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How a woman’s brain ages

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Women live longer than men, no wonder they are more often affected by dementia. About two thirds of people with the disease Alzheimer they are women, even if this gender difference only emerges after the age of eighty. Identifying the reasons could help to study possible therapies and forms of prevention.

It is the goal of a study that appeared on Jama Network Open, from which the hypothesis emerges that the basis of the difference is the fact that women, while relying on a greater cognitive reserve than males, also have a faster decline.

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A group of researchers led by Deborah Levine The University of Michigan worked on data relating to 26,000 individuals and found that “women perform better than men in global cognition, memory and executive function, that is, the set of processes necessary for the control of behavior. but they also deteriorate significantly faster, “he summarizes Michela Matteoli, professor of Humanitas University and director of the Institute of Neuroscience of the Cnr.

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A photograph of the existing, which highlights possible fragility without identifying the causes. “Since the female population has higher initial cognitive scores, we cannot exclude that doctors do not observe significant cognitive decline in women up to a substantial loss of these abilities,” she adds. Matteoli. And there may also be a female advantage in masking the early signs of Alzheimer’s, which makes the onset of the disease more sudden and seemingly rapid.

Although, he warns Elvira Deleplace, head of the neuropsychopharmacology group of Cnr-Ibbc: “The classification of a cognitive performance is complex, and the division between cognitive abilities and memory is not so clear-cut”.

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Own Deleplace is the first author of a study that identifies among the causes of the greater prevalence of dementia among women the fact that they use different cognitive strategies from males to perform the same tasks, thus activating different brain areas.

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To orient themselves in space, for example, men resort to a view from above, recreating a sort of aerial spatial map, women favor the choice between right-left or forward-backward, a strategy defined as route-finding or egocentric.

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“Our idea – he explains Deleplace – is that women tend to under-stimulate certain areas of the brain such as the hippocampus, which are particularly sensitive to the effect of estrogen, which in this way would be less protected from aging because fewer synapses are created “.

Elements that emerge from gender medicine studies. Explains Deleplace: “Today, for example, we know that in women the maturation of the brain is completed earlier than in men, and that estrogen plays an important role in various biological functions.”

And there is no doubt that hormones also play a role in the development of cognitive functions: “After menopause, estrogen production decreases significantly, and for years it was thought that in this way a protective factor was lost”, continues the researcher: “This is partly true, but we realized that hormone replacement therapy does not offer particular advantages, except perhaps in the early stages of cognitive decline, and that other factors come into play anyway”.

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As he explains Matteoli: “Think of hypertensive disorders in pregnancy, which affect about 12% of pregnant women, and are associated with an increased risk of brain atrophy and cognitive decline decades later.” To which genetic factors could be added: researchers at Stanford University have found that carriers of a variant of the ApoE-4 gene, which increases the risk of Alzheimer’s, are twice as likely to develop the disease as women who do not have this variant. , while for men the increase in risk is modest.

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There are also social factors to take into consideration such as the level of education: “Cognitive stimulation has important protective effects, because it helps to create cognitive resources”, he explains. Deleplace. We are not just talking about school education, although in general more educated people have a more interesting and creative job: “Older women often had fewer opportunities for education and work,” she adds. Matteoli.

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What we do know is that cognitive degeneration is a long-standing process, and that we can do a lot to slow it down: “The death rate from cardiovascular disease is higher in men than in women. In particular, given that men with one lifestyle at risk die younger from these pathologies, one of the hypotheses that emerge is that those over 65 have a lifestyle that is protective for the brain, as well as for the heart “, he recalls Matteoli.

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Precisely because we know that neurodegeneration begins about twenty years before the onset of symptoms, it is important to work on prevention.

A correct lifestyle can do a lot: it is important to keep metabolism under control and also physical activity, especially aerobic, is useful, “especially for women, because it stimulates the production of new neurons in the areas of the brain where this it is possible “, continues the researcher. And it can be an opportunity to combine training and socializing through activities such as dancing, or to devote yourself to orienteering, which consists in reaching an arrival point following a path with the help of a map, an outdoor activity which also includes cognitive training.

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“The activities useful for prevention have a common denominator, the reduction of the inflammatory load of our body”, he recalls Matteoli. An ongoing project called Train the Brain shows how physical and cognitive activity can significantly slow down the impairment of subjects with mild cognitive impairment, delaying the development of Alzheimer’s disease.

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“We should also ask ourselves to what extent the tools that simplify our lives, from smartphones to navigators, reduce the stimuli that keep our brain in training, for example by removing the habit of memorizing information”, he concludes. Deleplace. “Meanwhile, we are trying to understand which forms of cognitive decline may signal a greater risk of developing dementia: an important difference, but difficult to bring out in population studies.”

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Lots of vegetables and few sugars

What if dementia has a metabolic origin? The hypothesis has been around for some time; now a confirmation seems to come from a study carried out by Brigham Young University in collaboration with other American universities.

“Perhaps in the future we could define Alzheimer’s as a form of insulin resistance in the brain,” he explains Benjamin bikman, professor of physiology at Byu and head of the study published in the journal Alzheimer&Dementia.

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Researchers studied RNA from the brains of Alzheimer’s patients post-mortem to evaluate their metabolic activity, identifying an alteration in glucose metabolism that compromises the brain’s ability to use it for its energy needs.

The phenomenon has also been highlighted by other studies, but it is the first time that the mechanism has been explained at the cellular level, and it could clarify why so far the efforts to achieve an effective therapy by attacking the amyloid protein plaques have not been particularly effective. “This data makes us understand the importance of keeping our metabolism in check,” he explains Bikman who recommends a diet rich in vegetables and fruit and low in sugar and refined carbohydrates.

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And, given that fat metabolism appears to function normally in these patients, if the results were confirmed, so would a treatment based on ketones – the molecules that form when the insulin level is low and the body burns fat instead of carbohydrates – could help slow down cognitive impairment.

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