Over the past few decades, the scientific community has shed some light on the vast differences between male and female patient health with an increasing focus on female cardiovascular disease pathology. The reason underlying varying reactions to the same diseases between men and women has been related to the brain, and in particular, sex hormones. Testosterone and estrogen are not only vital to fertility and reproductive functions, but they also play a critical role in brain health, and in particular sex-based risk factors associated with neurodegenerative disease. Emerging research reveals that the brains of males and females are much less different in structure than in how they age as well as the effects aging has on their brain health.
Taking place between March 15-21, 2021, Brain Awareness Week is a global campaign aimed at promoting brain science and research while working to further public awareness of brain health. As a field of medicine, brain health belongs at the forefront of patient health, especially in the case of women as it is considered a vital marker of female health. However, the female brain has been largely overlooked in research efforts and by the scientific community in the past spotlighting a pressing need for increased consideration of the aspect as a facet of overall health.
Currently, it is estimated that 3.3 million women aged 65 and above have Alzheimer’s disease (AD) in the United States – comprising approximately 67% of the AD patient population comprising approximately 67% of AD patients. Overall, women face an increased risk of developing AD due to hormonal shifts that occur during menopause which can increase the risk of neurological changes. Furthermore, women above the age of 60 are twice as likely to develop Alzheimer’s disease over the course of the rest of their lives as they are to develop breast cancer yet the condition is not widely recognized as a women’s health issue. As current and emerging clinical data indicate, the disproportionate prevalence of neurodegenerative diseases in female patients necessitates more comprehensive medical intervention and the development of targeted prevention initiatives.
The Female Brain and Alzheimer’s Disease
According to recent research from investigators at Weill Cornell Medicine women in mid-life have approximately 30% more Alzheimer’s-related plaques than men of the same age. As part of their study, researchers evaluated 121 middle-aged participants without AD symptoms and with the presence of some risk factors such as genetic risk or a family history of disease. They discovered that women also had a 22% lower brain glucose metabolism indicative of lower energy levels in the brain, as well as 11% more brain shrinkage. Both of these neurological biomarkers were associated with menopause.
Noting the significantly increased brain changes associated with AD in female participants, the team of researchers set out to identify relevant risk factors, including age, education, cholesterol levels, smoking status, dietary habits, exercise levels, diabetes, menopause, hormonal therapy, and hysterectomy among others. They found that menopause was the primary predictor of Alzheimer’s disease-related changes in women’s brains and while hormonal therapy was also associated with the condition, women undergoing treatment exhibited fewer negative brain changes.
Although additional research in this field is necessary, the latest findings point to the need to address Alzheimer’s disease-related risks in female patients at an earlier age and with more strategic interventions. Further study is needed to determine what types and doses of hormonal therapeutics may prove beneficial for brain function while also minimizing the potential for adverse health effects.
Menopause, Hormonal Risk Factors, and Neurological Health
Although menopause is not often associated with the brain, approximately 80% of women going through menopause experience at least some neurological symptoms ranging from insomnia and memory loss to depression and anxiety. Left unaddressed, these changes may escalate to serious neurological conditions.
Despite being the only neurodegenerative condition that affects more women than men, Alzheimer’s disease in the female patient remains under-recognized. Gaps in knowledge and scientific literature highlight the need to explore the specific factors that contribute to women’s increased vulnerability to a number of conditions that negatively impact overall brain health. A growing understanding of the varying reasons underlying cognitive changes in both women and men as well as the sex differences in neurological aging and function will likely change the way AD and other neurodegenerative conditions are treated.
Due to advances in research, there are newly discovered opportunities to identify, address, and act upon telling risk factors before clinical symptoms of neurological conditions emerge. Doing so will require comprehensive training and medical education for physicians, enhanced public awareness, and strategic prevention initiatives. Compelling evidence exists revealing the significant benefit of specific medical and lifestyle practices on female brain health; lifestyle interventions can be both safer and better tolerated than traditional pharmacologic approaches while also being just as effective. Most importantly, prevention and treatment protocols should be tailored to each patient’s unique risk profile and needs and incorporate brain health as part of a holistic view of patient care.
As stress has been found to modulate the brain’s reward response, researchers at the University of California, Santa Barbara (UCSB) conducted a study investigating the effects of discrimination and dealing with negative stigma on brain functioning. The new study revealed the negative implications of racial stereotyping on the behavior of the subcortical nucleus accumbens, an area of the brain associated with anticipation of reward and punishment. Their findings were published in a paper featured in Social Cognitive and Affective Neuroscience.
Consequences of Racial Stigmatization
Study author Kyle Ratner, a social psychologist, and his colleagues investigated the effect of negative stereotyping on brain processing in 40 Latinx UCSB students. Participants were randomly assigned to either stigma condition or control groups. Researchers monitored participants’ brain functioning using a functional MRI as they were shown a rapid series of eight 2-3-minute videos pertaining to childhood obesity, high school dropout rates, gang-related violence, and teenage pregnancy.
In the stigmatized group, videos discussed the topics from the Latinx community perspective, suggesting that these individuals were disproportionately affected by them. Meanwhile, the control group was shown videos as related to the general U.S. population. After watching the videos, participants were asked to complete a Monetary Incentive Delay task in which faster response times resulted in monetary rewards.
Altered Brain Functioning
According to the study’s authors, machine learning analyses indicated that incentive-related patterns differed between Latinx participants subjected to negative stereotypes and those within the control group. Researchers found that individuals in the stigma condition group were significantly slower at the task than the control group, indicating disparities linked to the framing of the videos shown.
These effects were tied to personal motivation as related to nucleus accumbens functioning, according to the study’s authors, who highlight the compounding nature of external stressors that is affecting the health of disadvantaged demographics.
“It is clear that people who belong to historically marginalized groups in the U.S. contend with burdensome stressors on top of the everyday stressors that members of non-disadvantaged groups experience,” Ratner told Medical News Today in a recent article. “For instance, there is the trauma of overt racism, stigmatizing portrayals in the media and popular culture, and systemic discrimination that leads to disadvantages in many domains of life, from employment and education to healthcare and housing to the legal system.”
As such, the latest findings implicate that stigmatizing minority populations may impact how these individuals process incentives, expanding understanding of the association between racial stereotyping and personal motivation. This has significant implications for the wellbeing and health of members of these communities and requires further research efforts.
Despite the latest evidence, the study’s authors warn against generalizing their findings as the investigation primarily focused on a singular effect of stigmatization and only evaluated college students. They plan to conduct further experiments in a larger, more diverse cohort to improve the current understanding of systemic effects of structural racism and stereotyping on affected groups and their brain functioning.