Perimenopause reduces estrogen levels that previously supported neuronal energy, glucose metabolism, and defenses against amyloid plaque accumulation. Loss of estrogen leaves the brain more vulnerable to cognitive decline and increases Alzheimer's risk in women. Early-onset dementia diagnoses in younger adults have surged dramatically, signaling rising risk at earlier ages. The 40s represent a pivotal window to strengthen brain resilience through targeted prevention and lifestyle measures. Hormonal changes, combined with lifestyle and aging factors, converge to elevate cognitive risk during midlife. Proactive brain health strategies in midlife can help mitigate later decline.
For women, the 40s aren't just another decade-they're a crossroads where biology, lifestyle, and time collide. Perimenopause, that stealthy precursor to menopause, doesn't just bring hot flashes and mood swings; it quietly reshapes the brain, stripping away hormonal protections that once shielded cognitive function. Meanwhile, early-onset dementia cases are surging, with diagnoses in 30- to 54-year-olds skyrocketing by nearly 400% in just four years.
Estrogen isn't just about fertility. It's the brain's invisible ally, a hormone that "has superpowers" for cognitive function. For decades, it revs up neuronal energy, helping brain cells gobble glucose and fend off the sticky amyloid plaques tied to Alzheimer's. But in perimenopause, that shield cracks. "Women lose the superpower around menopause," Mosconi warns. "And the brain is left a little more vulnerable."
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