At this point, I have to turn off the tape recorder, and curse.
June 3, 2019 7:32 AM   Subscribe

"I was like, “Why don’t we know these basic things about female health?” She goes, “Welcome to my world.”". An interview with Dr. Lisa Mosconi about links between Menopause and Alzheimer's . It turns out that menopause affects far more than our childbearing potential. [NYT]
posted by Mchelly (18 comments total) 33 users marked this as a favorite
In the next three minutes, three people will develop Alzheimer’s disease. Two of them will be women.

The article begins with that statistic, but it's misleading. The risk of developing Alzheimer's increases with age, but women live longer than men. A 2016 meta-analysis of 22 studies found that there was no statistically significant difference in the incidence of Alzheimer's by sex of the subjects once age was controlled for.

That said, there is evidence that, at least for a people with a certain genetic risk factor, men and women have the same risk of Alzheimer's disease overall from age 55 to 85 years but women in that group were at increased risk vs men between ages 65 and 75 years, and that risk may be linked to menopause.
posted by jedicus at 7:58 AM on June 3, 2019 [7 favorites]

This is very relevant to me, as a woman with Alzheimer’s in the family. Thanks for posting this!
posted by corb at 8:10 AM on June 3, 2019 [1 favorite]

The risk of developing Alzheimer's increases with age, but women live longer than men.

Addressed in TFA:

Mosconi: even now, when I go give a talk, and I say, two thirds of all Alzheimer’s patients are women all over the world — every time the answer I get is that it’s because women live longer. Every single time. And it makes sense, and for so many years, people were like, well, yeah, that must be true. And then nobody would look into that. And if you think about that, how much longer do women live?

Copaken: Not much?

Mosconi: Four and a half years. In England, two years. Can that explain the fact that women have twice as much Alzheimer’s as men?

Copaken: No.

Mosconi: No. So people started looking into that. They showed that when you have this complicated survival and all these models where you account for everything, you can account for current age, age of death, differences in lifespan, differences in mortality rates, differences in cause of death. So if you do your best, statistically, to account for all these parameters, still women outnumber men 2:1 in the population. Even in England, where the difference is only two years, it’s the same exact ratio. So we know there’s more to it than that. And what we’re showing is that it’s not just aging. Our study shows that possibly, women start the disease earlier.

Copaken: Meaning what age?

Mosconi: Menopause.

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

Mosconi: Yeah, if they’re going to get Alzheimer’s, it looks like the disease starts when your brain is the most discombobulated it’s ever been past puberty. Whereas puberty was an explosion of joy and hormonal health, menopause is the opposite. There’s a crisis. Your brain is going through a crisis, and that’s when Alzheimer’s probably kicks in. Which means that women start the disease when they’re in their late 40s/early 50s. In some cases before that if they get surgical menopause. And so you live with these changes in your brain and then, let’s say it takes 10 years to develop the symptoms, then if you go through menopause at 50, you might get symptoms earlier at 60. Whereas if you’re a man, and these changes happen to your brain just because you’re aging chronologically, then you might get it at 70 or 80. So, that might be part of the problem: that women have more years to experience the disease. Not because they live longer, but because they start earlier.

(emphasis mine)
posted by cooker girl at 8:28 AM on June 3, 2019 [44 favorites]'s no history of Alzheimer's in my family, in fact, it's the opposite (my longest-lived grandparent lived into his 90s and still had his mental faculties, even though they were a bit slower than they had been for most of his life).

However, I notice what the article said about how removal of ovaries can impact Alzheimer's risk. I had one taken out when I was 26.

...Should....should I worry?
posted by EmpressCallipygos at 8:50 AM on June 3, 2019 [1 favorite]

So if you do your best, statistically, to account for all these parameters, still women outnumber men 2:1 in the population.

I have no doubt that Mosconi has an article in mind for this, but without a reference it's hard to evaluate. It may be different in different populations, but I'm not seeing evidence of a consistent 2:1 ratio. For example:
In the United States, studies overwhelmingly report that the incidence of AD dementia does not differ by sex, even after the age of 85 years. In other areas of the world, women do appear to have a higher incidence. For example, studies in several European countries report that women have a higher incidence of AD dementia after the age of 80. However, the Cognitive Function and Aging Study in the United Kingdom initially reported a higher incidence for men.
Mielke, Sex and Gender Differences in Alzheimer’s Disease Dementia, Psychiatric Times 2018 Nov. (emphasis added).

Similarly, a 2018 study of ~17,000 twins in Sweden found incidence was greater in women than men but that this difference was "consistent with women’s survival to older ages compared to men" and noted that "these findings are similar to incidence rates reported in other Swedish samples."

A 2019 paper by Mosconi claims that "[i]t long has been known that the prevalence of Alzheimer's disease (AD) is higher in women than in men, even accounting for women's increased longevity relative to men", for which she cites a 1997 study that did not specifically investigate that issue (controlling for longevity), but did find an increased risk for women at most ages. However, the next sentence in Mosconi's article cites the 2017 JAMA Neurology study that I mentioned above, which found no difference in AD risk between men and women across 55-85 but an increased risk for women from 65-75.

None of which is to say that there are not important sex-related differences in the cause and progression of AD! I only take issue with that specific claim, which I'm finding it difficult to find solid evidence for. At best I think one could say that the evidence is mixed and may depend on the particular population being studied.
posted by jedicus at 9:28 AM on June 3, 2019 [7 favorites]

So the Women’s Health Initiative started in 1993, and it was huge. There were like more than fifty thousand women involved in the trials. The trials went on for many, many years and then all of a sudden there were halted because early findings showed an increased risk of pretty much everything: an increased risk of blood clots, an increased risk of stroke, an increased risk of cardiovascular disease…So it was basically a disaster.
What was the effect on dementia? Data from that study seems like it would speak directly to some the ideas Dr. Mosconi is talking about.
Yes, yes, for sure. Cancer patients, too. All the cancer patients who are taking estrogen blocking medications. What happens to their brains? Do they get more Alzheimer’s?
Is there any Alzheimer's effect for men getting estrogen therapy for prostate cancer, I wonder? Or are men's and women's brains starting in such a different place that the effects will be completely different?
posted by clawsoon at 9:40 AM on June 3, 2019

This interview started out very interesting, discussing Mosconi's view of Alzheimer's in women, but it devolved into what felt like a really pop-culture pseudo-science thing about eating berries and dark chocolate.
posted by Orlop at 9:44 AM on June 3, 2019 [12 favorites]

I am just post-menopause myself, and I was interested in the places where she says that certain treatments seem to be effective if started before menopause. Too late for me! I will be interested as better information comes out about this over the next ten or fifteen years.

I remember an older friend talking to me about estrogen therapy many years ago, and saying that it was still pretty new and it wasn't really clear whether or how much helped menopausal women. "By the time you're my age," she said, "they'll know whether it's worth doing or not." When that big study was halted because of the increased risk of heart attack and, IIRC, stroke, and it stopped being routine to start women on estrogen, I thought, "Well, Denise was right! We do have a pretty good answer." I'll be interested to see if the generation coming after me has good answers on Alzheimer's.
posted by Orlop at 9:48 AM on June 3, 2019

My mom got a hysterectomy in her 30s, not unusual for women of her generation. She died of COPD complications at 69 and showed no signs of dementia so I can't use her as any kind of indicator.

I do now wonder about how many women had hysterectomies and hormone therapy in her generation though.

A friend had first her mom, then her dad get dementia at young ages; they lived in a town that was basically one giant oil refinery, you can often smell fumes. And many people growing old now grew up with leaded gas.

I'm not disagreeing there's no menopause connection but yeah, the GOOP-worthy diet advice at the end did raise my eyebrows.
posted by emjaybee at 10:50 AM on June 3, 2019

the GOOP-worthy diet advice at the end did raise my eyebrows

I found the nutrition advice to be fine and reasonable until the organic bit. like, yes we all know eat fruits and veggies, beans, omega 3s etc., but I'm sniffy about the organic angle. anyone here know more about that?

/51 year old woman
posted by supermedusa at 12:20 PM on June 3, 2019 [1 favorite]

This totally spooked me because I'm working towards elective surgery, I'm cursed with the BRCA gene mutation and I'm advised to act now(ish). IMO, it makes sense to be skeptical of non-organic foods. Hormones are used in many functions both for plants and animals, and within production of processed foods. After reading this I'm wondering if my rare and unusual allergy is hormon-related somehow. I think allergies always are, so it would make sense. Hormones are many things, not just sex. (This is not science language because I am scared, but some MeFi doctor could maybe explain hormones and allergies?)
On top of it all, during menopause I've dealt with stress at a level my therapist claims should be described as PTSD. After reading this article, I feel I have no future. I won't give up, but goddamit.
For the positive: on my dads' side, which is where we have the BRCA, everyone with the mutation has had cancer before they were 50. Except me. I changed to organic food in the late -80's. I get check-ups all the time, for obvious reasons. I'm still going with the surgery, I think, but it is thought-provoking. Would I be better off keeping my ovaries but having annual checks? I have no idea, I'm not a doctor.
posted by mumimor at 1:26 PM on June 3, 2019 [2 favorites]

Whereas puberty was an explosion of joy and hormonal health…
So uh, help me out here. I mean, I am a cis-man and all so not the population she refers to, but that is not how I would characterise puberty at all.
posted by rum-soaked space hobo at 1:39 PM on June 3, 2019 [20 favorites]

I found this article pretty scary, but then all the YOU NEED ANTIOXIDANTS now let’s list all the antioxidant foods, also make sure to eat organic, all the things that make you feel good are bad... and coincidentally I have published a book on this... really left me feeling confused and skeptical.
posted by Secretariat at 1:47 PM on June 3, 2019 [9 favorites]

Would I be better off keeping my ovaries but having annual checks? I have no idea, I'm not a doctor.

There is no definitive test for ovarian cancer. Annual checks for ovarian cancer are not a thing.
posted by Thella at 2:04 PM on June 3, 2019 [4 favorites]

Relevant to this, there is a very interesting discussion over on Peter Attia's podcast discussing the latest developments in hormone replacement therapy and whether it's a good idea or not. As someone on the threshold of menopause it definitely has me reconsidering whether or not I should take replacement estrogen.
posted by longdaysjourney at 8:30 AM on June 4, 2019 [3 favorites]

Muminor, I am also BRCA positive and had an oophorectomy several years ago. Feel free to message me if you want to chat!
Yeah, this news is pretty devastating to me, especially combined with my family history of Dementia. My menopause doctor definitely mentioned memory loss as a menopause symptom, but one we didn't know much about. Glad the research is being done, I guess...
posted by tangosnail at 9:56 AM on June 4, 2019 [1 favorite]

There is no definitive test for ovarian cancer. Annual checks for ovarian cancer are not a thing.'
Obviously, I know. They just test my CRP values and pray. Actually, I'd decided to start with the oophorectomy ASAP, so this article has really worried me.

Muminor, I am also BRCA positive and had an oophorectomy several years ago. Feel free to message me if you want to chat!
Thanks so much tangosnail. I'm calling the specialist tomorrow morning and I guess (because of national holidays) I won't see her before the week after next. I may write to you after that.

About hormone replacement therapy: I went into menopause before I learnt of the BRCA, and I decided against it even without knowing about my specific situation. I did have heat spells, and some emotional ups and downs, but nothing that really made me want to mess with my system, considering the risks. I think everyone should feel how problematic it is in their life before medicating. (I'm not against medicine in any form. When my therapist said I was in a bad state, I accepted taking anti-anxiety medicine for a while, to get back into the world. I hated the side effects, but it really helped me).
posted by mumimor at 12:30 PM on June 4, 2019 [1 favorite]

My dad had Alzheimer's, and I had my uterus out at age 33 and my ovaries out at age 38, both due to cancer. So, this was a hell of a read for me, I must say.
posted by rmd1023 at 6:25 PM on June 5, 2019

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