Alzheimer’s dementia is one of the greatest health fears for most of us – and a condition that disproportionately affects women. Now headline-grabbing new research[1] suggests taking HRT could reduce that risk for some women. Here GP and menopause specialist, Dr Rebeccah Tomlinson, discusses what the latest findings mean…
Figures show that over 600,000 women are currently living with dementia in this country, and it is the leading cause of death for women in the UK.[2] These figures are expected to rise as the age of the population increases. It is perhaps unsurprising then that this new study, carried out by researchers at the University of East Anglia and the University of Edinburgh, has generated a huge amount of coverage in the media as it shines a spotlight on the ‘potential importance’ of HRT in reducing the risk of developing Alzheimer’s dementia for some women.[3] Why it is particularly significant is because previously research has shown no conclusive benefits between HRT and any potential dementia health benefits. It has even been shown to have detrimental effects – including increasing the risk in post-menopausal women over the age of 65.[4]
What is not in any doubt, though, is that the risk of dementia is higher in women – with two thirds of those with Alzheimer’s being female (this has traditionally been attributed to the fact women live longer than men but now we are beginning to get a clearer picture about how declining oestrogen could also be a potent risk factor). Around a quarter of women in the UK also carry a gene called APOE4 which poses a significant genetic risk factor for the condition. I need to stress, however, that carrying this gene does not mean you are guaranteed to develop Alzheimer’s and this isn’t always clear in the media coverage.
What does the HRT study tell us?
Due to the ‘observational’ nature of this study (observational studies are where researchers observe or measure certain findings but don’t affect the outcomes so, for example, no treatment is given) the findings can only be used to call for more detailed and robust studies in the future.
What is needed now is more research into how the timing of HRT could be key in potentially reducing the risk of dementia for some women and starting it during the perimenopausal stage (the average age of women going through it is mid 40s[5]) could begin to replace hormones as they start to fall and brain changes begin. Suddenly giving HRT to women in later life, years after their oestrogen receptors have closed down may be too late. Similarly, we need to know what type of HRT and mode of delivery is more likely to yield more positive outcomes.
For example, research from 2021 has shown that women aged over 45 using transdermal HRT (patches) containing body-identical (i.e. hormones that are indistinguishable from ones produced naturally in the body) oestrogen were 73% less likely to get dementia and other brain degenerative conditions and the longer they stayed on HRT the better the results.[6]
Genetic testing
Genetic testing for the APOE4 gene is not readily available on the NHS as it is considered to have poor predictive value. Currently only those patients with a strong history of early onset dementia will be offered genetic testing. Also being a carrier does not automatically mean you will develop the condition and knowing that you have the gene can lead to undue stress and worry.
The Alzheimer’s Society also point out that, ‘Genetic testing can be difficult emotionally, not provide conclusive results and cause practical difficulties. Before considering genetic tests, it is vital that proper genetic counselling is provided to ensure it is the correct decision for the individual. It is also vital that, if someone does have testing, they receive full counselling about what the results mean.’ Dementia is a complex medical condition with many underlying causes and no one can predict your risk definitively.
What if I can’t take HRT?
There is no suggestion from the authors of this study that all women of perimenopausal and menopausal age should suddenly start taking HRT in a bid to stave off dementia. And significantly there are a range of reasons why a sizeable amount should not, and cannot, take it – including those who may be hypersensitive to the hormones in it, have an inherited genetic condition or a specific medical complaint including:
- Those with hypertension (high blood pressure) – said to affect around 26 per cent of women in this country.[i]
- Those with cardiovascular (heart and circulatory) disease – known to currently affect 3.6 million in the UK.[ii]
- Women with ovarian or uterine cancer.[iii] There are currently 41,000 women living with ovarian cancer according to figures from the charity Target Ovarian Cancer[iv] and uterine cancer is the fourth most common cancer in women in the UK – with one in 36 women being diagnosed with it in their lifetime.[v]
- Those who carry the breast cancer gene (BRCA1 or BRCA2). Research estimates that around 1% of the UK population has the BRCA mutation – an estimated one in 400.[vi]
If, via genetic testing, you find that you do carry the APOE4 and/or the BRCA genes then there may be many questions you want answering regarding your risks surrounding both breast cancer and Alzheimer’s Dementia. You can ask your GP to refer you for genetic counselling where you will be given a clearer picture as to your risks of developing these conditions. The choice to take HRT given the current risks and benefits is then a decision that only you can make. If you do not feel that you are getting all your questions answered then please seek advice from a Specialist in this area.
How to reduce your risk of dementia
In the meantime, whilst we wait for further research, there are a number of things you can be doing to reduce your risk of dementia:
- Make sure your blood pressure and cholesterol levels are healthy and well- managed. High blood pressure can damage the blood vessels in the areas of your brain responsible for cognition and memory and increase your risk of Alzheimer’s.[7] It can also limit blood flow to your brain leading to vascular dementia (caused by reduced blood flow to the brain). Having higher levels of LDL ‘bad’ cholesterol and lower levels of HDL ‘good’ cholesterol are linked to having more amyloid plaques (the build-up and accumulation of protein fragments between neurons) in the brain, something associated with those with Alzheimer’s dementia.[8] These amyloid plaques initially develop, and impact on, the areas of the brain associated with memory and other cognitive functions.
- Consider taking specific supplements shown to protect cognitive health. For example, omega 3 – this essential fatty acid (found naturally in oily fish and nuts and seeds) appears to support blood flow to the brain and healthy blood flow helps with memory. Phytoestrogens (plant-based compounds that can mimic oestrogen in the body) found in foods like soy, seeds, nuts, vegetables and fruits, pulses and herbs like red clover can also help by acting as a kind of hormone replacement. Supplements may have higher levels of phytoestrogens than food.
- Think about HRT as a treatment option – particularly if you are perimenopausal. Research has shown that oestrogen may help protect the brain from Alzheimer’s by blocking some of the harmful effects of amyloid proteins.[9] HRT is not a one size fits all solution and if you have not tolerated it in the past but would like to give it another go see your GP or menopause specialist to discuss a different HRT regime. But as mentioned for some women, HRT isn’t an option – although there may be other prescribed medications available to help with specific perimenopausal or menopausal symptoms (you can discuss these with your GP or menopause specialist). But whether you can’t, or don’t want to take HRT many women find they manage their symptoms with lifestyle changes including regular exercise, maintaining a healthy weight, taking vitamin and/or herbal supplements, eating a healthy diet, tracking, recognising and reducing typical triggers like caffeine, alcohol and spicy foods and stopping smoking.
- Try to maintain an active and healthy lifestyle. Evidence is beginning to shape our understanding more and more of just how food is linked to brain health including memory. Research reveals those who ate a Mediterranean-inspired diet, with its high intake of fresh fruit and vegetables, nuts and seeds, pulses, herbs, extra virgin olive oil and fresh fish, in combination with regular exercise could cut their risk of Alzheimer’s by up to 40 per cent.[10] Regular exercise is also important and helps to encourage the growth of new blood vessels in the brain and protect new brain cells from damage. Being active also increases your heart rate which pumps more oxygen to the brain.
- Sleep well. Research is ongoing but it seems if you have had a history of not sleeping well your risk of dementia increases with one study suggesting it could rise by as much as 20 per cent.[11] We also know that the brain and body undergo many biological functions that only occur during sleep, including clearance of waste products that build up in the brain. Most of the removal of beta-amyloid plaque, for example, occurs during the deepest stages of sleep and evidence suggests if you get less than seven hours a night your brain has less time to flush it out – leading to it accumulating and potentially putting you at an increased risk of Alzheimer’s.[12]
- Keep your brain agile. There is evidence to show continued learning over the course of your life not only helps to keep you mentally stimulated but when you are not exposed to anything new cognitive decline becomes more likely.[13] Never stop learning, be open to trying new things, ‘train’ your brain with puzzles, quizzes, crosswords, Wordle, reading, keeping abreast of the news, discuss things with others, be active in your community etc. Don’t forget the ‘use it or lose it’ mantra.
If you have any worries about the risks of dementia and/or whether it is safe for you to take HRT do talk to a medical professional and/or a knowledgeable menopause specialist to get all the available information you need.
Additional resources
If you do have any worries because there is a history of dementia in your family and/or you do carry the APOE4 gene there are a range of organisations that offer support you and information (see below).
Alzheimer’s Society – provides information and support for anyone affected by dementia and runs a Dementia Connect support line (0333 150 3456)
Dementia UK – offers support for families affected by dementia
Sources and references:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830747/
[2] https://www.scie.org.uk/dementia/about/#:~:text=worldwide%2C%20around%2050%20million%20people,in%20women%20in%20the%20UK.
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830747/
[4] https://pubmed.ncbi.nlm.nih.gov/12771112/
[5] https://www.nhs.uk/conditions/menopause/
[6] https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/trc2.12174
[7] https://www.helpguide.org/articles/healthy-living/blood-pressure-and-your-brain.htm
[8] https://health.ucdavis.edu/alzheimers/insidernews/healthy_brain.html
[9] https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/hormones-and-dementia#:~:text=Oestrogen’s%20protective%20effects&text=Research%20has%20shown%20that%20oestrogen,of%20the%20amyloid%2D%CE%B2%20protein.
[10] https://www.cuimc.columbia.edu/news/exercise-and-mediterranean-type-diet-combined-associated-lower-risk-alzheimers-disease
[11] https://pubmed.ncbi.nlm.nih.gov/28890168/
[12] https://www.nih.gov/news-events/nih-research-matters/sleep-deprivation-increases-alzheimers-protein
[13] https://bmjopen.bmj.com/content/9/7/e027719
[i] https://www.bloodpressureuk.org/news/media-centre/blood-pressure-facts-and-figures/#:~:text=Around%20one%20in%20three%20adults,high%20blood%20pressure%5B4%5D.
[ii] https://www.hriuk.org/health/learn/cardiovascular-disease/women-and-heart-disease#:~:text=Heart%20disease%20is%20the%20number,UK%20living%20with%20heart%20disease.&text=Coronary%20heart%20disease%20kills%20more,due%20to%20a%20heart%20attack.
[iii] https://www.cancer.net/cancer-types/hereditary-breast-and-ovarian-cancer#:~:text=A%20diagnosis%20of%20Hereditary%20Breast,at%20age%2045%20or%20younger
[iv] https://targetovariancancer.org.uk/about-us/media-centre/key-facts-and-figures
[v] https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/incidence
[vi] https://www.cancer.net/cancer-types/hereditary-breast-and-ovarian-cancer#:~:text=A%20diagnosis%20of%20Hereditary%20Breast,at%20age%2045%20or%20younger
