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A Neuroscientist On Gender Disparity In Brain Health & The Alzheimer's Epidemic

Lisa Mosconi, Ph.D.
Neuroscientist By Lisa Mosconi, Ph.D.
Lisa Mosconi, Ph.D. is a neuroscientist and author. Currently, she is the Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, where she serves as an Associate Professor of Neuroscience in Neurology and Radiology.
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All over the world, women's equality, which has come so far since the days of American suffragettes and Women's Lib, is being re-evaluated in real time. Between #MeToo on the one hand and "lean in" on the other, between the increasing demand on women to contribute equally to the workforce and to the household despite the persistent gap in wages, questions come up every day about how equal, or how different, women are. At the same time, there are headline conversations about what it even means to be female to begin with. 

But there are deeper shades of nuance in these movements, ones that speak instead to how women are more subtly undermined—not assaulted, but neglected, dismissed, and at times sabotaged. For all the discussions about the many ways women are treated differently from men, one topic that remains woefully neglected is the one that is closest to my heart: the notion of gender disparity around health and wellness. 

For too long, women have been overlooked.

It doesn't take a scientist to point out that there is something askew with gender disparity. But it does take a scientist to denounce the way that women are also overlooked medically, where our needs too often go unrecognized, misattributed, or unaddressed. This is in large part due to the fact that the field of medicine has been historically male-dominated, which led to the fundamental model for most medical research being not a person but a man. For a number of reasons, medical interventions have been largely tested with, dosed for, and modeled based on their effects on men. 

This is not the source of a conspiracy theory but rather an acknowledgment of the compound effects of assumptions made over centuries, which have led to our teaching and practicing "bikini medicine." For those of you not familiar with the term: Historically, medical professionals believed that the only thing that set women apart from men were those body parts that lie beneath the small triangles of a bikini—namely, our reproductive organs. Setting these "parts" aside, as if one could, meant that most doctors would diagnose and treat both sexes in the exact same way. This biased approach remains just as prevalent and deeply destructive in the hard sciences as it is in many other aspects of culture at large. 

Given the worldview derived from that model, the very notion of women's health is problematic. If you ask doctors to look at a female patient through the lens of "women's health," they will likely run a mammogram or collect cells from the cervix to examine them for cancer. Doing blood tests for estrogen and other hormones is just as common a practice. In other words, women's health is confined to the health of our reproductive organs. Let's be clear that all these procedures have indeed changed and bettered the lives of millions of women around the world. However, these same lines of research, inquiry, and intervention are a direct consequence of a reductive understanding of what a woman is. 

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Brain health is women's health. 

Women's brain health is one of the most underrepresented and unspoken concerns, one that is constantly glossed over as a result of the male-based medical paradigm. Somehow, in the landscape of things that we're told a woman should be concerned with, her brain has seldom been one of them. Further, very few doctors have the knowledge or framework to address the many ways that brain health plays out differently in women than in men

Of all the challenges to brain aging, nothing compares to the unprecedented scale of Alzheimer's disease, which has become the most common form of dementia, currently affecting 5.7 million people in the United States alone. With rates increasing at their current clip, the disease will almost triple by 2050. On a global scale, Alzheimer's patients will number somewhere between the populations of Russia and Mexico! Bottom line: We are facing nothing less than an Alzheimer's epidemic. 

Today, Alzheimer's is as real a threat to women's health as breast cancer is.

Women in their 60s are about twice as likely to develop Alzheimer's over the rest of their lives as they are to develop breast cancer. And yet breast cancer is clearly identified as a women's health issue, while Alzheimer's is not. 

One of the most startling facts about the disease is that a 45-year-old woman has a one in five chance of developing Alzheimer's during her remaining life, while a man of the same age has only a one in 10 chance. This is no dismissal of the suffering that men with Alzheimer's will experience. But we need to confront the reality that, at the end of the day, many more women end their lives suffering from the disease.

And this is only the first blow in a one-two punch. 

The second blow is that, when it comes to providing caregiving throughout this continuing crisis, it is women once more who will bear the bulk of the burden. As it is mostly women who will find themselves, inadvertently or not, drafted into full-time caregiving roles. Currently, there are 10 million American women providing unpaid health care and assistance to loved ones with dementia, all simultaneously shouldering the steep emotional and financial tolls that accompany that crushing task. 

It is time to come to terms with these numbers—not only to confront the large-scale epidemic but also to finally acknowledge, investigate, and react to the very targeted crisis ahead in women's health. In recent years, scientists like me have grown more and more eager to uncover what it is about women's brains that makes us susceptible to Alzheimer's as well as to a host of other medical conditions that affect the brain. Why is this happening? Can we stop it from happening? Our investigations have raised an entire range of thought-provoking existential and scientific questions, not the least of which is: How is it possible we haven't figured this out yet? 

The bottom line, and where it leads us. 

In medicine, the simple fact is that we don't do as good a job of taking care of women as we do men. A woman often ends up having to prove she is as sick as a man, or has to mirror male symptoms, to receive the same level of care. 

As this is present in all aspects of our health care, it is no surprise then that it is equally true when it comes to the health of our brains. Women are falling prey to Alzheimer's but also to depression, migraines, and a number of other conditions that affect the brain. Yet modern medicine is largely unprepared to help them. 

Fortunately, scientists have come to the rescue. In recent years, an incredible amount of work has been done both to denounce and to investigate the gender disparity in brain health. My mission is to take this work past the rigors and paywalls of peer-reviewed research and to give a wider voice to "the forgotten gender." Since university, my work has focused on developing tools and strategies to optimize cognitive health, while at the same time warding off Alzheimer's, particularly in women. 

Witnessing my grandmother's bitter downward spiral into dementia propelled me to devote my entire career to researching any and all possibilities of detecting the disease ahead of time. When both of my grandmother's younger sisters developed Alzheimer's, too, while their brother did not, my determination grew stronger still. I now find myself keeping a close watch on my mom for any warning signs, though I feel reassured as she carefully attends to a healthy diet and practices her yoga headstands at age 76. 

As a middle-aged woman, I am concerned about my own risk. As a mother, I want to make sure my daughter has answers, options, and solutions.

As a scientist, it is my intention to help make preventive medical care to maintain cognitive function an integral part of every woman's medical requirements, as commonplace as regular mammograms, Pap tests, and colonoscopies. Together, let us literally turn the page toward a tomorrow in which there is a dedicated equality of assessment and treatment in health care, our brains included, providing true hope for all. 

As women, we experience gaps in income, power, and representation, but we also face a gap in knowledge about our health, collectively and individually. It's time to rectify this and to address our unique symptoms and concerns as related to our brains and to our bodies as a whole. We all want our cognitive life span to match our life span—we can't wait until signs of cognitive decline appear. We must be proactive now.

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How women can use their diet to protect their brain health

I’ve found there are seven steps to a well-nourished, active, and resilient female brain. These steps are designed to maximize intake of brain-healthy nutrients with a specific focus on keeping our brains young, balancing our hormones, and improving energy and mood, while also reducing the symptoms of menopause, protecting the heart, and supporting the immune system. 

Step 1: Manage your carbs. 

Not all carbs are created equal. These are my three golden rules to eating carbs:

  1. Vegetables and fruits are carbs. Vegetables should make up half of your plate at any given meal. 
  2. Whole grains are in; refined grains (white flour, white pasta, and white bread) are out. 
  3. Legumes and starches like sweet potatoes are also excellent sources of good carbs.
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Step 2: Meet Ms. Phytoestrogen.

There are two major types of phytoestrogens: isoflavones, found mostly in soy; and lignans, abundant in seeds, whole grains, and legumes, and in many fruits and vegetables. This makes a plant-based diet an excellent natural estrogen replacement therapy! 

If you are interested in eating more soy to boost your estrogens, make sure you eat fermented organic soy, and in small amounts at that. If we’re talking about using isoflavones to relieve menopausal symptoms, we’re looking to consume approximately 40 to 50 milligrams of isoflavones per day. This is equivalent to two servings of traditional soy foods, like a scoop of tofu served with a bowl of miso soup or a cup of edamame. 

Step 3: Protect your brain with antioxidants.

Of all the organs in the body, the brain is the one that suffers most from oxidative stress. Enter antioxidants, vitamin warriors that are at the ready to fight off free radicals on our behalf. 

Fruits such as berries, oranges, grapefruits, and apples (all which have a low-glycemic index) are excellent sources of these nutrients. While blueberries receive most of the attention, blackberries and gooseberries pull an even stronger antioxidant punch. Leafy green and cruciferous vegetables (spinach, kale, broccoli, cabbage), as well as onions, carrots, tomatoes, and squash, are also full of these powerhouses. Artichokes top the charts, possessing more antioxidant density than any other fruit or vegetable. Extra-virgin olive oil and flaxseed oil are loaded with vitamin E while also acting as excellent anti-inflammatories. Plant foods to the rescue!

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Step 4: Choose the right fats. 

Both the type and source (rather than the amount) of fats are key when assessing health risks in women. Does the fat you’re eating come primarily from fruits, vegetables, and seeds, or from animal sources? If from animal sources, is it from fatty fish like salmon, or is it from fried bacon? Does it come from fresh, homemade food or from a box?

Step 5: Feed your microbes.

You may have heard by now that a happy tummy equals a happy brain. That’s because our gut is home to the trillions of bacteria and other microorganisms that make up our microbiome. The vast majority of gut bacteria are beneficial to our health—they help us digest food, power up our metabolism, and even produce some essential vitamins. 

Sticking to a varied diet, limiting processed foods, avoiding prolonged restricted diets, and consuming adequate fiber, all keep our gut going strong. 

Step 6: Go organic as much as you can. 

Your body’s estrogen is not only influenced by the foods you eat— it is also being altered by your environment: what you breathe, absorb, and consume on a regular basis. While natural estrogens can be safe and helpful, there are innumerable man-made chemicals that masquerade as estrogen but in reality are its evil twin. These are known as xenoestrogens or endocrine disrupting compounds (EDCs). 

Overall, we are constantly exposed to thousands of substances that can seriously mess with our hormones. Paying attention to our food choices is a significant first step to avoiding contamination and thereby protecting our bodies, our brains, and our hormones. Organic crops are generally grown without synthetic pesticides, artificial fertilizers, irradiation (a form of radiation used to kill bacteria), or biotechnology. 

Step 7: Eat less. 

Reducing our caloric intake can boost cognitive capacity, reduce cellular aging, and promote longevity. The strategy behind this practice is based on nearly a century of scientific data showing that stressing our bodies and brains via calorie restriction pushes our cells to grow stronger and more resilient. 

Just as muscles get stronger the greater the resistance, so do your brain cells strengthen as they resist hunger. Caloric restriction also boosts the brain’s antioxidant defense system, which is particularly important for the female brain.

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