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381‒Alzheimer’s disease in women: how hormonal transitions impact the brain, new therapies, & more
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Podcast Introduction0:00Guest Background and Personal Motivation0:30Patient Awareness and Suffering in Alzheimer's4:30Types of Dementia Context8:02Alzheimer's Prevention Research13:02Alzheimer's Disproportionately Affects Women (2:1 Ratio)14:31Theories for Female Alzheimer's Risk25:30Types of Brain Scans: Structural vs. Functional27:45Brain Estrogen Receptor Imaging (Novel Technique)35:32Implications for Hormone Therapy Timing55:00Timing Hypothesis for Estrogen Therapy55:21Brain Compensation via Estrogen Receptor Density1:01:31Thought Experiments on Cycle Variations and Lifestyle1:07:32CARE Program Launch1:11:01Menopausal Hormone Therapy (MHT) and AD Risk1:15:32Education and Access to Hormone Therapy1:24:11Cautions for Hormone Replacement Therapy in Perimenopause1:25:00Precision Medicine Approach to Hormone Therapy1:27:31Selective Estrogen Receptor Modulators (SERMs)1:29:30Debunking Estrogen-Cancer Myth1:34:00Testosterone-Prostate Cancer Analogy1:35:31WHI Flaws and Media Influence1:38:30Biases in Observational Studies1:42:00Need for Biomarkers and RCTs1:44:30CARE Initiative1:46:30Lancet Commission 20241:51:31Hormone Therapy Post-Oophorectomy and Alzheimer's Risk1:52:57GLP-1 Agonists for Neuroprotection1:56:01Practical Advice for Women on Brain Health2:02:01Optimism for Alzheimer's Treatments2:08:31Building Brain Resilience2:10:30Call for Moonshot Funding2:13:01
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Peter Attia introduces the Drive podcast episode with guest Lisa Mosconi, combining topics of women's health (pre-, peri-, and post-menopause) and brain health, specifically Alzheimer's disease in women.
Lisa Mosconi, born and raised in Florence, Italy, has a PhD in neuroscience and nuclear medicine (branch of radiology). She focuses on brain scans, memory, language, and cognition. Her family includes nuclear physicists and army members.
- Grew up in a multi-generational household in Florence.
- Grandmother (rock of the family, intelligent, survived WWII, raised family while grandfather was POW) developed cognitive decline living on the same landing.
- Grandmother diagnosed with Alzheimer's disease; lost memory, communication, cooking ability.
- One of four siblings: all three sisters developed Alzheimer's and died from it in late 80s (onset late 70s, ~10-year duration, subtle start with mild cognitive impairment she masked); brother spared despite same age.
"It's very typical unfortunately it is quite typical."
Research using biological markers (brain imaging, blood fluids) detects early risk. Cognitive tests are late-stage.
- Preclinical phase: lasts decades; proteins/lesions visible, no objective impairment, but subjective changes (patients feel off, not performing as before).
- Brain resilient, compensates long time.
- Gray area: patients anxious/depressed, tests normal.
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