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How to keep your brain healthy in old age? 6 ways to protect the female brain

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Women’s bodies undergo major changes during different life stages. From puberty to pregnancy to menopause, women’s brains and bodies witness physical and mental transformations. With women in the UK living almost 4 years longer than men [1], there is a growing need to protect them against age related brain changes. This is further highlighted because 2 in 3 people being diagnosed with dementia are women [2]. Though some forgetfulness is normal in old age, dementia occurs when there is a decline in thinking, memory, and cognitive skills severe enough to affect daily life. Alzheimer’s disease is the most common form of dementia. The good news is there are many lifestyle interventions that can greatly reduce the risk of the disease. 

Why is dementia more common in females?

An important reproductive hormone in women, oestrogen, fluctuates monthly during menstrual cycles and drops by 95% during menopause. Though, evolutionarily, menopause was established to protect the ovaries from excess oestrogen, it also impacts brain health [3].  A recent discovery in 2022 has provided more insight on why women are at a higher risk of dementia. A harmful inflammatory compound called C3 was found in higher levels in the brains of women with Alzheimer’s compared to men with the disease [4]. Oestrogen is protective against production of C3, which is why menopausal women are at a greater risk. Studies have also found that menopausal women had higher levels of Alzheimer’s harmful compounds than men and pre-menopausal women [5].

Despite the harmful effects of the disease, being proactive towards brain health from a young age can limit the damaging effects. This was best seen in the Nun Study [6]. Nuns who practised brain-healthy habits lived a long, healthy life with minimal cognitive loss, despite their brains being inflicted by Alzheimer’s. They did this by keeping their brains active and developing multiple brain networks, thus building their rainy day fund, better known as cognitive reserve. Read more about this here.

How can you optimise cognitive health? 6 ways to a better brain

Dementia risk factors like your age and gender are out of your control. However, there are many factors that you are in charge of. Managing these lifestyle factors can massively reduce your risk of dementia. The Women’s Brain Health Initiative (WBHI) is a charitable foundation in the US and Canada and focuses on protecting women’s brain health. They have listed 6 factors that you can take control of and maximise your cognitive health for long term protection: nutrition, exercise, sleep, stress management, cognitive activities and having a social network. These are evidence-based and derived from a 2020 report where 28 leading dementia experts listed 12 risk factors that can delay or prevent 40% of dementia cases [7]

1. Eat healthy for a stronger, smarter brain.

Your brain is what you eat. And how it performs in old age will depend on what you feed it lifelong. There is a diet that has been especially designed and extensively researched for brain health. It is called the MIND diet (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay). It provides clear guidelines with 10 brain healthy foods that are encouraged and 5 foods that must be limited, with a total score of 15. The foods that must be consumed regularly include vegetables, nuts, whole grains, berries, beans, fish, poultry, and olive oil. Many of these foods have shown to reduce the formation and accumulation of Alzheimer’s toxic compounds. The diet also emphasises limiting butter, margarine, cheese, red meat, fried foods, and sweets. 

When the diet was designed and tested in those aged 80 and above, a score of at least 8.5/15, lowered the risk of Alzheimer’s by 53% [8]. You can start small and gradually incorporate MIND diet recommendations. Even if you adopt 7-8 recommendations, you can lower the risk by 35% [8].

Regardless of your current age and fitness levels, adopting the MIND diet can bring benefits. In a study of 50 obese women in their 40s and 50s, those who followed the MIND diet saw an improvement in memory scores in just 3 months [9]

Read details here and find a free meal plan! You can also check your MIND diet score as you make improvements to your diet.

2. Exercise to build your brain’s shield.

Being physically fit helps in the long run. Regular exercise keeps your body and brain fit and protects your brain against dementia. A 44-years long study [10] measured the physical fitness of women between the ages of 38-60. Women who were at the top of the charts, had an almost 90% lower risk of dementia. Their fitness also helped them delay the onset of Alzheimer’s by 11 years. Exercise benefits the brain by improving blood flow and oxygen, producing more brain cells, strengthening the connections between different brain areas and size of brain structures. Older women (60 yrs+) who engaged in brisk walking for 30-50 minutes, 3-4 times per week saw 15% improvement in blood flow to the brain [29]. 

The best part about physical activity is that you can choose the kind you enjoy doing. There have been numerous studies on cognitive benefits of different types like yoga, walking, cycling, weight lifting. A review of multiple studies found that 10-60 minutes of cycling or running on the treadmill can improve your attention and memory [11]. 

If you find it difficult to find time or equipment for structured exercise, you can still reap brain benefits by simply walking. The optimal dose is around 10,000 steps, which was found to lower the risk by 50% [12]. If you are just starting out, aim for at least 3800 steps per day and that will protect you with a 25% lower risk of dementia [12]. Simple steps can make a big difference to your brain health. 

3. Sleep well for a resilient brain.

A study of over 7000 older women (65 yrs+) looked at the effect on sleep on dementia risk. Those who slept 6 hours or less and those who slept 8 hours or more had over 35% more risk of getting dementia [13]. Aiming for around 7 hours of sleep can be protective against dementia. During sleep, your brain cleans out waste materials, including harmful compounds of Alzheimer’s, preventing their accumulation and consequently damage. This is true even in those with the high-risk gene [14]. Your brain’s waste drainage system works 60% more effectively when you get good sleep [15]. Sleep is important for other functions like organising memories, storing short term memories into long term storage. Sleep deprivation has been linked to damage of memory and learning areas of the brain [16]. The Alzheimer’s Association suggests ways to boost sleep quality: establishing regular sleep time and a sleep hygiene routine, avoidance of stimulants like alcohol, caffeine and screen time before bed, and being active during the day [17].

4. Manage your stress for a relaxed brain.

Over 1400 middle-aged women were studied for 35 years. Those who reported regular stress had a higher risk of dementia in their 70s [18], in some cases the risk was 17-24% higher [21]. Stress is known to cause structural damage to the learning and memory area. Consistently high levels of stress hormone, cortisol increases the deposition of Alzheimer’s harmful chemicals, and decreases the rate at which it is cleared out of the brain [18]. The good news is stress is easily manageable and there are many evidence-based techniques you can incorporate for brain benefits. One of the well-studied stress management techniques is the Mindfulness-based stress reduction (MBSR). It is an 8-week program and is based on self-regulation of emotions [19]. It is based on principles of meditation and yoga. Women who practised 25-30 mins of MBSR reported almost 16% reduction in stress in 16 weeks [20]. If you are outdoorsy, you would be happy to know that spending 20-30 mins in nature, 3 times a week can lower your stress hormone levels by almost 20% [23]. Going on a walk or owning a pet are other ways proven to lower cortisol levels. Read more about stress reduction here.

5. Engage in mental exercises for an active brain.

Your brain is designed to be mentally stimulated. Keeping it intellectually active reaps big benefits. People in their 50s were studied for almost a decade. Those who engaged in cognitive stimulating activities like reading the newspaper and having hobbies, had a 40% lower risk of developing dementia [22]. Cognitive activities help to maintain and promote skills like memory, processing speed and attention. They lower dementia risk by promoting growth of new brain cells in the learning and memory areas of the brain [25]. You can start now, because partaking in cognitive activities in your 30s, 40s will help reduce dementia risk by 38% in old age, as studied in a 44-years long study of women [26]. Indulging in your hobbies is great for your brain- the more, the merrier. Practising 6 leisure activities like knitting, walking, socialising, reading, volunteering, playing board games, and taking classes was found to decrease dementia by 38% [24].

6. Build your social network for a nourished brain.

Staying in touch with your family and friends can help protect your brain. Those in their 60s who met up with their friends on a regular basis had 12% lower risk of developing dementia [27]. Scientists are yet to uncover the exact mechanism but it has been proposed that socialising helps promote language and memory skills and lowers stress due to greater enjoyment [27]. The more social you are, the lower your dementia risk is. Women in their 70s were followed for 4 years. Those who had a large social network (friends and family they saw more than once a month, those they could rely on and confide in) had 26% lower risk of developing dementia [28]. If you find it hard to make friends, reach out to your community clubs, volunteer or join a hobby group and make new friends.

Reduce your dementia risk checklist.

There is a wealth of research that demonstrates that incorporating lifestyle changes lowers dementia risk. Making changes at any stage of life is helpful, so start today:

Recommendations

Dementia/Alzheimer’s risk 

Follow 7-8 MIND diet recommendations

35% lower risk [8]

Get 3800 steps daily in brisk walking 

25% lower risk [12]

Sleep well for 7 hours

35% lower risk [13]

Keep stress under control

Lower dementia risk

Indulge in 6 mentally stimulating activities

38% lower risk [24]

Socialise regularly

12% lower risk [27]


References

  1. Office for National Statistics (2021). National life tables – life expectancy in the UK 
  2. Alzheimer’s Research UK. (2022). The Impact of Dementia on Women. [online] 
  3. Labrie, F. et al. (2012). DHEA and intracrinology at menopause, a positive choice for evolution of the human species. Climacteric, 16(2), pp.205–213. 
  4. Yang, H. et al. (2022). Mechanistic insight into female predominance in Alzheimer’s disease based on aberrant protein S-nitrosylation of C3. Science Advances, 8(50).
  5. Rahman, A. et al. (2020). Sex-driven modifiers of Alzheimer risk. Neurology, 95(2), pp.e166–e178. 
  6. Snowdon, D.A. (1997). Aging and Alzheimer’s Disease: Lessons From the Nun Study. The Gerontologist, 37(2), pp.150–156.
  7. Livingston, G. et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), pp.413–446.
  8. Morris, M. C. et al. (2015). MIND diet associated with reduced incidence of Alzheimer's disease. Alzheimer's & dementia: the journal of the Alzheimer's Association, 11(9), 1007–1014.
  9. Arjmand, G. et al. (2022). Effect of MIND diet intervention on cognitive performance and brain structure in healthy obese women: a randomized controlled trial. Scientific Reports, 12(1).
  10. Hörder, H. et al. (2018). Midlife cardiovascular fitness and dementia. Neurology, 90(15), pp.e1298–e1305.
  11. Blomstrand, P. et al. (2020). Effects of a Single Exercise Workout on Memory and Learning Functions in Young Adults – a Systematic Review. Translational Sports Medicine.
  12. del Pozo Cruz, B. et al. (2022). Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurology.
  13. Chen, J.-C. et al. (2015). Sleep duration, cognitive decline, and dementia risk in older women. Alzheimer’s & Dementia, 12(1), pp.21–33.
  14. Lim, A.S.P. et al. (2013). Modification of the relationship of the apolipoprotein E ε4 allele to the risk of Alzheimer disease and neurofibrillary tangle density by sleep. JAMA neurology, [online] 70(12), pp.1544–51. 
  15. Alzheimer’s Research UK. (2021). Dreaming of a world without dementia: all you need to know about sleep and dementia - Alzheimer’s Research UK.
  16. Prince, T.-M. . and Abel, T. (2013). The impact of sleep loss on hippocampal function. Learning & Memory, 20(10), pp.558–569.
  17. Alzheimer’s Association. (2019). Treatments for Sleep Changes. 
  18. Johansson, L. et al. (2010). Midlife psychological stress and risk of dementia: a 35-year longitudinal population study. Brain : a journal of neurology133(Pt 8), 2217–2224.
  19. Marciniak, R. et al. (2020). The Effect of Mindfulness-Based Stress Reduction (MBSR) on Depression, Cognition, and Immunity in Mild Cognitive Impairment: A Pilot Feasibility Study. Clinical interventions in aging15, 1365–1381.
  20. Raja-Khan, N. et al. (2017). Mindfulness-Based Stress Reduction in Women with Overweight or Obesity: A Randomized Clinical Trial. Obesity (Silver Spring, Md.)25(8), 1349–1359.
  21. Barak, Y. (2022). Stress, Distress, Tensity, Neuroticism, and Risk of Dementia. JAMA Network Open, [online] 5(12), p.e2247124.
  22. Duffner, L.A. et al. (2022). The role of cognitive and social leisure activities in dementia risk: assessing longitudinal associations of modifiable and on-modifiable risk factors. Epidemiology and Psychiatric Sciences, 31.
  23. Hunter MR. et al. (2019) Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers. Frontiers in Psychology. 10:722.
  24. Scarmeas, N. et al. (2001). Influence of leisure activity on the incidence of Alzheimer’s Disease. Neurology, 57(12), pp.2236–2242. 
  25. Su, S. et al. (2022). Leisure Activities and the Risk of Dementia: A Systematic Review and Meta-Analysis. Neurology
  26. Najar, J. et al. (2019). Cognitive and physical activity and dementia: A 44-year longitudinal population study of women. Neurology92(12), e1322–e1330.
  27. Sommerlad, A. et al. (2019). Association of social contact with dementia and cognition: 28-year follow-up of the Whitehall II cohort study. PLOS Medicine, 16(8), p.e1002862.
  28. Crooks, V. C. et al. (2008). Social network, cognitive function, and dementia incidence among elderly women. American journal of public health98(7), 1221–1227.
  29. ScienceDaily. (2011). Moderate exercise dramatically improves brain blood flow in elderly women. [online] 

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