Exploring the Link Between Menopause and Alzheimer’s

Dr. Lisa Mosconi’s grandmother had two sisters and a brother. All three sisters died of Alzheimer’s. Their brother was spared. Why?

Deborah Copaken
May 30 · 37 min read
Dr. Lisa Mosconi, PhD, Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College shows how the brain scans of pre-menopausal women differ from those of women in menopause. Photo: Deborah Copaken

Dr. Mosconi in her office in New York Photo: Deborah Copaken

Deborah Copaken: So, let’s start at the beginning. How did you get interested in this specific topic? Alzheimer’s in general, but also women in Alzheimer’s specifically?

Oh my goodness.

You were 19, and you were researching in nuclear medicine already?

Okay, so you were still in university, but studying nuclear medicine on the side. As one does. So how old is your mother right now?

How’s she doing?

I’ve seen studies that show that instead of just doing brain games such as Sudoku or crossword puzzles, there’s evidence that just staying at your job in your sixties and seventies is good intellectual training if you want to try to avoid cognitive decline. What do you say to that?

Cognitive reserve?

Right. Which brings me to my next question, a personal one: I know that writing is good for my brain, but at 53 years old, having been a writer my entire life and now going through perimenopause, I find —

Yes, let’s do it, that would be fun!

Because what I have noticed, as a writer who obviously needs words to create what I do, I sometimes cannot remember… the other day I could not remember the word… and here I am forgetting it again! It was, oh my God, see, here I go again. It’s not asparagus, but it’s the thing that looks like this, and it’s got the little pointy things —

Artichoke! Yes. See, I knew it started with an “A,” and it looks like the top of the asparagus, so that came to mind, but I couldn’t think of the word for artichoke. And it was driving me crazy. I had it in my hands, even, and I couldn’t remember what it was called. And if you hadn’t just said it right now, I would have had to look up vegetables on my phone, I mean literally look up “green vegetables pointy leaves” and find it on Google. But this happens all the time to me now and I’m thinking that oh no —

Word finding. Exactly. And I don’t have any history of Alzheimer’s, but I have noticed that just in “brain abilities,” let’s call it, I’m losing it. And as a writer, that’s scary.

So when I read your op-ed, even though I work in this field, I did not know that women are twice as likely to get Alzheimer’s as men.

At the same time, I also know that women’s health is poorly studied. I will give you an example from my own life. So when I had my uterus removed, a hysterectomy, I was asked, what do you want: a partial, full, or a supracervical? And I was like, I don’t know —

They’re asking me! And they said well, it’s believed that the cervix plays a role in sexual pleasure. And I was like, Seriously, are you kidding me? This was back in 2012. So they took out the uterus and kept the cervix. Five years later, the cervix becomes diseased, has to come out, and when I went to see the surgeon who was going to remove it, she said, “Why didn’t you get this out when you got the hysterectomy?” I said, “I was told that it plays a role in sexual pleasure.” She goes, “No, no, that was debunked last year.” I was like, “Why don’t we know these basic things about female health?” And she goes, “Welcome to my world.”

We finally just got a 3D model of the clitoris two years ago! Two years ago! So now I know these things about my reproductive organs I should have known years ago. What I’m concerned about now is the brain, women’s brains in particular. So what does your research show? What have you found about menopause, perimenopause, and women’s brains?

Wait, what?

This is news to me right now.

Yeah.

Let’s start again, shall we?

70%????!!!!??????

What?

Right.

Ugh. Let’s go back to women and Alzheimer’s and your family. So, you have your grandmother and your two great aunts, all of whom got Alzheimer’s. But your great uncle, their brother, didn’t. Why?

So the doctor can see plaques on the brain, they know these women have Alzheimer’s, but they’re testing well on cognitive exams.

That’s great?

It took you 20 years to get grants to look into this?

I’m reading a book right now, I forget the name because I probably have Alzheimer’s too, but I’m reading a book right now about women and data bias. [Note: Invisible Women: Data Bias in a World Designed for Men by Caroline Criado Perez.] The author has this part where she talks about how they studied Viagra —

Yeah, but they studied Viagra, and they found that with women, it completely eliminated period cramps for four hours at a time with no side effects. And the doctor that discovered this went back to the NIH, twice, and said, “We need further studies on this. This is the holy grail for women,” and they said, “Well, dysmenorrhea is not a real issue.” So we now know everything we need to know about penises and how they get hard, and how Viagra can make them harder, but nothing about how Viagra could be helping the other 50% of the population, enormously.

Even this desk. This desk is not built for me, and it’s not built for you either. I was at the New York Public Library before I came here, and I was sitting there going, this table, this is made for a 6-foot man. I can’t type here. It’s too high. I was with my boyfriend, who is 6 feet tall, and I was like, you are comfortable at this table, I am not: Discuss.

That seems really important and unknown. What? Women’s brains age differently than men’s brains? How so?

Because there’s a judgment associated with better and worse, got it —

Yup. That’s where I am. Fun!

What does that mean? What does the red and the yellow mean?

And green is bad?

Yes, I’d love to see.

Dr. Mosconi shows the difference between pre-menopausal and menopausal brains. Photo: Deborah Copaken

And we’re associating hormones only with what’s going on in the uterus, right?

Yes. How do you make it better?

Wow.

Genetic predisposition to it, right? Or just any sort of predisposition?

And is that the same as testosterone in men?

So what do they have in their bodies that’s equivalent to estrogen that’s keeping their brains plastic?

I did not know that.

Saul Bellow. He became a father at 84.

Right, exactly. I’d probably have Mick Jagger’s baby if I still had a uterus.

Dr. Mosconi has an easy laugh. Photo: Deborah Copaken

So unfair!

Endocrine aging?

Endocrine aging, meaning you fall off the cliff, basically.

Yes! I’ve eaten the same as I’ve always had, and I’ve put on like a pound a year since my mid-forties. It’s all sitting here, right in my midsection, and I don’t do anything different. And I used to be thin and now I’m —

And the shape of it changes, where the fat goes, everything. And I see the number on the scale climb, and I’m like what, why? I’m being nice to you, body! I feed you good food, I exercise…

You mean bacteria in the gut?

So are you just studying women right now, or are you treating women as well?

You’re paying out of pocket.

And where are you finding your subjects?

Because they’re feeling foggy?

Right, you need to get into the Black community and to the Indian community and the —

Not much?

No.

Meaning what age?

So women start getting Alzheimer’s basically the moment that menopause hits if they’re going to get it?

So interesting.

So here’s something that may be completely unrelated, but I think it’s worth mentioning. As a young child, I had severe headaches, and I was going to all these headache clinics, and they couldn’t figure it out. We never figured it out. And then I went through puberty, and they went away. So now here I am in perimenopause and getting severe headaches again.

Exactly.

How old are you if you don’t mind my asking?

Are you going through menopause or perimenopause right now?

Are you going to study yourself when you do?

Because you’re interested enough with that history of it to want to know.

What about your mother, did she do brain scans as well?

They don’t do brain scans there?

Dr. Mosconi with brain scans of her subjects. Photo: Deborah Copaken

Did your mother, at age 74, become nervous about getting Alzheimer’s, or has she kinda pushed those thoughts away?

What would you tell a 50-year-old woman to do right now in terms of estrogen replacement?

What about diet?

Okay, so what are the good foods for a woman going through menopause and what are the bad foods?

What about swordfish and tuna?

So berries.

Really?

Where do you even find a goji berry these days?

Dark chocolate slows down cellular aging? I am going to go buy a bar right now.

Okay, so dark chocolate and berries, what else?

What about bananas?

Kiwi?

I was just in Istanbul yesterday. That is their diet. You’re just describing the diet of Turkey.

What about dried apricots? Those are good too, right?

It goes… across species?

Oh my God. [Laughs.] I never knew that’s what it stood for.

Wow. Okay, I am going to change our diet in our house. More Turkish apricots and nuts.

Brazilian nuts are the big ones, right?

I know, but you can mash them up into a smoothie. What else do I need to do, diet-wise, to keep my perimenopausal brain healthy?

Early onset of menopause from eating Cheez-Its?

A Twinkie?

Or the closer it tastes to plastic. [Laughs.]

Alright, so refined sugar we know is bad.

But let’s say you’re at a dinner and there is an amazing dessert. Do you eat the dessert or not?

Okay, good. [Laughs.]

Wow.

Avocados?

My mother and I, every summer, we have this stupid argument about organic fruit versus non-organic fruit, ever since I was diagnosed with atypia of the breast, which one doctor called atypia, the other called DCIS [ductal carcinoma in situ, cells within the ducts of the breast that have become cancer, but have not spread to surrounding tissue], but whatever. I say, “Please, when you go to the store, please bring back organic fruit. I’m not supposed to eat non-organic fruit.” What happens to the female body when you eat non-organic fruit? I know it’s bad, but I can never remember, in the heat of our argument, why.

So where else are we getting these, what are they called, xeno…?

But specifically on non-organic fruit, where are we getting the xenoestrogens from? From the spray on top of the fruit?

They’re disrupting the hormones in our own body?

So I am a 53-year-old woman who grew up in the United States which means I grew up on Ho Hos, Twinkies, fast food, and Coca-Cola. I am not unusual for my generation. I was born in the mid-’60s. A lot of people reading our blog are going to be in that same generation and have eaten the same crap that I grew up eating. So here’s my question: Are we doomed?

Right. Stress reduction. Big issue.

Wow.

This is why I got divorced. [Laughs.]

Yoga, divorce, a little meditation…

I try to exercise every day. Even if it just means going on a half hour walk with the dogs.

Like when you go to the grocery store and park in the farthest parking spot. When you have a chance to go either up an elevator, or an escalator, or stairs, take the stairs. I mean, there are shortcuts to exercise that happen every day. Or, for example, I was in LA for two months working on a TV show. So, I decided what I was going to do was not have a car, and get an Airbnb two miles from the office, so then I’d be forced to walk my two miles every day and back and forth.

Ruth Bader Ginsburg who is a Supreme Court Justice right now, there is a documentary about her, and they show this 80-something-year-old woman doing planks every day, and her brain is still sharp as a tack. Okay, so planking good, stress and smoking bad. Anything else?

No. Please don’t say that. Caffeine is not good?

What about wine? I read one study that said that wine, in moderation, is good for the brain.

So, you’re now 41 years old. You have a lifetime ahead of you in terms of research, in terms of what you could get done. When you get to the end of your life, what do you hope you will have done with these next 40 years?

Yeah, simple. Just a cure for Alzheimer’s, no biggie.

That’s a great goal, but one of the things that you said earlier sort of struck me which is that if we can figure out what this hormonal change in women does to the brain in terms of Alzheimer’s that could have wide-ranging results for Alzheimer’s in general.

So, maybe the fact that we’re finally looking at women and at these hormones could be at the root why this disease takes hold?

So, we also know that men have different levels of estrogen in them, correct?

They have very little estrogen. Are there ways to study transgender people?

To see what happens to women who transition to men or vice versa?

In a new book?

Well, you also probably don’t have the same number of subjects you would need to study the issue because it’s so new that transgender men and women are transitioning hormonally, so this is something you can be studying now, as we’re seeing this new population emerge.

Right. Of course.

Boobs and —

Hot flashes all over the city right now. [Laughs.]

Neurotrack

On a mission to improve cognitive health.

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Deborah Copaken

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Writes (SHUTTERBABE, THE RED BOOK, EMILY IN PARIS, ATLANTIC, NEUROTRACK, etc.) Shoots (photos.) Tries her best. Sometimes fails. https://www.deborahcopaken.com/

Neurotrack

On a mission to improve cognitive health.