5 Brain Health Wake-Up Calls Everyone Needs

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The statistics sound scary, but they’re important to read and remember: Seven million Americans are living with Alzheimer’s disease. Nearly two-thirds of those diagnosed are women. Although two in three Americans want guidance from a healthcare provider on brain health, only 14 percent have talked with their doctor about how to maintain it.

Yet here’s the hopeful news: More of us are thinking about our brain health and understand that there’s a lot we can do to lower our risk of dementia.

Over the years, The Sunday Paper has talked to leading brain health experts to help us rise above the noise and point us toward evidence-based truths all of us must know to protect our cognition. To kick off Alzheimer’s and Brain Awareness Month, we’ve gathered that knowledge and advice so it’s in one spot for you to read, return to, and share with loved ones. May it help you assess and take charge of your brain health in new ways and give you the facts you need to protect your mind now and for years to come.

Fact No. 1: Women are disproportionately affected by Alzheimer’s disease—and most don’t know it. 

A groundbreaking new report from the Cleveland Clinic Women’s Health and Research Center finds that misunderstanding persists when it comes to who’s most at risk for developing dementia. When asked whether men or women are more likely to get Alzheimer’s disease, just 19 percent of women polled answered correctly—and only 29 percent said they worry they may get the disease when they’re older.

This lack of awareness that women disproportionately suffer from Alzheimer’s and lack of concern that they’ll develop the disease mean too many women don’t even have dementia on their radar. That’s a shame, considering knowledge comes along with a sense of empowerment—and action. In that same poll, nearly nine in 10 of those who said they know women are at higher risk than men for Alzheimer’s are taking preventive measures to support their brain health.

The takeaway: Alzheimer’s disease can be prevented with lifestyle changes. For far too long, many of us—including our doctors—didn’t think Alzheimer’s disease was preventable. We assumed our genes were our destiny; if cognitive decline ran in the family, we thought that could be in our future as well.

Thankfully, we know better now, says Jessica Caldwell, PhD, former director of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic. “We know that about 40 percent of current cases of dementia and Alzheimer’s disease could have been prevented if we’d known decades ago how lifestyle contributed to risk,” Dr. Caldwell told The Sunday Paper. “Now, the science supports that doing things like not smoking, not drinking too much, avoiding diabetes, and taking other steps are so important when it comes to how our brains age.”

Understand that by doubling down on the habits that promote overall health, you’re doing a lot to help your brain health, too. Exercising regularly (aim for at least 150 minutes of moderate-intensity aerobic exercise per week), eating a healthy diet, and getting enough sleep are all key. Not smoking and limiting (or even better, eliminating) alcohol are also crucial. If you feel overwhelmed by these healthy lifestyle to-dos, simply do what you can, says Dr. Caldwell: “If there’s a recommended guideline, try to work up to that benchmark. And if you feel like you have room to do more, go ahead and do more.”

Fact No. 2: Menopause actually reshapes the female brain. 

For years now, Lisa Mosconi, MD, director of the Weill Cornell Women’s Brain Initiative and author of The Menopause Brain, has been educating the public about how the female brain ages differently than the male brain, and how hormones help explain why. Recently, Dr. Mosconi uncovered a way to measure estrogen activity in the brain and discovered something remarkable: Estrogen receptors in the female brain don’t shut down after menopause, as experts once thought. In fact, the female brain makes more estrogen receptors throughout the menopause transition, indicating the female brain is eager to sop up as much of this protective hormone as it possibly can.

“Estrogen receptors are not just permanent features on brain cells, they must be constantly made,” explains Dr. Mosconi. “Our study looked at women from age 40 to 65 and found these estrogen receptors are being actively made for many years after menopause.” Translation: The female brain is hungry for estrogen. “There’s no other reason to have all of these receptors.”

Louann Brizendine, a pioneering neurobiologist who’s focused much of her career on understanding the differences and similarities between women’s and men’s brains, says her research has shown that women’s brains get an “upgrade” in mid-life and beyond. Each decade, we get happier, we gain more focus, and we even get more direct. “We start to redefine the rules of relationships and speak up for what’s right,” she told The Sunday Paper. “We become more engaged and more thorough and better able to concentrate. We keep our eye on the prize.”

The takeaway: Dr. Mosconi’s research is proof of the brain’s amazing ability to adapt to hormonal changes—something that should be celebrated. “It’s essential for women to understand that the changes occurring in the brain during menopause are an expected part of the transition, which can, however, bring on many of the most bothersome symptoms of menopause,” Dr. Mosconi told The Sunday Paper. “By understanding how menopause affects the brain, women can better navigate this phase of life with confidence and resilience.”

Dr. Brizendine says what she most wants women to know is that caring for our minds and bodies through all stages of life is critical. And if you’re dealing with the brain changes that so often come with the menopause transition, you can trust that things will get better. “It’s important for us to have hope and to know that it’s worth it—to keep on persevering and doing the best you can for yourself because it matters for your brain, it matters for your happiness, it matters for the people you love in your life, and it matters for the joy you can have,” she says.

Fact No. 3: Treating hearing loss can help reduce your risk of dementia. 

Sadly, only one out of five people who could benefit from a hearing aid actually wears one. It’s a shame, especially considering research out of Johns Hopkins Medicine shows a clear link between hearing loss and dementia. In fact, mild hearing loss doubles a person’s risk of dementia, moderate hearing loss triples your risk, and those with severe hearing impairment have five times the risk.

Experts say that’s because hearing loss causes the brain to work harder, possibly hurting other functions like thinking and memory. Poor hearing also causes people to be less social and more isolated, which can lead to brain shrinkage.

“What I tell patients is that if you don’t use it, you lose it,” Mia Miller, MD, an otolaryngologist at Cedars-Sinai Medical Center, told Maria Shriver on TODAY. “If you’re not getting verbal information to the brain and you’re not using that language perception ability, you may lose some of that function over time.”

The takeaway: Ask for a hearing exam at every annual physical, no matter how old you are. “We check hearing in children in pediatric offices all the time,” says Dr. Miller. “We check sight throughout people’s lives. Hearing should be screened the way sight is screened. It doesn’t take very long, and it has a huge impact.”

Fact No. 4: There’s a huge toll on the caregivers for those with dementia—and we don’t talk about it enough. 

When Bruce Willis was diagnosed with frontotemporal dementia (FTD), his wife Emma Heming Willis struggled with whether and how to make the news public. She talks about the day her husband received his diagnosis and how there was “no guidance, no hope, just shock.” Too many loved ones of those diagnosed with dementia can relate to Emma’s experience.

In her book, The Unexpected Journey, Emma shares that all she really wanted is someone who’d been through what she was going through to tell her, “This feels terrible right now. Your life is in shambles. But it’s going to be okay. Here are some things to think about and put in place so you cannot just survive but thrive.” Because she didn’t get that advice, she wrote the book she wishes someone handed her after her husband’s diagnosis.

The takeaway: “For me, knowledge is power, and building a supportive community around me has been vital,” Emma told The Sunday Paper. “Dementia not only affects your loved one but can shake a whole family's foundation, and self, if you allow it. Identifying the right resources to educate and enlighten myself has been powerful and has allowed me the space to continue to move forward in the most positive way so that I can be the best mother, wife, daughter, friend, and care partner. I want to be able to share that with the next person who finds themselves here.”

Fact No. 5: A new blood test that can detect Alzheimer’s disease early. Knowing what it shows (and doesn’t) can help you decide if it’s right for you.

If you could take a blood test that detects changes in the brain linked to Alzheimer’s years before symptoms begin, would you take it? It’s a question more of us may face, as new blood tests promise to identify signs of the disease earlier than ever before. Yet with that promise comes questions. What can these tests tell us? What can’t they show? And how can we decide if the results will feel empowering—or overwhelming?

First, it’s important to understand that Alzheimer’s disease has two major abnormalities, plaques and tangles, Paul Aisen, MD, one of the leading experts in Alzheimer’s research, told The Sunday Paper. “The blood tests for Alzheimer’s disease are accurate indicators of amyloid in the brain,” he says, which can start accumulating in the brain 25 years before any symptoms surface.

In Dr. Aisen’s view—one that’s shared by many of his colleagues—the presence of amyloid in the brain defines the onset of Alzheimer’s disease. Which means that if you do the blood test and it’s positive for amyloid in the brain, it’s very likely you’ll develop symptoms in the next 10 or 15 years, Dr. Aisen explains.

The takeaway: As of today, we have no treatments for the pre-symptomatic stage of Alzheimer’s disease. There are two large studies underway now testing whether the drugs that are on the market for symptomatic Alzheimer’s may work in those with no symptoms. “So, for now, we are not recommending the test unless someone is interested in joining one of the clinical trials,” says Dr. Aisen.

However, if you have worrisome cognitive symptoms, Dr. Aisen recommends that you consider having the test. That’s because the therapy we currently have removes amyloid, and the sooner you start that therapy the better. If you test positive, talk to your doctor about starting on one of the two approved disease slowing medications, Lecanemab or Donanemab. “This is an important choice, because while these drugs don’t stop the disease, they slow it down by 30 percent,” says Dr. Aisen. “And the sooner you start the therapy, the more effective it is.”