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Melanie Cole (Host): Thanks for tuning in to Back To Health, the podcast that brings you up-to-the-minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And today, we're delving into women's brain health, aging, and the risk of Alzheimer's disease. Joining me is Dr. Silky Pahlajani. She's an Assistant Professor of Behavioral Neurology in the Department of Neurology and Radiology at Weill Cornell Medicine.

Dr. Pahlajani, this is such a great episode and, for women, something that we think about all the time. You know, we think about our brain health and we wonder if there are things that we can do. So, first of all, is memory loss a normal part of aging? Is it something that's inevitable? We hear about dementia and Alzheimer's. Is it inevitable that some memory loss happens?

Dr Silky Pahlajani: Hi, Melanie. Yes. So that's a great question. And I'm really delighted to be here to talk about such an important topic. So we know that aging clearly has some impact on aspects of cognition and memory. The older you are, the chances increase of things like misplacing our keys, forgetting why we walked into a room or searching for the right name of an actor or just searching for a word often described as tip of the tongue syndrome.

However, I think what's important to focus on is that there are factors that can reduce the risk of cognitive decline despite aging, and can offset the effects of aging, which we can discuss in just a bit. And mainly because there are plenty of older adults who don't develop cognitive impairment or memory loss with age, and then there are those who do.

Melanie Cole (Host): We'll that's so interesting. Then tell us about dementia and how it's different than Alzheimer's disease. Tell us a little bit about this umbrella term and really the difference between them, if there is one and risk factors, if you would. Cover that. I know it's a lot, but it's really important information.

Dr Silky Pahlajani: Oh, absolutely. And that's a really common question, understandably, because often the words dementia and Alzheimer's are used interchangeably. However, Alzheimer's is a type of dementia and it's a general term for those symptoms associated with memory loss severe enough to interfere with daily functioning, which is a really important distinction.

So we know that there are different types of dementias with various etiologies and causes. However, Alzheimer's type is the most common type. At this point, I think it's really important when you asked about risk factors, it's important to briefly touch on the role of genetics because people often wonder about the chances of developing Alzheimer's if there's a positive family history.

So there are basically two types of Alzheimer's disease. There's early onset and late onset. Early onset, which does have a strong genetic component is diagnosed prior to the age of 65, usually in the 40s or 50s, but that's not the vast majority, which is the key thing to remember. Early onset is due to a genetic variant of the apolipoprotein E4 gene or ApoE4. And in those who have two copies of this allele, which is only 2% to 3% of people are the ones who really go on to develop early-onset Alzheimer's.

So majority of people with Alzheimer's have the late onset form, which symptoms are apparent in their mid-60s or later. And about 25% of those people carry one copy of the ApoE4 gene. And basically, it's associated with increased risk for developing AD. So there's not a causal relationship. And inheriting an ApoE4 allele does not mean that a person will definitely develop Alzheimer's because there are those who have that allele and will never go on to develop the disease and others who don't have it and do develop the disease.

Melanie Cole (Host): Wow, what a great educator you are. That was an excellent explanation. So are women more at risk? And if they are, do we know why?

Dr Silky Pahlajani: So in short, yes, women do have an increased risk of developing Alzheimer's compared to men. In fact of the 6.2 million Americans currently with Alzheimer's disease, about two-thirds of them are women. And in order to better understand why is the primary focus of the women's brain initiative. This was launched by our director and neuroscientist, Dr. Lisa Mosconi. And what her 15 plus years of research has shown is that women's brains actually age differently than men, primarily due to hormonal differences that play a key role.

So for women specifically, we're talking about menopause. It's important to realize that there's a constant exchange between the brain and the rest of the systems in our body, that includes the reproductive system. So when women experience symptoms of menopause, such as hot flashes, insomnia, night sweats, memory and mood changes, these actually start in the brain and not in the ovaries, which is generally not how we think of menopause. And this is because there's crosstalk from the brain to the ovaries and ovaries to the brain, if you will, via something called the neuroendocrine system.

By the same token, estrogen is not just a reproductive hormone, but a form of estrogen called estradiol, is vital for energy production in the brain and hence impacts brain function.

Melanie Cole (Host): I thought that it was probably something hormonal, because that would be the only thing that made sense. So Dr. Pahlajani, are there any treatment options for dementia? Is there anything that we can do that can stop or reverse the disease process? Tell us about the medical field. What are you guys doing for this disease and condition to help slow it down and for families?

Dr Silky Pahlajani: So currently, something very exciting has happened actually this year. The FDA approved a new medication for Alzheimer's disease. And even though there's a lot of speculation regarding how efficacious it is or how beneficial it is, it's really encouraging because it's taken even 20 years to get to this point. There have been other medications in the past that have come and gone, without really good efficacy in terms of treatment. And other than that, there really is no good answer because the current treatments or medications we do give are really not a cure. They may delay progression perhaps by a year or so, but they're really not the definitive, I would say, cure for Alzheimer's disease.

Melanie Cole (Host): So now, what about things that we can do? Are there things that we can do to protect ourselves from developing dementia or just to keep a healthy brain? I mean, I'm an exercise physiologist, so I know that muscle can be trained and helps to keep us healthy and the heart and the brain, our muscles. So tell us a little bit about things we can do, whether it's healthy lifestyle, as you just mentioned, exercise. And then there's the whole food thing, Dr. Pahlajani, that people want to know about. If there are foods like fish oil and antioxidants and those kinds of things. So kind of give us the holistic or complementary medicine picture of this as it were.

Dr Silky Pahlajani: Yes, absolutely. I am so happy to answer this question because there are actually lots of things that we can do on our end in terms of delaying cognitive decline or decreases the chances of developing dementia despite aging. And it's a well-known fact that exercise is good for the body and it's usually associated with physical health. What most people don't realize is that exercise is also great for the brain. And that's a fact backed by scientific data, specifically referring to cardiovascular or aerobic exercise, so anything that raises your heart rate for at least 30 minutes, four to five times a week.

And there's a very simple and logical explanation, for this, because essentially when the heart pumps faster, there is an increase in blood flow throughout the body including the brain and therefore more oxygen is going to the brain and there's more oxygen exchange. And not only that, exercise increases the release of various chemicals that are protective for the brain. One of the chemicals is a protein called brain-derived neurotrophic factor or BDNF. And it actually plays a key role in promoting neuronal plasticity, which is formation of new neurons and minimizing the loss of existing ones specifically in the hippocampus, which is the brain's main memory center. And studies show that exercise can reduce the chance of developing cognitive decline by up to 30%, which is I feel a big percentage, so a rule of thumb is what's good for the heart is good for the brain.

Another factor also is reducing stress and anxiety levels. You know, I have patients who tell me all the time, they're worried about getting Alzheimer's disease. And I tell them worrying about memory loss can lead to memory loss because when our brain is occupied being anxious or stressed, there's less room for memory and it impacts our ability to focus and concentrate. So it's something to really keep in mind that these aren't just things that we like to preach as physicians. They're actually true. There's hard evidence supporting all of this.

Another one is adequate sleep, it's key. And by that, I mean, seven to eight hours. Sleep is the garbage truck for your brain. It's when the body gets rid of toxins and replenishes itself. So it's essential. There's a difference between even getting six hours versus seven of sleep. That one hour actually has a big impact and can increase the chances of depression, anxiety, the six hours versus seven hours.

So these all tie into memory and cognition, it's all connected and it's all related to each other. You know, our brain is connected to the whole body and it's important to keep that in mind.

Melanie Cole (Host): Well, I'm so glad that you mentioned all of those lifestyle things. But now there are supplements and people talk about the supplements, B12 and folic acid, and B6. Do any of these help at all, Dr. Pahlajani?

Dr Silky Pahlajani: My take on supplements really is the better approach, so to speak, is really trying to get nutrients from foods. And research points to plant based nutrients as one of the best ways to get our intake of antioxidants, which are supportive of women's brain health. There are studies that have shown time and time again that the Mediterranean diet is great for brain. Interestingly enough, it includes foods rich in plant-based estrogens, which act as mild estrogens in our bodies. And as I mentioned earlier, when women go through menopause, there is a decline in estrogen levels. So being able to eat a proper diet can actually mitigate some of that decline.

Other antioxidant rich foods that enhance brain functionality actually include coffee beans. So a double espresso is the beverage with the highest antioxidant power or one to two cups of American coffee, however, no more than that, because then you have diminishing return and then gains decline.

Another food that we all have heard about is berries, which are full of antioxidants. And third one, omega-3s, which are found in fish. There are clinical trials showing that eating three ounces of fish twice a week, so primarily fatty fish, like salmon, anchovies is enough to decrease the risk factor for dementia compared to people who do not eat fish. Omega-3s aren't only found in fish. So for those who are vegetarians, things like extra-virgin olive oil, flax seed oil. So one tablespoon of flaxseed oil a day basically gives you all the omega-3s that you need for that day, which I think is pretty astonishing.

Melanie Cole (Host): That's so interesting. And I'm so glad you gave us that list. As we wrap up Dr. Pahlajani, I'd love you to tell us about anything else that you want us to know about dementia and Alzheimer's and, really for this Women's Health Wednesday series, things that we can do, keeping our brains strong, even math problems, puzzles, socializing. You've already talked about sleep and lifestyle. Wrap it up for us with your best advice and the information you would like us to take away as women about our brain health and aging.

Dr Silky Pahlajani: Absolutely. I'm really glad that you touched up on socializing and puzzles because oftentimes people say, you know, they've been doing crosswords for their whole life. They read a lot. I just want to make sure that. Things like reading and doing crosswords, it's excellent. However, there really is no comparison when it comes to social interaction and stimulating the brain with something new, we need to challenge our brain. It's like any other muscle in the body. We need to cross train it. So for those who don't like cards or learning new card games or learning a new language, that is exactly what I want them to do. Because like any other muscle, our brain also has a tendency to plateau when same things are done over and over again. It's just not challenging for the brain anymore. Social interaction, which is probably one of the most key things, because it stimulates our brain to think on its feet, it really forces us to think in abstract ways, I think is one of the, biggest things in addition to the other healthy lifestyle changes that I mentioned. And I feel like another takeaway is definitely what's good for the heart is good for the brain and supplements cannot replace a healthy lifestyle and diet. That's an investment, I think, into our cognitive future.

Melanie Cole (Host): Such great information. Thank you so much, Dr. Pahlajani, for joining us today.

And Weill Cornell medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad you joined us for Women's Health Wednesday. We hope you'll tune in and be part of a community and a fast growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health.

Please download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, please go to weillcornell.org and search podcasts. And parents, always remember to check out our Kids HealthCast. I'm Melanie Cole.

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