1. Menopause and the Brain: Lifting the Fog Majid Fotuhi, MD PhD

2. New Discoveries 2

3. “This book may be the most important you’ll ever read. Certainly, what Dr. Fotuhi teaches in this book has changed my life.” Michael Roizen, M.D. Chairman of the Wellness Institute- The Cleveland Clinic 3

4. “ Dr. Fotuhi has summarized the latest discoveries that show how we can grow our brains bigger and stronger…” Mehmet Oz, M.D. The Dr. Oz Show 4

5. Objectives  Why does the brain shrink with aging?  Menopause, hormones, and the brain  What else can be done: Brain Fitness Program 5

6. Objectives  Why does the brain shrink with aging?  Menopause, hormones, and the brain  What else can be done: Brain Fitness Program 6

7. Memory Lapses Memory Lapses or Alzheimer’s? Age-Associated Memory Impairment MCI Alzheimer’s 7

8. Short-term: Hippocampus Long-term: Cortex Cortex Hippocampus 8

9. Beautiful Neurons in Hippocampus 9

10. With Aging, Hippocampus Atrophies Faster than the Rest of the Brain  Hippocampus shrinks by about 0.5% per year after age 50  That is the reason memory lapses become more frequent after age 50 10

11. Overlapping Causes of Atrophy in Hippocampus Obesity Stroke Sleep Apnea Concussion AD Diabetes Hypertension Stress 11

12. Less Brain Volume in Patients with Sleep Apnea Am J Respir Crit Care Med 2002; 166:1382–7 12

13. Obesity Shrinks the Brain  Associated with reduced brain volume Ward, et al., 2005  Slows cognitive function Debette, et al., 2011  Brains of overweight and obese individuals appeared 8 and 16 years older, respectively Raji, et al., 2010 13 Brain Research Volume 1280, 14 July 2009, Pages 186–194

14. Multiple Vascular Risk Factors: Worse Brain Atrophy Multiple Vascular Risk Factors No Vascular Risk Factors Hippocampus 14

15. Stress Shrinks Brain Cells in Hippocampus Stress Control 15

16. Depression and the Brain  The number of days of depression is associated with the severity of hippocampal atrophy Sheline, et al, (1996). PNAS, 93(9);3908-13.  Depression is associated with impaired memory, executive function and processing speed Egger et al, (2008). Psychiatry Research: Neuroimaging; 164(3): 237-44) Sheline, (1996). PNAS, 93(9);3908-13. 16

17. Why do we forget names?  Hypertension  Diabetes  Alcoholism  Depression  Heart failure  Obesity  High cholesterol  Head trauma  Aging  Poor sleep  Too much work  Information overload  Too many responsibilities  Fatigue  Poor attention  Poor diet  “Can’t do it” mentality 17

18. 18 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

19. Objectives  Why does the brain shrink with aging?  Menopause, hormones, and the brain  What else can be done: Brain Fitness Program 19

20. Estrogen Improves Memory and Brain Health  Estrogen provides a neuroprotective effect against cognitive decline and dementia  With less estrogen levels in menopause, many (not all) women experience memory loss, mood changes, and sleep issues. health.howstuffworks.com 20

21. Worse Physical Symptoms = Worse Cognitive Symptoms  Women with more hot flashes experience more cognitive deficits  Intensity of menopause symptoms is associated with more memory and attention complaints for longer durations Drogos, et al. Menopause, Vol. 20(12). 2013. www.dailymail.co.uk 21

22. Menopause Effects on Mood and Sleep 60-70% of women have no symptoms; others may have:  More cortisol  Less sleep  More depression Antonijevic, et al. (2003). Psychoneuroendocrinology. 28(3): 401-18.; Baker, et al. (1997). Journal of Psychosomatic Research, 43(4):359-69. Shelbycounselingassociates.org 22

23. Menopause and Sleep Issues: Insomnia  Prevalence of hot flashes correlates with prevalence of insomnia Ohayon, et al. (2006). Arch Intern Med, 166(12):1262-68.  Menopausal women spend significantly longer times awake at night and have lower sleep efficiency Xu, et al. (2011). Sleep Medicine, 12(1);65-9. 23

24. Menopause and Sleep Issues: Sleep Apnea  Increases prevalence of sleep apnea with menopause  Post-menopausal women had significantly higher AHI (worse sleep apnea) compared to pre- menopausal subjects 24 Eichling, et al. (2005). Journal of Clinical Sleep Medicine, 1(3).; Dancey, et al. (2001). CHEST, 120(1): 151-5.

25. Menopause: More Weight Gain and Insulin Resistance 25 Adipose Tissue Obesity Insulin Resistance Menopause J.R. Rettberg, et al. Frontiers in Neuroendocrinology, 35 (2014), 8-30.

26. Is there a solution? 266

27. Hormone Replacement Therapy (HRT)  Women receiving HRT performed better on verbal and visual memory tests  Greater blood flow to the hippocampus after HRT for two years Resnick, et al. (2006). Annals, 949: 203-14. 27 Image source: Foxnews.com

28. Hormone Replacement Therapy J.R. Rettberg, et al. Frontiers in Neuroendocrinology, 35 (2014), 8-30. Adipose Tissue Obesity Insulin Resistance Menopause Hormone Replacement 28

29. Life After Menopause  Complaints of memory impairment decreased post-menopause Hachul, et al. (2009). European Journal of Obsterics & Gynecology and Reproductive Biology, 145(1):81-4.  Those who took estrogen during menopause scored significantly higher on cognitive tests Jacobs, et al. (1998). Neurology, 50(2): 368-73. Huffingtonpost.com 29

30. Hormone Replacement Therapy Risks:  Increased risk of breast cancer  Estrogen-progestin is associated with higher risk than estrogen alone  JAMA. 2000; 283(4): 485-91.  Increased risk of stroke  Elevates CRP levels  BMJ. 2005; 330:342.; JAMA. 2002;288(8):980-7.  HRT should be avoided in women with: -a history of breast cancer or family history of cancer -a history of tendency for blood clots 30

31. Objectives  Why does the brain shrink with aging?  Menopause, hormones, and the brain  What else can be done: Brain Fitness Program 31

32. Brain Fitness Program  A multidisciplinary program devoted to: - Improving memory and brain performance - Enhancing long-term brain health - Reducing risk for dementia, Alzheimer’s disease and stroke in the future  Each patient receives a comprehensive baseline assessment followed by a personalized treatment plan  This program is based on latest research and has shown remarkable results 32

33. Comprehensive Diagnostics to Evaluate Brain Health Customized Treatment Program to Maximize Brain Performance NeurExpand’s Unique Integrative Approach 33

34. Remarkable Results Hippocampus After Before 34

35. 35 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

36. THANK YOU! INFO@NEUREXPAND.COM 36