Minneapolis St. Paul Mental Health Blog

Menopause and Alzheimer's

Menopause and Alzheimer's Disease | How they affect each other

Menopause causes metabolic changes in the brain that may increase the risk of Alzheimer’s disease.

The scan to the left shows brain activity (e.g., metabolism) in a premenopausal woman; the scan to the right shows brain activity in a postmenopausal woman. The color scale reflects brain activity, with brighter colors indicating more activity, and darker colors indicating lower activity.

The scan to the right (menopause) looks 'greener' and overall darker, which means that the woman's brain has substantially lower brain activity (more than 30 percent less) than the one to the left (no signs of menopause).

Menopause causes metabolic changes in the brain that may increase the risk of Alzheimer’s disease, a team from Weill Cornell Medicine and the University of Arizona Health Sciences has shown in new research.

The findings, published Oct. 10 in PLoS One, could help solve a longstanding mystery about Alzheimer’s, namely, why women get this fatal neurodegenerative disorder more often than men—even accounting for the fact that women on average live longer. The investigators say the results also eventually may lead to the development of screening tests and early interventions to reverse or slow the observed metabolic changes.
Alzheimer’s afflicts more than 5 million Americans, including one-third of Americans older than 85, and the disease process is known to begin several decades before dementia sets in.

“This study suggests there may be a critical window of opportunity, when women are in their 40s and 50s, to detect metabolic signs of higher Alzheimer’s risk and apply strategies to reduce that risk,” said lead author Dr. Lisa Mosconi, who was recruited to Weill Cornell Medicine as an associate professor of neuroscience in neurology.

For the study, Dr. Mosconi and her colleagues, including senior author Dr. Roberta Brinton from the University of Arizona Health Sciences in Tucson, used the imaging test positron emission tomography (PET) to measure the use of glucose—a principal fuel source for cellular activity—in the brains of 43 healthy women ages 40 to 60. Of those, 15 were pre-menopausal, 14 were transitioning to menopause (peri-menopause) and 14 were menopausal.

The tests revealed the women who had undergone menopause or were peri-menopausal had markedly lower levels of glucose metabolism in several key brain regions than those who were pre-menopausal. Scientists in prior studies have seen a similar pattern of “hypometabolism” in the brains of patients in the earliest stages of Alzheimer’s — and even in mice that model the disease.

In addition, menopausal and peri-menopausal patients showed lower levels of activity for an important metabolic enzyme called mitochondrial cytochrome oxidase, as well as lower scores on standard memory tests. The strong contrast with pre-menopausal patients remained even when accounting that the menopausal and peri-menopausal women were older.

“Our findings show that the loss of estrogen in menopause doesn’t just diminish fertility,” said Dr. Mosconi, associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian. “It also means the loss of a key neuroprotective element in the female brain and a higher vulnerability to brain aging and Alzheimer’s disease. We urgently need to address these problems because, currently, 850 million women worldwide are entering or have entered menopause. Our studies demonstrate that women need medical attention in their 40s, well in advance of any endocrine or neurological symptoms.”

The findings add to mounting evidence that there is physiological connection between menopause and Alzheimer’s. Dr. Mosconi and colleagues published a study in Neurology in September that linked menopause to increased accumulation of the Alzheimer’s-associated protein amyloid beta in the brain. The investigators also observed reduced volumes of gray matter (brain cells) and white matter (nerve fiber bundles) in brain regions that are strongly affected in Alzheimer’s.

Menopause long has been known to cause brain-related symptoms, including depression, anxiety, insomnia and cognitive deficits. Scientists widely believe they are caused largely by declines in estrogen levels. Estrogen receptors are found on cells throughout the brain and evidencesuggests that reduced signaling through these receptors due to low estrogen levels can leave brain cells generally more vulnerable to disease and dysfunction.

More specifically, the authors suggest that the menopausal fall in estrogen may trigger a shift to a “starvation reaction” in brain cells — a metabolic state that is beneficial in the short term but can be harmful in the long term.

“Our work indicates that women may need antioxidants to protect their brain activity and mitochondria in combination with strategies to maintain estrogen levels,” Dr. Mosconi said, noting that exercise and foods that are rich in antioxidants, such as flaxseeds, also may help boost estrogen production. “We believe that more research is needed to test efficacy and safety of hormonal-replacement therapies at the very early stages of menopause, and to correlate hormonal changes with risk of Alzheimer’s. This is a major priority at our Alzheimer’s Prevention Clinic.”

Dr. Mosconi and her colleagues now plan to expand their patient group, and also hope to perform longer-term, more comprehensive analyses of neural and metabolic markers during and after menopause. This work may lead to the development of biomarkers that could help investigators identify at-risk patients.

“We really need to follow larger groups of women over long periods to see how this menopausal change in metabolism relates to Alzheimer’s,” she said.

Said Dr. Brinton, a leading neuroscientist in the field of Alzheimer’s, the aging female brain and regenerative therapeutics: “Outcomes of this study will provide critical evidence for early changes in the aging female brain that are relevant to the two-fold greater lifetime risk in Alzheimer’s disease. Importantly, these results indicate that we know when to intervene in the aging process to divert the potential for developing this devastating disease.”

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Autism and Mental Health

Mental Health Update | Folic Acid, fighting Autism?

Mental Health Minnesota | By taking folic acid around the time of conception, mothers-to-be may reduce their child's risk of pesticide-related autism.

It's estimated that one in 68 U.S. children has an autism spectrum disorder, which can range from mild to severe.

There is no single cause, but research suggests a combination of genetic and environmental influences plays a role, according to the U.S. National Institutes of Health.

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fitness-exercise

Resistance Exercise | Lower Anxiety w/ aerobic based training

Mental Health Help | People who do resistance exercises like weight lifting may experience less anxiety than people who don’t workout.

Researchers analyzed data from 16 previously published studies with a total of 922 participants who were randomly assigned to do resistance training or be inactive.

Resistance workouts were associated with a reduction in anxiety symptoms regardless of whether or not participants had a mental health disorder, though the effect was more pronounced in healthy people who didn’t report any physical or psychological problems.

“The positive effects of exercise training on mental health are well established; however, the majority of this knowledge is based on studies involving aerobic based training,” said lead study author Brett Gordon, a physical education and sports researcher at the University of Limerick in Ireland.

“RET (resistance exercise training) significantly reduced anxiety in both healthy participants and those with a physical or mental illness, and the effect size of these reductions is comparable to that of frontline treatments such as medication and psychotherapy,” Gordon said by email. “RET is a low-cost behavior with minimal risk, and can be an effective tool to reduce anxiety for healthy and ill alike.”

Because the analysis only focused on resistance training, the results can’t show whether this type of activity might be better or worse than aerobic or other types of exercise for easing anxiety symptoms.

While the effects of resistance exercise on the brain are not as well understood as the impact of aerobic workouts, emerging research has also linked resistance training to less shrinkage of white matter in the brain, said Dianna Purvis Jaffin of the Brain Performance Institute at the University of Texas at Dallas.

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Exercise and Depression

Exercise for 1 hour per week | Reduce the risk for Depression

Engaging in just one hour of leisure-time physical activity per week can reduce your risk of future depression...

...according to a new study—which is the largest and most extensive of its kind to date. This paper, “Exercise and the Prevention of Depression: Results of the HUNT Cohort Study,” was published online ahead of print October 3 in The American Journal of Psychiatry.

The findings of this study suggest that surprisingly small amounts of low-intensity physical activity (60 minutes of exercise per week, without becoming breathless or sweating) can protect against future depression, regardless of age or gender.

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Exercise improves Mental Health | Prevent Depression

Mental Health and exerciseMental Health | Engaging in just one hour of leisure-time physical activity per week can reduce your risk of future depression,

…according to a new study—which is the largest and most extensive of its kind to date. This paper, “Exercise and the Prevention of Depression: Results of the HUNT Cohort Study,” was published online in The American Journal of Psychiatry.

The findings of this study suggest that surprisingly small amounts of low-intensity physical activity (60 minutes of exercise per week, without becoming breathless or sweating) can protect against future depression, regardless of age or gender.

This international research team was led by the Black Dog Institute in Australia who conducted an in-depth analysis of the Health Study of Nord-Trøndelag County (HUNT study) which is one of the largest and most comprehensive population-based health surveys ever undertaken. HUNT involved 33,908 male and female Norwegian adults who had their levels of exercise and symptoms of depression and anxiety monitored over an 11-year period.

The latest findings that just 60 minutes of easy exercise per week can act as a prophylaxis against future depression adds to a growing body of evidence that small doses of physical activity can reap huge psychological and physical health benefits.

For example, an August 2017 Tufts-led study found that inactive older adults who added just 48 minutes of moderate physical activity per week (in the form of walking-based exercises) significantly lowered their risk for major mobility disability. Additionally, anything above 48 minutes of moderate exercise per week was a tipping point associated with improvements in overall physical functioning when compared to adults who were sedentary.

At the beginning of the HUNT study, all participants were asked to report their frequencyof weekly exercise and their degree of aerobic intensity without becoming breathless or sweating, becoming breathless and sweating, or exhausting themselves.
During the follow-up stage of the study, participants completed a self-report questionnaire (the Hospital Anxiety and Depression Scale) to indicate any emerging anxiety or depression over the years.

Notably, the researchers found that people did not have to become breathless, sweaty, or exhaust themselves to reap psychological benefits from exercise. In fact, the authors observed that low levels of aerobic intensity were just as effective as moderate-to-vigorous physical activity (MVPA) in terms of protecting against future depression.

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Sleep Problems

Sleep Problems? Breathing Problems? Risk factors

People who experience certain breathing problems at night may be more likely to develop cognitive impairment than individuals without any difficulties breathing while they sleep.

Data obtained from 14 previously published studies with a total of more than 4.2 million men and women showed that people with sleep-disordered breathing had 26 percent higher odds of developing cognitive impairment, researchers report in JAMA Neurology.

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