Dr. Jessica Caldwell of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic
Women's Alzheimer's Movement at Cleveland Clinic
Dr. Jessica Caldwell, Neuropsychologist
All quarter long, as part of our #VBGIVESBACK partnership with the Women’s Alzheimer’s Movement (WAM) at Cleveland Clinic, we’ve learned that Alzheimer’s grossly discriminates against women. The stats are staggering: two out of three Alzheimer’s patients are female. But did you ever wonder… why?
We did, and went straight to the source to better understand what it is about our biology and the way women age that makes us more susceptible.
Meet Jessica Caldwell, PhD, director of the WAM Prevention Center at Cleveland Clinic in Las Vegas. Not only is she a neuropsychologist treating patients in the clinic, but she’s also active behind the scenes as a researcher studying how sex and gender impact the disease. Here, she explains the science of it all.
Q&A
Why are women disproportionately impacted by Alzheimer’s?
Previously, the thinking was that women—on average—live longer than men. We now know there’s more to it. There’s the genetic factor, for instance. Studies have shown that if a woman has the APOE4 gene, her risk of Alzheimer’s is up to four times greater than a man who has it. Lifestyle-wise, on average, men are more likely to be physically active; we’re more at risk by being sedentary. And then there’s menopause and the rapid loss of estrogen that comes with it…
Previously, the thinking was that women—on average—live longer than men. We now know there’s more to it. There’s the genetic factor, for instance. Studies have shown that if a woman has the APOE4 gene, her risk of Alzheimer’s is up to four times greater than a man who has it. Lifestyle-wise, on average, men are more likely to be physically active; we’re more at risk by being sedentary. And then there’s menopause and the rapid loss of estrogen that comes with it…
How does menopause increase risk?
Estrogen isn’t just about reproduction; it’s important for the entire body and brain. When we lose estrogen, we lose memory support and, during menopause, our body has to rapidly readjust. It’s so significant that, if you give someone a memory test before, during and after menopause, for many women, you’ll see a dip in memory. The theory for Alzheimer’s is that some women don’t recover as well from that loss of estrogen. The research now is trying to identify these women—is it because of genetics? A lack of exercise?
Estrogen isn’t just about reproduction; it’s important for the entire body and brain. When we lose estrogen, we lose memory support and, during menopause, our body has to rapidly readjust. It’s so significant that, if you give someone a memory test before, during and after menopause, for many women, you’ll see a dip in memory. The theory for Alzheimer’s is that some women don’t recover as well from that loss of estrogen. The research now is trying to identify these women—is it because of genetics? A lack of exercise?
What does this mean for people who are taking hormone replacement therapy (HRT)—or on the flip side, for those diagnosed with breast cancer, undergoing endocrine therapy to lower estrogen?
Anti-estrogen therapies for breast cancer can—in the moment, yes—have a negative impact on memory, but to my knowledge, they have not been linked to risk for dementia. As for those taking HRT, women who have menopause early—before about age 45—benefit from HRT. Those with a typical age of menopause—around age 53—may also benefit, but the literature is not finalized. What we do know is that it is not great to start taking estrogen if you’re long past menopause; that is actually bad for your brain.
Anti-estrogen therapies for breast cancer can—in the moment, yes—have a negative impact on memory, but to my knowledge, they have not been linked to risk for dementia. As for those taking HRT, women who have menopause early—before about age 45—benefit from HRT. Those with a typical age of menopause—around age 53—may also benefit, but the literature is not finalized. What we do know is that it is not great to start taking estrogen if you’re long past menopause; that is actually bad for your brain.
And how does Alzheimer’s affect women differently than men?
Women tend to be identified later than men. We think it’s because we have stronger verbal memory, so when women start to show symptoms of memory loss, the Alzheimer’s process tends to be further along. While it might seem like that’s an advantage—it takes women longer to show memory loss—what it means is that, once we do, we’ve already run out of that reserve and decline faster.
The other way Alzheimer’s affects women differently is not related to the disease process itself. In addition to being more at risk, women are also more likely to be a caregiver for someone with Alzheimer’s—for most, that’s a stressful situation and stress isn’t great for your memory.
Women tend to be identified later than men. We think it’s because we have stronger verbal memory, so when women start to show symptoms of memory loss, the Alzheimer’s process tends to be further along. While it might seem like that’s an advantage—it takes women longer to show memory loss—what it means is that, once we do, we’ve already run out of that reserve and decline faster.
The other way Alzheimer’s affects women differently is not related to the disease process itself. In addition to being more at risk, women are also more likely to be a caregiver for someone with Alzheimer’s—for most, that’s a stressful situation and stress isn’t great for your memory.
The WAM Prevention Center at Cleveland Clinic in Las Vegas.
Stereotypes about Alzheimer’s you’d like to clarify?
1. That we’re all just going to get it, especially if it’s in your family, and there’s nothing we can do about it. Forty percent of current cases could have been avoided if we had just known earlier that lifestyle affects brain health. There’s a lot you can do to decrease your odds.
2. That if you’ve been diagnosed with Alzheimer’s, that’s the end. Those lifestyle changes, like more sleep and eating whole foods, will improve your quality of life and potentially improve your memory for some time.
3. That we shouldn’t talk about it. The stigma around Alzheimer’s holds us all back. We need to be able to talk about the disease—whether as a family or as a community—and talk about it with younger people so they can build better habits for prevention.
1. That we’re all just going to get it, especially if it’s in your family, and there’s nothing we can do about it. Forty percent of current cases could have been avoided if we had just known earlier that lifestyle affects brain health. There’s a lot you can do to decrease your odds.
2. That if you’ve been diagnosed with Alzheimer’s, that’s the end. Those lifestyle changes, like more sleep and eating whole foods, will improve your quality of life and potentially improve your memory for some time.
3. That we shouldn’t talk about it. The stigma around Alzheimer’s holds us all back. We need to be able to talk about the disease—whether as a family or as a community—and talk about it with younger people so they can build better habits for prevention.
The lifestyle changes—for example, exercising. Can you break down how that decreases our risk exactly?
When you exercise, your brain releases a neurochemical that supports memory. Exercise consistently and you’ll get a sustained release of it. People don’t realize that exercise is, hands down, the best thing you can do for your brain because not only does it make a direct impact—by helping you grow new neural pathways and cells—but it can improve sleep and counter symptoms of depression, both of which reduce Alzheimer’s risk. And, of course, exercise is great for heart health, which, in turn, is good for brain health.
And when I say exercise, I mean 150 minutes a week of moderate-intensity aerobic exercise, like a brisk walk. It’s not a leisurely stroll, but it’s also not your peak effort—you don’t want to be breathing so hard you can’t hold a conversation.
When you exercise, your brain releases a neurochemical that supports memory. Exercise consistently and you’ll get a sustained release of it. People don’t realize that exercise is, hands down, the best thing you can do for your brain because not only does it make a direct impact—by helping you grow new neural pathways and cells—but it can improve sleep and counter symptoms of depression, both of which reduce Alzheimer’s risk. And, of course, exercise is great for heart health, which, in turn, is good for brain health.
And when I say exercise, I mean 150 minutes a week of moderate-intensity aerobic exercise, like a brisk walk. It’s not a leisurely stroll, but it’s also not your peak effort—you don’t want to be breathing so hard you can’t hold a conversation.
What about sleep?
When we sleep, we consolidate memory. That means, at certain sleep stages, your brain is actually unpackaging things you learned or experienced that day, then repackaging and shuttling them to long-term storage. Bad sleep means less opportunity to do that. If you’re chronically sleep-deprived, you may start to have memory issues. During sleep, we also clear debris out of the brain. That’s important because recent research has found that the debris we clear includes a protein called amyloid, which builds up in the brain in patients with Alzheimer’s disease.
When we sleep, we consolidate memory. That means, at certain sleep stages, your brain is actually unpackaging things you learned or experienced that day, then repackaging and shuttling them to long-term storage. Bad sleep means less opportunity to do that. If you’re chronically sleep-deprived, you may start to have memory issues. During sleep, we also clear debris out of the brain. That’s important because recent research has found that the debris we clear includes a protein called amyloid, which builds up in the brain in patients with Alzheimer’s disease.
“For the longest time there wasn’t much funding for women’s health in general. WAM and [founder] Maria Shriver have really played a critical role in boosting attention to the problem.”
How has WAM made an impact on Alzheimer’s research?
For the longest time there wasn’t much funding for women’s health in general. WAM and [founder] Maria Shriver have really played a critical role in boosting attention to the problem. And by funding, for the most part, early-career women who may not otherwise get the funding, WAM grants catalyze these researchers to then get larger grants from, for example, the National Institutes of Health. Research moves faster than it otherwise would.
For the longest time there wasn’t much funding for women’s health in general. WAM and [founder] Maria Shriver have really played a critical role in boosting attention to the problem. And by funding, for the most part, early-career women who may not otherwise get the funding, WAM grants catalyze these researchers to then get larger grants from, for example, the National Institutes of Health. Research moves faster than it otherwise would.
Could you share some of the breakthroughs WAM has supported through the years?
WAM has funded research on how to medically reduce risk, how sleep problems contribute to risk, the connection to gut health, how to build better estrogen…. This is especially impactful because insurance doesn’t pay for Alzheimer’s prevention, so right now we depend on philanthropy to get this research done.
WAM has funded research on how to medically reduce risk, how sleep problems contribute to risk, the connection to gut health, how to build better estrogen…. This is especially impactful because insurance doesn’t pay for Alzheimer’s prevention, so right now we depend on philanthropy to get this research done.
What are you most hopeful about right now?
I’m excited that so many people are talking about this. Because if we are doing the science but not effectively communicating it and getting that knowledge out to the people who are at risk, then we’re not going to make long-term changes.
I’m excited that so many people are talking about this. Because if we are doing the science but not effectively communicating it and getting that knowledge out to the people who are at risk, then we’re not going to make long-term changes.
From now to the end of June, we will donate a portion of proceeds from every single veronicabeard.com order to the Women’s Alzheimer’s Movement at Cleveland Clinic, which is changing the future for women and Alzheimer’s through prevention, research, education and advocacy. Learn more about the partnership here. #VBGIVESBACK
