0:00:01.292,0:00:03.809 Women are works of art. 0:00:03.833,0:00:06.393 On the outside as on the inside. 0:00:06.417,0:00:09.809 I am a neuroscientist[br]and I focus on the inside, 0:00:09.833,0:00:12.393 especially on women's brains. 0:00:12.417,0:00:15.268 There are many theories[br]on how women's brains differ 0:00:15.292,0:00:16.559 from men's brains, 0:00:16.583,0:00:18.684 and I've been looking[br]at brains for 20 years 0:00:18.708,0:00:21.684 and can guarantee[br]that there is no such thing 0:00:21.708,0:00:23.768 as a gendered brain. 0:00:23.792,0:00:26.101 Pink and blue, Barbie and Lego, 0:00:26.125,0:00:28.809 those are all inventions[br]that have nothing to do 0:00:28.833,0:00:31.083 with the way our brains are built. 0:00:32.125,0:00:35.226 That said, women's brains[br]differ from men's brains 0:00:35.250,0:00:36.643 in some respects. 0:00:36.667,0:00:38.893 And I'm here to talk[br]about these differences 0:00:38.917,0:00:42.226 because they actually matter[br]for our health. 0:00:42.250,0:00:43.518 For example, 0:00:43.542,0:00:47.309 women are more likely than men[br]to be diagnosed with an anxiety disorder 0:00:47.333,0:00:48.726 or depression, 0:00:48.750,0:00:51.476 not to mention headaches and migraines. 0:00:51.500,0:00:53.976 But also, [unclear] my research, 0:00:54.000,0:00:57.726 women are more likely than men[br]to have Alzheimer's disease. 0:00:57.750,0:01:00.018 Alzheimer's disease[br]is the most common cause 0:01:00.042,0:01:02.184 of dementia on the planet, 0:01:02.208,0:01:07.768 affecting close to six million people[br]in the United States alone. 0:01:07.792,0:01:11.309 But almost two thirds of all those people 0:01:11.333,0:01:13.226 are actually women. 0:01:13.250,0:01:16.018 So for every man[br]suffering from Alzheimer's 0:01:16.042,0:01:17.643 there are two women. 0:01:17.667,0:01:20.643 So why is that overall? 0:01:20.667,0:01:22.018 Is it age? 0:01:22.042,0:01:23.434 Is it lifespan? 0:01:23.458,0:01:25.601 What else could it be? 0:01:25.625,0:01:26.976 A few years ago, 0:01:27.000,0:01:28.934 I launched the Women's Brain Initiative 0:01:28.958,0:01:31.226 at Weill Cornell Medicine[br]in New York City, 0:01:31.250,0:01:33.601 exactly to answer those questions. 0:01:33.625,0:01:36.667 And tonight, I'm here with some answers. 0:01:37.750,0:01:42.476 So it turns out[br]our brains age differently, 0:01:42.500,0:01:46.208 and menopause plays[br]a key role here for women. 0:01:47.250,0:01:50.476 Now most people think of the brain[br]as a kind of black box, 0:01:50.500,0:01:52.476 isolated from the rest of the body. 0:01:52.500,0:01:55.601 But in reality, our brains[br]are in constant interaction 0:01:55.625,0:01:56.893 with the rest of us. 0:01:56.917,0:01:58.393 And perhaps surprisingly, 0:01:58.417,0:02:02.018 the interactions[br]with the reproductive system 0:02:02.042,0:02:05.851 are crucial for brain aging in women. 0:02:05.875,0:02:08.643 These interactions[br]are mediated by our hormones. 0:02:08.667,0:02:12.643 And we know that hormones differ[br]between the genders. 0:02:12.667,0:02:16.226 Men have more testosterone,[br]women have more estrogens. 0:02:16.250,0:02:17.684 But what really matters here 0:02:17.708,0:02:21.393 is that these hormones differ[br]in their longevity. 0:02:21.417,0:02:24.601 Men's testosterone doesn't run out[br]until late in life, 0:02:24.625,0:02:29.476 which is a slow and pretty much[br]symptom-free process, of course. 0:02:29.500,0:02:33.018 (Laughter) 0:02:33.042,0:02:35.434 Women's estrogens, on the other hand, 0:02:35.458,0:02:38.434 start fading in midlife, during menopause, 0:02:38.458,0:02:42.059 which is anything but symptom-free. 0:02:42.083,0:02:45.018 We associate menopause with the ovaries, 0:02:45.042,0:02:47.851 but when women say[br]that they're having hot flashes, 0:02:47.875,0:02:51.809 night sweats, insomnia,[br]memory lapses, depression, anxiety, 0:02:51.833,0:02:54.184 those symptoms don't start in the ovaries. 0:02:54.208,0:02:56.768 They start in the brain. 0:02:56.792,0:02:58.893 Those are neurological symptoms. 0:02:58.917,0:03:02.309 We're just not used[br]to thinking about them as such. 0:03:02.333,0:03:03.643 So why is that? 0:03:03.667,0:03:07.393 Why are our brains impacted by menopause? 0:03:07.417,0:03:08.684 Well, first of all, 0:03:08.708,0:03:12.809 our brains and ovaries are part[br]of the neuroendocrine system. 0:03:12.833,0:03:15.351 As part of the system,[br]the brain talks to the ovaries 0:03:15.375,0:03:17.233 and the ovaries talk back to the brain, 0:03:17.257,0:03:20.351 every day of our lives as women. 0:03:20.375,0:03:24.268 So the health of the ovaries[br]is linked to the health of the brain. 0:03:24.292,0:03:26.309 And the other way around. 0:03:26.333,0:03:27.643 At the same time, 0:03:27.667,0:03:31.309 hormones like estrogen[br]are not only involved in reproduction, 0:03:31.333,0:03:33.976 but also in brain function. 0:03:34.000,0:03:36.559 And estrogen in particular, or estradiol, 0:03:36.583,0:03:40.726 is really key for energy[br]production in the brain. 0:03:40.750,0:03:42.309 At the cellular level, 0:03:42.333,0:03:46.309 estrogen literally pushes neurons[br]to burn glucose to make energy. 0:03:46.333,0:03:47.768 If your estrogen is high, 0:03:47.792,0:03:49.893 your brain energy is high. 0:03:49.917,0:03:52.184 When your estrogen declines though, 0:03:52.208,0:03:56.101 your neurons start slowing down[br]and age faster. 0:03:56.125,0:03:58.184 And studies have shown that this process 0:03:58.208,0:04:01.601 can even lead to the formation[br]of amyloid plaques, 0:04:01.625,0:04:03.184 or Alzheimer's plaques, 0:04:03.208,0:04:06.309 which are a hallmark[br]of Alzheimer's disease. 0:04:06.333,0:04:09.143 These effects are stronger[br]in specific brain regions, 0:04:09.167,0:04:11.059 starting with the hypothalamus, 0:04:11.083,0:04:14.184 which is in charge of regulating[br]body temperature. 0:04:14.208,0:04:17.268 When estrogen doesn't activate[br]the hypothalamus correctly, 0:04:17.292,0:04:21.018 the brain cannot regulate[br]body temperature correctly. 0:04:21.042,0:04:23.434 So those hot flashes that women get, 0:04:23.458,0:04:25.559 that's the hypothalamus. 0:04:25.583,0:04:28.934 Then there's the brain stem,[br]in charge of sleep and wake. 0:04:28.958,0:04:31.643 When estrogen doesn't activate[br]the brain stem correctly, 0:04:31.667,0:04:33.601 we have trouble sleeping. 0:04:33.625,0:04:34.934 Or it's the amygdala, 0:04:34.958,0:04:38.226 the emotional center of the brain,[br]close to the hippocampus, 0:04:38.250,0:04:40.268 the memory center of the brain. 0:04:40.292,0:04:43.143 When estrogen levels ebb in these regions, 0:04:43.167,0:04:45.226 we start getting mood swings perhaps 0:04:45.250,0:04:46.518 and forget things. 0:04:46.542,0:04:50.976 So this is the brain anatomy[br]of menopause, if you will. 0:04:51.000,0:04:52.268 But let me show you 0:04:52.292,0:04:55.226 what an actual[br]woman's brain can look like. 0:04:55.250,0:04:56.976 So this is a kind of brain scan 0:04:57.000,0:04:59.726 called positron emission[br]tomography or PET. 0:04:59.750,0:05:01.851 It looks at brain energy levels. 0:05:01.875,0:05:05.518 And this is what you want[br]your brain to look like 0:05:05.542,0:05:07.226 when you're in your 40s. 0:05:07.250,0:05:09.309 Really nice and bright. 0:05:09.333,0:05:12.393 Now this brain belongs to a woman[br]who was 43 years old 0:05:12.417,0:05:15.518 when she was first scanned,[br]before menopause. 0:05:15.542,0:05:20.393 And this is the same brain[br]just eight years later, 0:05:20.417,0:05:22.684 after menopause. 0:05:22.708,0:05:24.518 If we put them side by side, 0:05:24.542,0:05:26.976 I think you can easily see[br]how the bright yellow 0:05:27.000,0:05:29.768 turned orange, almost purple. 0:05:29.792,0:05:34.292 That's a 30 percent drop[br]in brain energy levels. 0:05:35.417,0:05:37.393 Now in general, 0:05:37.417,0:05:42.768 this just doesn't seem to happen[br]to a man of the same age. 0:05:42.792,0:05:44.976 In our studies with hundreds of people, 0:05:45.000,0:05:49.809 we show that middle-aged men[br]usually have high brain-energy levels. 0:05:49.833,0:05:54.018 For women, brain energy[br]is usually fine before menopause 0:05:54.042,0:05:57.500 but then it gradually declines[br]during the transition. 0:05:58.875,0:06:01.768 And this was found independent of age. 0:06:01.792,0:06:04.893 It didn't matter[br]if the women were 40, 50 or 60. 0:06:04.917,0:06:09.393 What mattered most[br]was that they were in menopause. 0:06:09.417,0:06:12.101 So of course we need[br]more research to confirm this, 0:06:12.125,0:06:14.726 but it looks like women's brains midlife 0:06:14.750,0:06:17.393 are more sensitive to hormonal aging 0:06:17.417,0:06:20.018 than just straight up chronological aging. 0:06:20.042,0:06:22.184 And this is important information to have 0:06:22.208,0:06:25.518 because so many women[br]can feel these changes. 0:06:25.542,0:06:27.518 So many of our patients have said to me 0:06:27.542,0:06:30.518 that they feel like their minds[br]are playing tricks on them, 0:06:30.542,0:06:32.184 to put it mildly. 0:06:32.208,0:06:35.393 So I really want to validate this[br]because it's real. 0:06:35.417,0:06:38.809 And so just to clarify, if this is you, 0:06:38.833,0:06:41.101 you are not crazy. 0:06:41.125,0:06:42.851 (Laughter) 0:06:42.875,0:06:44.643 (Applause) 0:06:44.667,0:06:45.917 Thank you. 0:06:46.708,0:06:47.976 It's important. 0:06:48.000,0:06:51.059 So many women have worried[br]that they might be losing their minds. 0:06:51.083,0:06:54.643 But the truth is that your brain[br]might be going through a transition, 0:06:54.667,0:06:56.191 or is going through a transition 0:06:56.215,0:06:59.309 and needs time and support to adjust. 0:06:59.333,0:07:00.893 Also, if anyone is concerned 0:07:00.917,0:07:04.018 that middle-aged women[br]might be underperformers, 0:07:04.042,0:07:07.143 I'll just quickly add[br]that we looked at cognitive performance, 0:07:07.167,0:07:08.476 God forbid, right? 0:07:08.500,0:07:09.934 (Laughter) 0:07:09.958,0:07:11.684 Let's not do that. 0:07:11.708,0:07:13.601 But we looked at cognitive performance 0:07:13.625,0:07:17.059 and we found absolutely no differences[br]between men and women 0:07:17.083,0:07:19.684 before and after menopause. 0:07:19.708,0:07:21.934 And other studies confirm this. 0:07:21.958,0:07:24.768 So basically, we may be tired, 0:07:24.792,0:07:26.934 but we are just as sharp. 0:07:26.958,0:07:29.351 (Laughter) 0:07:29.375,0:07:31.393 Get that out of the way. 0:07:31.417,0:07:32.684 That all said, 0:07:32.708,0:07:35.768 there is something else more serious[br]that deserves our attention. 0:07:35.792,0:07:37.059 If you remember, 0:07:37.083,0:07:39.934 I mentioned that estrogen declines[br]could potentially promote 0:07:39.958,0:07:42.809 the formation of amyloid plaques,[br]or Alzheimer's plaques. 0:07:42.833,0:07:46.434 But there's another kind of brain scan[br]that looks exactly at those plaques. 0:07:46.458,0:07:50.309 And we used it to show[br]that middle-aged men hardly have any, 0:07:50.333,0:07:51.601 which is great. 0:07:51.625,0:07:53.059 But for women 0:07:53.083,0:07:58.268 there's quite a bit of an increase[br]during the transition to menopause. 0:07:58.292,0:08:00.351 And I want to be really, really clear here 0:08:00.375,0:08:02.768 that not all women develop the plaques, 0:08:02.792,0:08:06.018 and not all women with the plaques[br]develop dementia. 0:08:06.042,0:08:08.059 Having the plaques is a risk factor, 0:08:08.083,0:08:12.476 it is not in any way a diagnosis,[br]especially at this stage. 0:08:12.500,0:08:14.768 But still, it's quite an insight 0:08:14.792,0:08:17.434 to associate Alzheimer's with menopause. 0:08:17.458,0:08:19.976 We think of menopause[br]as belonging to middle age, 0:08:20.000,0:08:22.518 and Alzheimer's as belonging to old age. 0:08:22.542,0:08:23.809 But in reality, 0:08:23.833,0:08:25.851 many studies, including my own work, 0:08:25.875,0:08:30.101 had shown that Alzheimer's disease[br]starts with negative changes in the brain 0:08:30.125,0:08:34.684 years if not decades[br]prior to clinical symptoms. 0:08:34.708,0:08:36.018 So for women, 0:08:36.042,0:08:38.976 it looks like this process[br]starts in midlife, 0:08:39.000,0:08:40.393 during menopause. 0:08:40.417,0:08:42.309 Which is important information to have, 0:08:42.333,0:08:46.559 because it gives us a time line[br]to start looking for those changes. 0:08:46.583,0:08:48.726 So in terms of a time line, 0:08:48.750,0:08:52.101 most women go through menopause[br]in their early 50s. 0:08:52.125,0:08:53.893 But it can be earlier. 0:08:53.917,0:08:56.809 Often because of medical interventions. 0:08:56.833,0:09:00.726 And the common example is a hysterectomy[br]and/or an oophorectomy, 0:09:00.750,0:09:03.393 which is the surgical[br]removal of the uterus 0:09:03.417,0:09:05.351 and/or the ovaries. 0:09:05.375,0:09:07.851 And unfortunately, there is evidence 0:09:07.875,0:09:11.059 that having the uterus,[br]and more so the ovaries removed 0:09:11.083,0:09:12.809 prior to menopause 0:09:12.833,0:09:17.434 correlates with the higher risk[br]of dementia in women. 0:09:17.458,0:09:19.559 And I know that this is upsetting news, 0:09:19.583,0:09:21.684 and it's definitely depressing news, 0:09:21.708,0:09:23.351 but we need to talk about it 0:09:23.375,0:09:26.893 because most women[br]are not aware of this correlation, 0:09:26.917,0:09:30.101 and it seems a very important[br]information to have. 0:09:30.125,0:09:33.184 Also, no one is suggesting[br]that women decline these procedures 0:09:33.208,0:09:34.893 if they need them. 0:09:34.917,0:09:38.601 The point here is that we really need[br]to better understand 0:09:38.625,0:09:42.018 what happens to our brains[br]as we go through menopause, 0:09:42.042,0:09:43.726 natural or medical, 0:09:43.750,0:09:47.184 and how to protect[br]our brains in the process. 0:09:47.208,0:09:48.559 So how do we do that? 0:09:48.583,0:09:50.018 How do we protect our brains? 0:09:50.042,0:09:51.893 Should we take hormones? 0:09:51.917,0:09:54.559 That's a fair question,[br]it's a good question. 0:09:54.583,0:09:57.184 And the shortest possible answer right now 0:09:57.208,0:09:59.684 is that hormonal therapy can be helpful 0:09:59.708,0:10:02.976 to alleviate a number of symptoms,[br]like hot flashes, 0:10:03.000,0:10:06.768 but it's not currently recommended[br]for dementia prevention. 0:10:06.792,0:10:10.184 And many of us are working[br]on testing different formulations, 0:10:10.208,0:10:12.768 and different dosages,[br]and different time lines, 0:10:12.792,0:10:16.851 and hopefully, all this work will lead[br]to a change in recommendations 0:10:16.875,0:10:18.768 in the future. 0:10:18.792,0:10:22.143 Meanwhile, there are other things[br]that we can do today 0:10:22.167,0:10:24.893 to support our hormones[br]and their effects on the brain 0:10:24.917,0:10:26.976 that do now require medications, 0:10:27.000,0:10:30.934 but do require taking a good look[br]at our lifestyle. 0:10:30.958,0:10:33.226 That's because the foods we eat, 0:10:33.250,0:10:34.934 how much exercise we get, 0:10:34.958,0:10:37.101 how much sleep we get or don't get, 0:10:37.125,0:10:39.101 how much stress we have in our lives, 0:10:39.125,0:10:42.309 those are all things that can actually[br]impact our hormones 0:10:42.333,0:10:44.684 for better and for worse. 0:10:44.708,0:10:46.684 Food, for example. 0:10:46.708,0:10:48.601 There are many diets out there, 0:10:48.625,0:10:52.434 but studies have shown[br]that the Mediterranean diet in particular 0:10:52.458,0:10:55.643 is supportive of women's health. 0:10:55.667,0:10:59.101 Women on this diet have a much lower risk 0:10:59.125,0:11:01.643 of cognitive decline, of depression, 0:11:01.667,0:11:04.684 of heart disease,[br]of stroke, and of cancer, 0:11:04.708,0:11:07.518 and they also have fewer hot flashes. 0:11:07.542,0:11:09.851 What's interesting about this diet 0:11:09.875,0:11:13.976 is that it's quite rich in foods[br]that contain estrogens 0:11:14.000,0:11:17.643 in the form of phytoestrogens[br]or estrogens from plants 0:11:17.667,0:11:20.643 that act like mild estrogens[br]in our bodies. 0:11:20.667,0:11:24.143 Some phytoestrogens have been linked[br]to a possible risk of cancer, 0:11:24.167,0:11:27.351 but not the ones in this diet,[br]which are safe. 0:11:27.375,0:11:29.976 Especially from flax seeds, 0:11:30.000,0:11:32.976 sesame seeds, dried apricots, 0:11:33.000,0:11:35.559 legumes and a number of fruits. 0:11:35.583,0:11:37.476 And for some good news, 0:11:37.500,0:11:41.643 dark chocolate[br]contains phytoestrogens too. 0:11:41.667,0:11:44.059 So diet is one way to gain estrogens, 0:11:44.083,0:11:48.351 but it's just as important to avoid things[br]that suppress our estrogens instead, 0:11:48.375,0:11:50.309 especially stress. 0:11:50.333,0:11:53.309 Stress can literally steal your estrogens, 0:11:53.333,0:11:56.809 and that's because cortisol,[br]which is the main stress hormone, 0:11:56.833,0:11:59.434 works in balance with our estrogens. 0:11:59.458,0:12:02.143 So if cortisol goes up,[br]your estrogens go down. 0:12:02.167,0:12:05.059 If cortisol goes down,[br]your estrogens go back up. 0:12:05.083,0:12:07.351 So reducing stress is really important. 0:12:07.375,0:12:09.643 It doesn't just help your day, 0:12:09.667,0:12:12.393 it also helps your brain. 0:12:12.417,0:12:13.934 So these are just a few things 0:12:13.958,0:12:15.684 that we can do to support our brains 0:12:15.708,0:12:16.976 and there are more. 0:12:17.000,0:12:18.393 But the important thing here 0:12:18.417,0:12:21.976 is that changing the way[br]we understand the female brain 0:12:22.000,0:12:25.143 really changes the way[br]that we care for it, 0:12:25.167,0:12:27.934 and the way that we frame women's health. 0:12:27.958,0:12:30.893 And the more women[br]demand this information, 0:12:30.917,0:12:34.309 the sooner we'll be able to break[br]the taboos around menopause, 0:12:34.333,0:12:37.226 and also come up with solutions[br]that actually work, 0:12:37.250,0:12:38.851 not just for Alzheimer's disease, 0:12:38.875,0:12:41.559 but for women's brain health as a whole. 0:12:41.583,0:12:44.268 Brain health is women's health. 0:12:44.292,0:12:45.559 Thank you. 0:12:45.583,0:12:47.518 (Applause) 0:12:47.542,0:12:48.809 Thank you. 0:12:48.833,0:12:50.083 Oh, thank you.