger for Alzheimer’s development in women, which would provide new, sex-specific targets for drug development. This knowledge is crucial, as currently 850 million women all over the world have just entered or are about to enter menopause!

WAM: Your book breaks ground by delving into women-focused brain research. Describe your primary findings and why they are exciting to you.

LISA MOSCONI: My new book, The XX Brain, is entirely and unapologetically focused on women’s brain health. Because, let’s be honest, nobody talks about women’s brains, unless it’s in a negative or condescending way! But from a neuroscientist’s perspective, women’s brain health is one of the most under-researched, under-studied and under-diagnosed medical fields.

In the book, I explain why women have been chronically understudied in science, which is really a combination of a few factors. First, there’s one important moment back in the 60’s when a drug called thalidomide was provided to women, and it later turned out that the drug had catastrophic effects on pregnancies — it affected the fetus, and then the babies. So the FDA, out of legitimate concern, decided that women of childbearing age would no longer participate in experimental clinical trials. As a result, we have entire bodies of medical research that no longer have the participation of women, and were not informed by women. The second aspect is that all this research without women in it reinforced a fundamental underlying bias that women are just men with different reproductive organs – which I refer to as “Bikini Medicine”. Even now that we actively enroll women in research, most studies lump men and women together. So before, we had research that was based on men, and now we are still treating women and men as broadly indistinguishable except…there are ovaries in there.

This approach has severe consequences for women’s health, especially as our brains are concerned. For context, women are:

  • Twice as likely to have anxiety and depression as men;
  • Three times more likely to develop autoimmune disorders that attack the brain like Multiple Sclerosis;
  • Four times more likely to suffer from headaches and migraines;
  • More likely to develop meningiomas, the most common form of brain tumors;
  • And far more likely to die of a stroke.

On top of all this, women are almost twice as likely than men to end up with a diagnosis of Alzheimer’s disease. As real a concern as breast cancer is to women’s health, women in their 60’s are about twice as likely to develop Alzheimer’s over the rest of their lives as they are to develop breast cancer. And yet, breast cancer is clearly identified as a women’s health issue, while Alzheimer’s is not.

In particular, research has identified menopause as a trigger for Alzheimer’s-related brain changes in women, as well as anxiety, depression, and most of the other conditions listed above. This is likely due to the loss of estrogen, which is a neuroprotective hormone, literally shielding the brain from aging and harm.

Luckily, there are solutions! Which I described in detail in the book.

WAM: Based on your research, what are some of the factors affecting women (rather than men) that lead to Alzheimer’s?

LISA MOSCONI: There are several known risk factors for Alzheimer’s disease that affect women more than men, and some factors that affect only women, like menopause. The major culprits are a poor diet, lack of exercise, poor sleep, chronic stress, inflammation, and some medical conditions including thyroid disease and diabetes.

What’s curious though is that there is one risk factor that’s been associated with a higher risk of Alzheimer’s disease in men and men alone, and that is… not being married to a woman. I’d argue that social isolation and lack of loving support is what really makes a difference, not the gender of your partner.

WAM: At what age should we start Alzheimer’s prevention techniques, and give us 5 steps women can take to keep their brains resilient with age.

LISA MOSCONI: The sooner the better, but it’s NEVER too late to take care of your brain. My 5 steps would be:

  1. Stay away from processed food. Stick to a healthy diet rich in fresh vegetables, fruit, whole grain, legumes, and fish, and consume meat and dairy in moderation.
  2. Keep your body moving. You don’t have to run a marathon. The female brain seems to prefer the slow burn of consistent, low-to-moderate activity.
  3. Prioritize sleep. So many of us have a hard time sleeping, but that’s really the only chance our busy brains have to detox and even remove harmful toxins like Alzheimer’s plaques.
  4. Reduce stress. There are many ways to do this, which I describe in the book.
  5. Get tested! Know your numbers, and work with your doctor to address any medical conditions or risks. If you’re up for a brain scan, we’re actively enrolling women aged 35-65 in our studies at the Weill Cornell Women’s Brain Initiative in NY city.

WAM: What do you hope women will take away from this book?

LISA MOSCONI: Brain health is women’s health. The more women demand scientifically accurate, evidence-based information, the sooner we’ll be able to not only break the taboos around menopause but also come up with solutions that actually work – not just for Alzheimer’s disease but for women’s brain health as a whole. Like Maria often says, your brain is one of your greatest assets. Prioritizing brain health is a must at any age.

My book,The XX Brain, is a woman’s guide to optimal, life-long brain health. I put my heart and soul into writing it – not to mention 15 years of research — and hope that it will help all women better understand their brains, and how to take care of them!

For more information or to purchase The XX Brain, click here.