0:00:01.286,0:00:03.825 Women are works of art. 0:00:03.849,0:00:06.381 On the outside as on the inside. 0:00:06.405,0:00:09.823 I am a neuroscientist[br]and I focus on the inside, 0:00:09.847,0:00:11.950 especially on women's brains. 0:00:12.403,0:00:15.266 There are many theories[br]on how women's brains differ 0:00:15.290,0:00:16.482 from men's brains, 0:00:16.506,0:00:18.680 and I've been looking[br]at brains for 20 years 0:00:18.704,0:00:21.681 and can guarantee[br]that there is no such thing 0:00:21.705,0:00:23.196 as a gendered brain. 0:00:23.807,0:00:26.109 Pink and blue, Barbie and Lego, 0:00:26.133,0:00:28.809 those are all inventions[br]that have nothing to do 0:00:28.833,0:00:31.100 with the way our brains are built. 0:00:32.115,0:00:35.242 That said, women's brains[br]differ from men's brains 0:00:35.266,0:00:36.623 in some respects. 0:00:36.647,0:00:38.880 And I'm here to talk[br]about these differences 0:00:38.904,0:00:41.904 because they actually matter[br]for our health. 0:00:42.244,0:00:43.402 For example, 0:00:43.426,0:00:47.323 women are more likely than men[br]to be diagnosed with an anxiety disorder 0:00:47.347,0:00:48.712 or depression, 0:00:48.736,0:00:51.458 not to mention headaches and migraines. 0:00:51.482,0:00:53.986 But also, [unclear] my research, 0:00:54.010,0:00:57.402 women are more likely than men[br]to have Alzheimer's disease. 0:00:57.760,0:01:00.029 Alzheimer's disease[br]is the most common cause 0:01:00.053,0:01:02.196 of dementia on the planet, 0:01:02.220,0:01:07.290 affecting close to six million people[br]in the United States alone. 0:01:07.790,0:01:11.316 But almost two thirds of all those people 0:01:11.340,0:01:13.210 are actually women. 0:01:13.234,0:01:16.020 So for every man[br]suffering from Alzheimer's 0:01:16.044,0:01:17.624 there are two women. 0:01:17.648,0:01:20.649 So why is that overall? 0:01:20.673,0:01:22.029 Is it age? 0:01:22.053,0:01:23.418 Is it lifespan? 0:01:23.442,0:01:24.909 What else could it be? 0:01:25.644,0:01:26.970 A few years ago, 0:01:26.994,0:01:28.938 I launched the Women's Brain Initiative 0:01:28.962,0:01:31.216 at Weill Cornell Medicine[br]in New York City, 0:01:31.240,0:01:33.597 exactly to answer those questions. 0:01:33.621,0:01:36.676 And tonight, I'm here with some answers. 0:01:37.752,0:01:42.458 So it turns out our brains[br]age differently, 0:01:42.482,0:01:46.202 and menopause plays[br]a key role here for women. 0:01:47.252,0:01:50.472 Now most people think of the brain[br]as a kind of black box, 0:01:50.496,0:01:52.490 isolated from the rest of the body. 0:01:52.514,0:01:55.611 But in reality, our brains[br]are in constant interaction 0:01:55.635,0:01:56.823 with the rest of us. 0:01:56.847,0:01:58.412 And perhaps surprisingly, 0:01:58.436,0:02:02.009 the interactions[br]with the reproductive system 0:02:02.033,0:02:05.302 are crucial for brain aging in women. 0:02:05.882,0:02:08.652 These interactions[br]are mediated by our hormones. 0:02:08.676,0:02:12.040 And we know that hormones differ[br]between the genders. 0:02:12.649,0:02:16.228 Men have more testosterone,[br]women have more estrogens. 0:02:16.252,0:02:17.696 But what really matters here 0:02:17.720,0:02:20.968 is that these hormones differ[br]in their longevity. 0:02:21.420,0:02:24.619 Men's testosterone doesn't run out[br]until late in life, 0:02:24.643,0:02:29.074 which is a slow and pretty much[br]symptom-free process, of course. 0:02:29.508,0:02:33.006 (Laughter) 0:02:33.030,0:02:35.419 Women's estrogens, on the other hand, 0:02:35.443,0:02:38.450 start fading in midlife, during menopause, 0:02:38.474,0:02:41.497 which is anything but symptom-free. 0:02:42.101,0:02:44.998 We associate menopause with the ovaries, 0:02:45.022,0:02:47.842 but when women say[br]that they're having hot flashes, 0:02:47.866,0:02:51.793 night sweats, insomnia,[br]memory lapses, depression, anxiety, 0:02:51.817,0:02:54.166 those symptoms don't start in the ovaries. 0:02:54.190,0:02:56.436 They start in the brain. 0:02:56.794,0:02:58.895 Those are neurological symptoms. 0:02:58.919,0:03:02.299 We're just not used to[br]thinking about them as such. 0:03:02.323,0:03:03.649 So why is that? 0:03:03.673,0:03:06.902 Why are our brains impacted by menopause? 0:03:07.419,0:03:08.577 Well, first of all, 0:03:08.601,0:03:12.800 our brains and ovaries are part[br]of the neuro-endocrine system. 0:03:12.824,0:03:15.336 As part of the system,[br]the brain talks to the ovaries 0:03:15.360,0:03:17.232 and the ovaries talk back to the brain, 0:03:17.256,0:03:20.348 every day of our lives as women. 0:03:20.372,0:03:24.276 So the health of the ovaries[br]is linked to the health of the brain. 0:03:24.300,0:03:25.967 And the other way around. 0:03:26.316,0:03:27.656 At the same time, 0:03:27.680,0:03:31.323 hormones like estrogen[br]are not only involved in reproduction, 0:03:31.347,0:03:33.680 but also in brain function. 0:03:33.998,0:03:36.545 And estrogen in particular, or estradiol, 0:03:36.569,0:03:40.347 is really key for energy[br]production in the brain. 0:03:40.768,0:03:42.291 At the cellular level, 0:03:42.315,0:03:46.302 estrogen literally pushes neurons[br]to burn glucose to make energy. 0:03:46.326,0:03:47.769 If your estrogen is high, 0:03:47.793,0:03:49.881 your brain energy is high. 0:03:49.905,0:03:52.182 When your estrogen declines though, 0:03:52.206,0:03:56.109 your neurons start slowing down[br]and age faster, 0:03:56.133,0:03:58.204 And studies have shown that this process 0:03:58.228,0:04:01.593 can even lead to the formation[br]of amyloid plaques, 0:04:01.617,0:04:03.172 or Alzheimer's plaques, 0:04:03.196,0:04:06.013 which are a hallmark[br]of Alzheimer's disease. 0:04:06.323,0:04:09.124 These effects are stronger[br]in specific brain regions, 0:04:09.148,0:04:11.070 starting with the hypothalamus, 0:04:11.094,0:04:13.823 which is in charge of regulating[br]body temperature. 0:04:14.212,0:04:17.283 When estrogen doesn't active[br]the hypothalamus correctly, 0:04:17.307,0:04:21.006 the brain cannot regulate[br]body temperature correctly. 0:04:21.030,0:04:23.426 So those hot flashes that women get, 0:04:23.450,0:04:25.050 that's the hypothalamus. 0:04:25.592,0:04:28.933 Then there's the brain stem,[br]in charge of sleep and wake. 0:04:28.957,0:04:31.655 When estrogen doesn't activate[br]the brain stem correctly, 0:04:31.679,0:04:33.616 we have trouble sleeping. 0:04:33.640,0:04:34.940 Or it's the amygdala, 0:04:34.964,0:04:38.244 the emotional center of the brain,[br]close to the hippocampus, 0:04:38.268,0:04:40.268 the memory center of the brain. 0:04:40.292,0:04:43.148 When estrogen levels [unclear][br]in these regions, 0:04:43.172,0:04:45.220 we start getting mood swings perhaps 0:04:45.244,0:04:46.529 and forget things. 0:04:46.553,0:04:50.574 So this is the brain anatomy[br]of menopause, if you will. 0:04:50.995,0:04:52.170 But let me show you 0:04:52.194,0:04:54.717 what an actual[br]woman's brain can look like. 0:04:55.249,0:04:56.959 So this is a kind of brain scan 0:04:56.983,0:04:59.735 called positron emission[br]tomography or PET. 0:04:59.759,0:05:01.870 It looks at brain energy levels. 0:05:01.894,0:05:05.504 And this is what you want[br]your brain to look like 0:05:05.528,0:05:07.219 when you're in your 40s. 0:05:07.243,0:05:08.861 Really nice and bright. 0:05:09.314,0:05:12.381 Now this brain belongs to a woman[br]who was 43 years old 0:05:12.405,0:05:15.500 when she was first scanned,[br]before menopause. 0:05:15.524,0:05:20.381 And this is the same brain[br]just eight years later, 0:05:20.405,0:05:22.336 after menopause. 0:05:22.720,0:05:24.514 If we put them side by side, 0:05:24.538,0:05:26.992 I think you can easily see[br]how the bright yellow 0:05:27.016,0:05:29.188 turned orange, almost purple. 0:05:29.776,0:05:34.373 That's a 30 percent drop[br]in brain energy levels. 0:05:35.437,0:05:37.406 Now in general, 0:05:37.430,0:05:42.305 this just doesn't seem to happen[br]to a man of the same age. 0:05:42.786,0:05:44.990 In our studies with hundreds of people, 0:05:45.014,0:05:49.815 we show that middle-aged men[br]usually have high brain-energy levels. 0:05:49.839,0:05:54.023 For women, brain energy[br]is usually fine before menopause 0:05:54.047,0:05:57.491 but then it gradually declines[br]during the transition. 0:05:58.857,0:06:01.751 And this was found independent of age. 0:06:01.775,0:06:04.879 It didn't matter if the women[br]were 40, 50 or 60. 0:06:04.903,0:06:08.847 What mattered most[br]was that they were in menopause. 0:06:09.434,0:06:12.117 So of course we need[br]more research to confirm this, 0:06:12.141,0:06:14.721 but it looks like women's brains midlife 0:06:14.745,0:06:17.403 are more sensitive to hormonal aging 0:06:17.427,0:06:20.022 than just straight up chronological aging. 0:06:20.046,0:06:22.180 And this is important information to have 0:06:22.204,0:06:25.498 because so many women[br]can feel these changes. 0:06:25.522,0:06:27.534 So many of our patients have said to me 0:06:27.558,0:06:30.498 that they feel that their minds[br]play tricks on them, 0:06:30.522,0:06:31.672 to put it mildly. 0:06:32.205,0:06:35.403 So I really want to validate this[br]because it's real. 0:06:35.427,0:06:38.823 And so just to clarify, if this is you, 0:06:38.847,0:06:41.082 you are not crazy. 0:06:41.106,0:06:42.858 (Laughter) 0:06:42.882,0:06:44.645 (Applause) 0:06:44.669,0:06:45.819 Thank you. 0:06:46.714,0:06:47.872 It's important. 0:06:47.896,0:06:50.983 So many women have worried[br]that they might be losing their minds. 0:06:51.007,0:06:54.624 But the truth is that your brain[br]might be going through a transition, 0:06:54.648,0:06:56.188 or is going through a transition 0:06:56.212,0:06:58.983 and needs time and support to adjust. 0:06:59.349,0:07:00.896 Also, if anyone is concerned 0:07:00.920,0:07:04.015 that middle-aged women[br]might be underperformers, 0:07:04.039,0:07:07.126 I'll just quickly add[br]that we looked at cognitive performance, 0:07:07.150,0:07:08.476 God forbid, right? 0:07:08.500,0:07:09.934 (Laughter) 0:07:09.958,0:07:11.158 Let's not do that. 0:07:11.720,0:07:13.585 But we looked at cognitive performance, 0:07:13.609,0:07:17.069 and we found absolutely no differences[br]between men and women 0:07:17.093,0:07:19.672 before and after menopause. 0:07:19.696,0:07:21.926 And other studies confirm this. 0:07:21.950,0:07:24.768 So basically, we may be tired, 0:07:24.792,0:07:26.934 but we are just as sharp. 0:07:26.958,0:07:29.331 (Laughter) 0:07:29.355,0:07:30.847 Get that out of the way. 0:07:31.419,0:07:32.601 That all said, 0:07:32.625,0:07:35.680 there is something else more serious[br]that deserves our attention. 0:07:35.704,0:07:36.887 If you remember, 0:07:36.911,0:07:39.744 I mentioned that estrogen declines[br]could potentially promote 0:07:39.768,0:07:42.474 the formation of amyloid plaques,[br]or Alzheimer's plaques. 0:07:42.839,0:07:44.664 But there's another kind of brain scan 0:07:44.688,0:07:46.450 that looks exactly at those plaques. 0:07:46.474,0:07:50.327 And we used it to show[br]that middle-aged men hardly have any, 0:07:50.351,0:07:51.522 which is great. 0:07:51.546,0:07:53.053 But for women 0:07:53.077,0:07:58.255 there's quite a bit of an increase[br]during the transition to menopause. 0:07:58.279,0:08:00.282 And I want to be really, really clear here 0:08:00.306,0:08:02.770 that not all women develop the plaques, 0:08:02.794,0:08:06.001 and not all women with the plaques[br]develop dementia. 0:08:06.025,0:08:08.080 Having the plaques is a risk factor, 0:08:08.104,0:08:11.699 it is not in any way a diagnosis,[br]especially at this stage. 0:08:12.501,0:08:14.786 But still, it's quite an insight 0:08:14.810,0:08:17.444 to associate Alzheimer's with menopause. 0:08:17.468,0:08:19.992 We think of menopause[br]as belonging to middle age, 0:08:20.016,0:08:22.538 and Alzheimer's as belonging to old age. 0:08:22.562,0:08:23.720 But in reality, 0:08:23.744,0:08:25.847 many studies, including my own work, 0:08:25.871,0:08:30.117 had shown that Alzheimer's disease[br]starts with negative changes in the brain 0:08:30.141,0:08:34.335 years if not decades[br]prior to clinical symptoms. 0:08:34.689,0:08:36.006 So for women, 0:08:36.030,0:08:38.966 it looks like this process[br]starts in midlife, 0:08:38.990,0:08:40.402 during menopause. 0:08:40.426,0:08:42.300 Which is important information to have, 0:08:42.324,0:08:46.189 because it gives us a time line[br]to start looking for those changes. 0:08:46.602,0:08:48.721 So in terms of a time line, 0:08:48.745,0:08:52.109 most women go through menopause[br]in their early 50s. 0:08:52.133,0:08:53.888 But it can be earlier. 0:08:53.912,0:08:56.512 Often because of medical interventions. 0:08:56.815,0:09:00.728 And the common example is a hysterectomy[br]and/or an oophorectomy, 0:09:00.752,0:09:03.387 which is the surgical[br]removal of the uterus 0:09:03.411,0:09:05.029 and/or the ovaries. 0:09:05.363,0:09:07.871 And unfortunately, there is evidence 0:09:07.895,0:09:11.069 that having the uterus,[br]and more so the uterus removed 0:09:11.093,0:09:12.799 prior to menopause 0:09:12.823,0:09:16.735 correlates with the higher risk[br]of dementia in women. 0:09:17.442,0:09:19.545 And I know that this is upsetting news, 0:09:19.569,0:09:21.696 and it's definitely depressing news, 0:09:21.720,0:09:23.335 but we need to talk about it 0:09:23.359,0:09:26.887 because most women are not aware[br]of this correlation, 0:09:26.911,0:09:30.117 and it seems a very important[br]information to have. 0:09:30.141,0:09:33.179 Also, no one is suggesting[br]that women decline these procedures 0:09:33.203,0:09:34.910 if they need them. 0:09:34.934,0:09:38.586 The point here is that we really need[br]to better understand 0:09:38.610,0:09:42.022 what happens to our brains[br]as we go through menopause, 0:09:42.046,0:09:43.744 natural or medical, 0:09:43.768,0:09:46.834 and how to protect[br]our brains in the process. 0:09:47.196,0:09:48.577 So how do we do that? 0:09:48.601,0:09:49.998 How do we protect our brains? 0:09:50.022,0:09:51.895 Should we take hormones? 0:09:51.919,0:09:54.569 That's a fair question,[br]it's a good question. 0:09:54.593,0:09:57.180 And the shortest possible answer right now 0:09:57.204,0:09:59.680 is that hormonal therapy can be helpful 0:09:59.704,0:10:02.958 to alleviate a number of symptoms[br]like hot flashes, 0:10:02.982,0:10:06.749 but it's not currently recommended[br]for dementia prevention. 0:10:06.773,0:10:10.201 And many of us are working[br]on testing different formulations, 0:10:10.225,0:10:12.749 and different dosages[br]and different time lines, 0:10:12.773,0:10:16.856 and hopefully, all this work will lead[br]to a change in recommendations 0:10:16.880,0:10:18.030 in the future. 0:10:18.807,0:10:22.141 Meanwhile, there are other things[br]that we can do today 0:10:22.165,0:10:24.879 to support our hormones[br]and their effects on the brain 0:10:24.903,0:10:26.981 that do now require medications, 0:10:27.005,0:10:30.500 but do require taking a good look[br]at our lifestyle. 0:10:30.963,0:10:33.217 That's because the foods we eat, 0:10:33.241,0:10:34.947 how much exercise we get, 0:10:34.971,0:10:37.114 how much sleep we get or don't get, 0:10:37.138,0:10:39.098 how much stress we have in our lives, 0:10:39.122,0:10:42.313 those are all things that can actually[br]impact our hormones 0:10:42.337,0:10:44.202 for better and for worse. 0:10:44.694,0:10:46.678 Food, for example. 0:10:46.702,0:10:48.591 There are many diets out there, 0:10:48.615,0:10:52.434 but studies have shown[br]that the Mediterranean diet in particular 0:10:52.458,0:10:55.188 is supportive of women's health. 0:10:55.673,0:10:59.089 Women on this diet have a much lower risk 0:10:59.113,0:11:01.634 of cognitive decline, of depression, 0:11:01.658,0:11:04.697 of heart disease, of stroke,[br]and of cancer, 0:11:04.721,0:11:07.530 and they also have fewer hot flashes. 0:11:07.554,0:11:09.847 What's interesting about this diet 0:11:09.871,0:11:13.958 is that it's quite rich in foods[br]that contain estrogens 0:11:13.982,0:11:17.648 in the form of phytoestrogens[br]or estrogens from plants 0:11:17.672,0:11:20.656 that act like mild estrogens[br]in our bodies. 0:11:20.680,0:11:24.125 Some phytoestrogens have been linked[br]to a possible risk of cancer, 0:11:24.149,0:11:27.369 but the ones in this diet, which are safe. 0:11:27.393,0:11:29.956 Especially from flax seeds, 0:11:29.980,0:11:32.964 sesame seeds, dried apricots, 0:11:32.988,0:11:35.544 legumes and a number of fruits. 0:11:35.568,0:11:37.466 And for some good news, 0:11:37.490,0:11:40.878 dark chocolate contains[br]phytoestrogens too. 0:11:41.680,0:11:44.061 So diet is one way to gain estrogens, 0:11:44.085,0:11:48.371 but it's just as important to avoid things[br]that suppress our estrogens instead, 0:11:48.395,0:11:49.978 especially stress. 0:11:50.347,0:11:53.323 Stress can literally steal your estrogens, 0:11:53.347,0:11:56.815 and that's because cortisol,[br]which is the main stress hormone, 0:11:56.839,0:11:59.418 works in balance with our estrogens. 0:11:59.442,0:12:02.149 So if cortisol goes up,[br]your estrogens go down. 0:12:02.173,0:12:05.077 If cortisol goes down,[br]your estrogens go back up. 0:12:05.101,0:12:07.334 So reducing stress is really important. 0:12:07.358,0:12:09.649 It doesn't just help your day, 0:12:09.673,0:12:11.648 it also helps your brain. 0:12:12.427,0:12:13.918 So these are just a few things 0:12:13.942,0:12:15.681 that we can do to support our brains 0:12:15.705,0:12:16.871 and there are more. 0:12:16.895,0:12:18.304 But important thing here 0:12:18.328,0:12:21.981 is that changing the way[br]we understand the female brain 0:12:22.005,0:12:25.148 really changes the way[br]that we care for it, 0:12:25.172,0:12:27.941 and the way that we frame women's health. 0:12:27.965,0:12:30.878 And the more women[br]demand this information, 0:12:30.902,0:12:34.322 the sooner we'll be able to break[br]the taboos around menopause, 0:12:34.346,0:12:37.220 and also come up with solutions[br]that actually work, 0:12:37.244,0:12:38.846 not just for Alzheimer's disease, 0:12:38.870,0:12:41.569 but for women's brain health as a whole. 0:12:41.593,0:12:44.286 Brain health is women's health. 0:12:44.310,0:12:45.475 Thank you. 0:12:45.499,0:12:47.102 (Applause) 0:12:47.540,0:12:48.690 Thank you. 0:12:48.714,0:12:49.864 Oh, thank you.