HOW TO BE A WOMAN
Episode Introduction Dementia is a women’s health issue, but it is rarely framed in that way. Two-thirds of people living with Alzheimer’s disease are women, and yet it is not something we tend to talk about in those terms. Women’s health has long been synonymous with reproductive health, and of course reproductive conditions can affect women profoundly, but they are not what most of us will die of. In many countries, dementia is the leading cause of death in women. But when was the last time you thought consciously about what you can do for your brain health? We know that the changes associated with dementia begin two to three decades before any symptoms appear, and that a significant proportion of the risk is modifiable through lifestyle. It is something every woman at midlife needs to be thinking about. But it is also a confusing space to navigate. There are mixed messages about brain changes at menopause, conflicting views on whether hormone therapy is protective, and no shortage of supplements claiming to do things the evidence does not support. In this episode, I speak with Professor Cassandra Szoeke, a neurologist, author, and principal investigator on the Women’s Healthy Ageing Project, one of the longest-running longitudinal studies of women’s brain health in the world. We get into what is actually happening to our brains at midlife, the difference between cognitive symptoms at menopause and dementia, what we do and do not yet know about the relationship between menopause and brain health, and what you should be doing right now to protect your brain for the long term. Guest Bio Professor Cassandra Szoeke [https://www.profszoeke.com/] is a neurologist, clinician-scientist, author [https://www.amazon.sg/Secrets-Womens-Healthy-Ageing-Living/dp/0522877230/ref=asc_df_0522877230?mcid=4d6e195bfd69310daa32139476db199c&tag=googleshoppin-22&linkCode=df0&hvadid=692713909844&hvpos=&hvnetw=g&hvrand=5717791260998028692&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9062505&hvtargid=pla-1315864379961&psc=1&gad_source=1] and is currently the Director of the Women’s Healthy Ageing Program and Lead of the seXXspecific education for the Academy in HealthCare at Monash Centre for Health Research & Translation. She was the principal investigator of the Women’s Healthy Ageing Project (WHAP), [https://www.monash.edu/medicine/mchri/themes/womens-healthy-ageing-program] a landmark longitudinal study tracking women’s brain and cardiovascular health from midlife onwards, which has generated important sex-specific findings in dementia research. Professor Szoeke is a leading voice in the field of sex differences in disease and is the author of work spanning cognitive aging, hormones, and healthy longevity. She is internationally recognised for her advocacy for women-specific research frameworks and for translating complex science into actionable clinical guidance. What We Cover 00:03 -- Why Alzheimer’s is a women’s health issue • Female specific risk factors for Alzheimers- what do we know 04:16 -- Alzheimer’s, vascular dementia, and mixed pathology • The difference between Alzheimer’s disease (amyloid accumulation) and vascular dementia (blood vessel damage) 08:31 -- Why women’s brains are more vulnerable • The microvascular versus macrovascular distinction • How oestrogen loss at menopause accelerates both heart disease and dementia risk. 12:56 -- Does dementia presents differently in women? 16:05 -- What menopause actually does to the brain • The difference between brain remodelling, which is adaptive, and the progressive neuronal loss that defines dementia. 21:40 -- Brain fog at menopause: dementia or not? 27:38 -- Hormone therapy and the brain: what the evidence shows 34:40 -- Professor Szoeke’s top three prevention priorities for women 40:25 -- Supplements, diet, and what the data actually supports 45:25 -- Social connection, brain stimulation, and the research frontier • Why Sudoku does not reduce dementia risk but genuine social engagement likely does. What You Will Learn • Why are women more likely than men to develop Alzheimer’s disease? • What is the difference between Alzheimer’s dementia and vascular dementia? • How does oestrogen protect the brain, and what happens when it is withdrawn at menopause? • Does early menopause increase the risk of dementia? • Is menopause brain fog the same as early dementia? • Does the APOE gene carry a greater risk for women than for men? • Does hormone therapy protect against dementia if started early enough? • What type of exercise is best for protecting the brain as you age? • Why does HDL cholesterol matter more than LDL for women’s brain health? • What is the best diet for brain health? Key Takeaways • Dementia is not a gender-neutral condition and more women need to be aware of protecting their brain health. • Brain fog at menopause is real, but it is almost always driven by the physical disruptions of the transition, not by neurodegeneration. Treating the symptoms often clears the fog. • Your most important levers for brain protection are daily physical activity, blood pressure control, and staying socially and intellectually active. Further Resources and Support Research and Education Women’s Healthy Ageing Project (WHAP) [https://www.whap.unimelb.edu.au/] -- Professor Szoeke’s longitudinal study of women’s brain and cardiovascular health from midlife, University of Melbourne. Lancet Commission on Dementia Prevention, Intervention, and Care [https://www.thelancet.com/commissions/dementia2024] -- The most comprehensive global review of modifiable dementia risk factors, updated in 2024. Alzheimer’s Disease International [https://www.alzint.org/] -- International federation of Alzheimer associations, with resources and research spanning over 100 countries. Support Organisations Alzheimer’s Association (US) [https://www.alz.org/] -- Support, information, and research funding for people affected by Alzheimer’s and other dementias. Alzheimer’s Society (UK) [https://www.alzheimers.org.uk/] -- Information, helplines, and local support services for people living with dementia and their carers. Dementia Australia [https://www.dementia.org.au/] -- Australia’s peak dementia body, with resources, helplines, and advocacy. Alzheimer’s Disease Association (Singapore) [https://alz.org.sg/] -- Support and services for people living with dementia and their families across Singapore. Menopause and Hormone Therapy Information The Menopause Society (formerly NAMS) [https://www.menopause.org/] -- Evidence-based information on menopause management and hormone therapy from a leading professional body. British Menopause Society [https://thebms.org.uk/] -- Clinical guidelines and patient resources on menopause, including HRT and long-term health risk. Jean Hailes for Women’s Health (Australia) [https://www.jeanhailes.org.au/] -- Accessible, evidence-based women’s health resources covering menopause and cognitive health. The content of this podcast is for educational purposes only. It is not intended to replace the doctor-patient relationship, nor does it constitute personalised medical advice. If you are affected by any of the topics discussed, please speak to your doctor or a qualified healthcare professional. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thewomanshandbook.substack.com [https://thewomanshandbook.substack.com?utm_medium=podcast&utm_campaign=CTA_1]
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