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So one of the things is intrigued me more recently is I've been hearing about tom dementia with women and that is more prevalent than we first thought.

Could you comment on that?

I can.

So you've used the word prevalence.

I'm talking about dementia in the general sense, which covers off everything that sits under it, leg Alzheimer's and dementia.

So sometimes what we're hearing our is Alzheimer's disease and related dementia.

So dementia is like this kind of big umbrella for you know, kind of a group of symptoms.

And Alzheimer's disease is one of the.

Main cognitive declineate's call it that.

Well, no, because it's different cognitive decline.

I meant that.

So yeah, so is that it's you know, to do a definition.

That's important.

So we have to be really clear precise about what we're talking about.

That's just to be pedantic or else we.

That's why path but that's what a neuroscignist does.

There's a science of this.

So yeah, so we've got dementia is the umbrella term for the symptoms, and Alzheimer's disease is one of the main causes of that.

And it's important because there are other types of deminsions like vascular front of temporal dementia and some of these types of dementia's the prevalence is greater in men than in women.

But overall we tend to focus on out We typically talking about Alzheimer's disease.

And we've got a couple of things here, and bear with me, because we have to get into the stats, and stats aren't even really my jam, but I'll try and be really short and hopefully clear.

So we talk about prevalence, and I like to think about prevalence is like the pool of the people that with a particular disease that everyone's.

Kind of swimming around in.

And so if we look at, say, the prevalence of dementia, and we've got to look at different countries in the world as well, but let's look at, say, in Australia, the prevalence poll of people with dementia, there are more women swimming in the pool of prevalence than men.

We've also got incidence, which is kind of like the inflow, and it's easy to Incidence is inflow, and so we've got people flowing into the pool, which are the new diagnoses of dementia.

And they've also got people dying, which is mortality, which is kind of the outflow.

And so we've got more women in the pool than men.

And is that because more women and the men are flowing into the pool, or are more men flowing out faster, or a woman living longer?

What's the you know what's going on here, And it's kind of all of those things.

The men flow out of the pool faster and younger because typically they are more likely to die off younger and have a health span and a lifespan which are more closely matched.

So typically old men live to a certain age, they may get dementia, and they'll.

Probably die quite quickly.

Just kind of like you want like the shortest gap, the smallest amount of time possible between health span and lifespan.

We basically want to be like Queen Elizabeth.

We want to be working.

We want to meet the prime new prime minister, and then die the next day.

That would be everyone's ideal.

You don't want to have ten years in a nursing home, right, you don't want to do that.

You want to live like the Queen did.

She also had four kids.

She was also very very wealthy.

She did all She's like kind of like the if you had to design a brain health scenario, the Queen would be it.

Socioeconomic privilege being one of the things up there, all of the healthcare in.

The world, et cetera.

So we've got prevalence and incidents.

If we look at incidents in Australia, so we look at people in their seventies and eighties, the inflow of males and females in Australia is kind of similar.

So we've got the same.

Numbers of people in their seventies and eighties flowing into the prevalence pool.

It's not like there's way more women flowing in.

All of a sudden.

All of a sudden, there's similar numbers flowing in.

Of the new diagnoses and diagnosis is also kind of confusing because different people are going to get different diagnosed at different points in their life or different points in the disease process.

Maybe they're in aged care, maybe they're already in hospital, maybe you know, they're still living at home.

So that incidence is also kind of going to be skewed one way or another.

It's only once we get up into our nineties that there's more women flowing in, and then we've got more men have flowed out, more women overall in the pool.

So that and what's interesting is if you look at in different parts of the world, the incidence is the rate of inflow is very, very different.

So if you go to very low income countries, there's way more women flowing in at younger ages into that prevalence pool than men.

So there's even more women floating around in the prevalence pool than there are men, but they're all flowing out at a much younger age than in a healthy wealthy women in Australia, the women are too.

Yeah, so it can't simply be about biological sex if the inflow rate differs in different.

Parts of the world.

And in fact, what we're seeing over time in healthy, wealthy countries is that the inflow is actually slowing Down's more people are living longer, they're not flowing out as quick, but the inflow is slowing down.

And that's because we're getting better at treating a lot of the diseases that cause dementia.

So we're getting better at treating cardiovascular disease, at understanding a lot of the risk fact which cause people to get dementia in the first place.

And were you're talking about all the demensions as.

I'm talking about all dementias.

Now men and are much more likely to get vascular dementias like as a you know, globally because that's typically caused by poor or cardiovascular health.

And historically men have drunk more and more, and you had more stressful jobs, particularly when they were young, particularly like men in the thirties, forties and fifties than now, there was more kind of you know, they had a tougher life.

So we see when we look, we have to like almost take a global perspective and understand incidents and prevalence because if we just go, oh, there's two women and the men and the poor for everyone man, then we we sort of default back to, well, there must be twice as much riskful it is, but we've got to understand and flows and outflows.

Yeah that makes sense.

Yeah, and so it's I'm not very I need to practice saying this is more succinct way.

So then we can sort of start winding back and go, well, what might cause the inflow to be different?

And you know, we know women live longer, that's why there's more of them floating around in the poll.

And what causes women to live longer, We're not entirely sure.

Maybe it's to do with the fact we've got two X chromosomes and males have got one X and y and we've got two x's, and so maybe there are some you know, genes coding for certain factors proteins, and genes code for proteins which may have some kind of knock on effect for health.

And if there's a fault in one of the chromosomes, we've got to back up chromosome.

Men haven't got a back up chromosome, So maybe that accounts for some of the longevity.

Maybe it's to do with the fact that our reproductive lives and all of the estrogen we experience during pregnancy, and then the fact that we've gone through pregnancy in motherhood.

Perhaps there's some resilience built in there that enables us to live for slightly longer.

But the longer we live than the more chance we have of developing Alzheimer's disease.

So there's lots of that's interesting too.

But there's lots of different factors in there.

So there's the longevity factor, there's the X chromosome factor.

But once you get above the age of ninety, there's definitely more women coming.

In, but there might be more nine year old women too.

There are, but if you just are looking at ninety year.

Olds, you're still getting more if you're just looking at the incidents, we're still getting more women.

If we have the same amount of women and same men and men more of those women.

But we're looking at ninety year olds, So what was their lives like ninety years ago?

We've got to look at the It's not just the fact that they It's not like you're just the stationary object who's ninety years old.

You've got a life that you've lived up until that point.

That goes to causation as opposed to correlation.

And I think what they've been to a correlation, not causation, because no one can so, well, how do you live your life.

When you were Yeah, I mean you can kind of look back.

I mean, we've got longitudinal studies and there are ways we can, you know, can look at say what was you know, and there's studies that compare different people living in different states in the US or looking in different countries in the world, what kind of what was the socioeconomic status of the country you grew up in.

What opportunities were there for education and employment and enrichment.

And we see in countries and in states in the US where there's great a genda inequality, there is a greater risk of dementia in those women, and that's because they haven't had the same opportunities for enrichment.

Perhaps they didn't have as many years in education, Perhaps they didn't have the same opportunity for intellectual enrichment and unemployment particularly.

You know, the more inequality there is, the more socioeconomic inequality there is, the more damage that does, particularly to women versus men who have typically got more opportunities in those places.

So there's heaps of different kinds of factors, which lots of variable, Yeah, lots of variables which are adding up.

And I almost think it's like a to imagine, like you've got like those old fashioned scales where you can put the weights on each side, and you see you've got risk factors on one side, you've got protective factors on another, and you're going to try you want it to kind of balance in your favor, but obviously you know it's still balancing on like biology, like you you know, there's somethings that we can't change.

We can't change our you know, our biological sex.

We can't change our age.

But there's risk factors and protective factors, and we know, education is protective potecularly because it's about the kind of enriched experiences that we have during childhood.

So there's a degree.

Of difference between someone who leaves school at age twelve.

Well, my parents leave school at age fifteen, both.

Of them did.

My dad didn't even go to the.

Yeah, versus me.

I have the PhD.

So the degree, you know, I've got like ten or twelve years more formal education than they have.

And we do see across population is that the more years of formal education you've got, that builds cognitive reserve and cognitive resilience in your brain, so that your brain is more resilient to aging.

Let's assume you haven't done something like that.

Let's say you didn't do that between twenty and thirty thirty, whatever it was, but you started at forty.

Yeah.

So we've also got some really interesting data that looks at the type of employment that you're in.

Some data came out at the end of last year.

It's kind of wild.

It looked across all different kinds of jobs that people did, and it was looking to see which and looking to see what kind of job do you do as an adult and what's your risk of developing Alzheimer's disease later in life.

And the most protected, the two most protective jobs were taxi drivers and ambulance drivers.

Serious did serious and they they cover every job like pretty much, they.

Covered every job.

And what they even did was they were like, well, what about if we look at like pilots or train or ship captain who they're looking So they thought, well, it's something to do with driving a vehicle.

But what we think is it's seck.

And so if you think about what and this is not a modern day uber driver with his iPhone, but like a London Cabby say, or an ambulance driver who is constantly having to react and respond and problems solve, and it's very very cognitively and engaging.

And you think about what our brains evolved to do was to navigate and move us through the world.

They didn't evolve really for us to sit on a computer and think about neuroscience.

They evolved.

They evolved so we could navigate and search and seek and find and problem solve.

And that's what brains evolved to do, was to navigate around the world, move this body and navigate it around the world and solve complex problems and that's what they're doing.

Pilots aren't doing this quite the same thing.

They're not navigating through the clouds, they're not having to turn corners and you know.

And so those two professions came out on top, and they even in comparison to other vehicle drivers.

So that's pretty interesting.

Right.

So we're seeing we've got early life education.

By early life, I mean childhood and adolescents.

But then the degree with which you continue to stimulate your brain and your career is again another important way in which we would build up cognitive reserve and kind of keep.

Challenging your brain and using.

It and getting it to do things that you know, as another a little weight on the protection scale.

It's not going to stop you getting Alzheimer's disease, but that's another little weight you can put on the protective side.

On the cognitive reserves.

If you don't mind for just one second, is that in terms of longevity, because if you're cognitive reserve, you got more you know, crudely, you've got more protection against early on set for example, Like you just protection, it doesn't mean it's not going to happen to get more more on the weight as you of your scale.

When people talk about as wet at older, we should sort of take up another language and learn to play music or do something that actually exercised our brain, is probably my point as opposed to retiring and doing nothing.

Definitely is cognitive continuing to build your cognitive reserve or maintaining your cognitive reserve in terms of longevity and life spent health span as well or probably health span bringing more importantly, is that a thing that is a neuroscience like yourself.

Would recommend absolutely?

And what are the sort of things we're talking about, Like we're not going to start driving a cab, but like around London.

Yeah, yeah, I mean that would be great if that's what we all did.

Anything that challenges you in multiple ways, not just it's not just enough to do sudoka well, not just enough to do cross with its like do them and and also do other.

Things and for easion, what else, So that if I can.

Do things which are which engage your brain with other people and perhaps enable you to move so I mean I physically.

Yeah, my my.

When I wrote the first my first first round of the Women's Brain Book, I kind of got to the end of that and I said, oh my goodness, I've spent a whole year sitting at home by myself, at my desk, doing nothing with my dog, kind of worrying about what other people think about what I've written.

So it wasn't a very good recipe for brain health.

And I thought, I want to do the exact opposite of this, And luckily the suburb I live up in the Northern Beaches had just started a musical theater group.

Now I cannot sing, nor can I dance, but I do like, don't mind being on stage.

I like a bit of a lecture, and so I joined that because that was the exact opposite I was like with other people.

I was singing and dart well, I'm lip syncing and learning to dance, interacting and engaging and learning something new with people.

It was the complete opposite of sitting at home writing a book.

And it is just so fun and funny and such a joy to be engaged with that group of people.

So there's things like that that we can do, but not everyone's going to want to go and do music theater.

I've got a book club for a while, we become a walking book club because actually what we were doing most of the time was sitting around talking about what the house up the road went for what price, you know, and it isn't that ridiculous, and then drinking too much wine and eating all the cheese, And then we thought we'd need to be a little bit healthier.

So then we started training for the bloody long walks up and down the Northern Beaches so we would become a walking book club.

So we still talked about house prices, but we were walking at the same time.

So finding ways to kind of challenge yourself and engage yourself that it is fun and involves other people, I think is part of that.

Most people who were still working and aren't retired are typically probably already doing enough.

I think that there's a tendency for people who are perhaps and this is perhaps what people were thinking ten years ago, you know, when like brain training, computerized brain training was a really big thing.

So people were like working all day in office and then rushing home and they're sitting at the computer and doing Lamosity brain training at night.

The biggest waste of time ever, what they should have been doing was going outside and you know, playing pickleball or football or going for a surf or whatever doing something physically inactive, and the more engaging and fun and social the physical activity is.

As well, the social part of is import I.

Think the social part of it's incredibly important.

Yeah, we can you know, you can do it by yourself, but I think the tendency to do things is more when you're doing it with other people.

And one of the most complicated things that we can do as a human with a brain is interact socially with others.

And like we talked about pregnancy, right, the parts of the brain that change during puberty and during pregnancy are involved with social interactions.

Like that's what the brain is prioritized is to be most important to change during pregnancy as the social brain, because that's kind of what our brain is.

It's a social law.

It's there to interact and engage with other members of our species.

How would you what would you say if And it's a bit out there, but a way of engaging your social brain is to start talking to AI.

I mean, like, U use I love a bit of chat GPT chat.

Yeah, well I'm serious, like because the way it talks to you these days and you can talk back to it nicely.

And yeah, I mean it's not studies on this yet.

You're not really interacting with another person.

So what does that mean.

Interact face to face if we and like that kind of I'm taking social cues from the social cues and we've got you know, there's all of this research which looks at human brains and looks like bio behavior or synchrony.

So when we're interacting with other people, our biology can you heart rates can be similar, our hormone levels can be similar, our breathing rates can be similar.

We might start moving our bodies in the same way.

And when we even move our bodies in the same way, like say we're dancing, Armies have been getting people to march for millennia because they know that that and answers that feeling of I am part of something bigger than me, like it enhances in group synchrony.

And we also know that our brains start to synchronize as well, our brain waves.

If we were to measure people's brain waves, they're synchronized when they are harmonizing and when they're on the same wavelength as other people.

And that's incredibly powerful tool to encourage us because it feels really good as well, you know, when you're in sync with someone and you're on the same wavelength and you're having a really good conversation or interaction, it feels really good and we want to do more of that.

When you meet someone and you know, you just like don't hit it off, and you can't kind of you know, like it's just weird you don't, yeah, which is a very different experience from when you just click with someone straight away, and it feels very rewarding and engaging and you want to do more and more and more.

And so we've got this kind of drive to connect with other with other people, and we are social creatures.

We need If we are socially isolated, we are lonely.

Well, that's incredibly damaging for brain health.

We know how bad it is for mental health.

It doesn't matter what age you are.

But you're a newborn baby, a teenager, and an isolated new mother.

You know, you're middle age, and you've got no mates.

You're in a nursing home all by yourself, and you had this engaged social life and now you're sitting in a nursing home.

No oney becomes and visits you.

I mean, that's like heartbreaking.

If you think about someone who's had an amazing life and then they're alone.

You know, it doesn't matter which stage we're at.

That's one of the main things that our brain needs.

As soon as we don't have that, our risk for all kinds of issues increases mental health, poor overall health, longevity, health span.

Which is one of the reason why Alzheimers as formal dimentia can be sort of sort of fairly fatal because probably as I understand, people go, we're into an isolation process because they don't really know what they're doing, and there's sort of a lot of times you get put in a home or something like that no one wants to visit because they get people get confronted.

It's really hard if someone that does have Alzheimer's because you know, you all kinds of behavioral and personality.

Changes and people avoid them.

Yeah, absolutely, which is sad.

And we know that social isolation as well as a risk factor for dementia and some of the other can cause it.

Yeah, it's also a risk factive.

So you know, we're talking about the scales like on your risk side as loneliness of social isolation, and that's probably one because of the need for a brain to interact and engage socially, but too maybe the pragmatics of getting to health appointments or eating well or having someone help you, you know, get dressed and be healthy and you know, get out the door and exercise and all of the kinds of things that we need we need to do.

And we also know a couple of the other very very sort of weighty risk factors for dementia and Alzheimer's disease, one which is no one ever talks about, which is because it's very unseexy as hearing loss at midlife.

It's about seven percent of cases of Alzheimer's disease globally, and partly that is because of the social isolation that comes as a consequence of having untreated hearing loss because you're not interacting and engaging you withdraw.

It's not the fact that your brain isn't I mean, your brain isn't getting that stimulus which it needs, but it's also the fact that you're what you're not doing as a consequence of untreated hearing loss.

So again that's got that knock on social effect.

So catch twenty two.

It just keeps repeating on Itah, yeah, yeah, And there's so much.

For some people, there's a real stigma about wearing hearing aids, although I think that's changing because there's so much smaller that people can't see them.

So again, so that's another that's a risk factor.

And then in late.

Life vision losses as well, because again we are incredibly we get so much interaction throughout what we see.

So much of our brain is taken up with visual processing, reading other people's social cues, but reading books and just seeing what's going on in the world, the rising and the setting of the sun, every aspect is visual for us, and we lose that sensory input.

So again the brain is just kind of shutting down one of the inputs, and that's an increased risk as well, one of the one of the weights we put on that risk side of the scale.

I can I just talk something about talk about could you talk about it more importantly a topic you know, I know nothing about it or I don't know very little about other than some observations and the changes in a female during the menopause period, and or probably more importantly, let's start with perimenopause.

What does that mean and what what are the what happens to a woman during this process.

Yeah, I'm saying, gosh, it's a big topic.

So so because I can be so long winded, I need to really be more succinct.

I'm going to try and be more succinct to us.

We'll be here for like five hours.

Let's talk about perimenopause first.

Perry menopause first.

So well, so starting with puberty, because we've got to kind of go back to puberty until we can come We've got to start at the beginning before we can come to the end.

Puberty starts in your brain sort of turns the over is on, and then every month you've got this, like for most women, every month or so, you've got this like cycle where you ovulate and if you don't become pregnant, the egg dies, and you've got these kind of hormones which are released from your ovaries.

First of all estrogen around ovulation, and then during the low tail phase, if the eggs are ovulated, you get this kind of rise and then full of progesterone, and then that kind of happens every month.

But those hormones are in conversation with your brain because hormones are molecules that get released into the blood, they travel around the body, they make their way into the brain and they latch onto receptors on cells and have knock on effects.

And so the brain and the ovaries have been in conversation every month throughout your reproductive life, unless you were on the pel in which you have higher levels of synthetic hormones and you flatline your natural hormones.

And that's a.

Great foot source of contraception and has lots of actually positive impacts on the brain for some woman, and other women may have negative impacts.

We can talk about that later.

Or you're pregnant, right, you don't have that same site clink when your eggs start getting old.

So it's the eggs the ovaries that then drive the end of that conversation.

Brain started it when sometime in your forties for most women, very rarely for someone in their thirties, but typically in your sort of early mid late forties, eggs start to get a bit old.

That's what it's harder to get pregnant, and that conversation gets a little less reliable between the hormone that the ovaries in the brain, and so one month, the ovaries may not release much estrogen and the brain the hypothalamus and the brain is like waiting for that signal and it's kind of going, I can't hear anything, like make more, and the ovaries go okay.

So the next month they might make way too, and the brain's going not and not that much and the ovaries go okay.

So there's this kind of weird, sort of roller coaster two moons.

It's very volatile, and for someonoman that volatility could last for two months, some woman that could last for two years.

It could last, you know, for varying amounts of.

Time you call perimenotoporse.

We would call this perimenopause, So that's the months and years leading up to the final menstrual period, and then we would say that a woman is in menopause when she hasn't had a period for twelve months, right, So up until that point you're in perimenopause and then you're in menopause.

So they're quite different physiological states.

And one of the kind of the hallmarks of perimenopause is your periods get shorter and heavier, or they and then they start getting longer, and then they fade away altogether.

But in that time you've got this massive hormonal flux.

It's not that the estrogen's just dribbling away.

It's sometimes it's really high and sometimes it's really low and chaotic.

And that's why he is responding to what the brain message from the brain, and the brain's responding to the message from.

The Everything is in as a feedback loop.

So it's this conversation where they're shouting at each other and whispering and they're all over the place, and then eventually it all stops and then everything flatlines.

This is all HRT aside.

So what is happening is our body and our brain is responding to these changing levels of hormones.

And not only are is the brain saying hey to the overs I can't hear you too much, not enough.

The brain is also responding to those changing levels.

Now, what we understand most well is the role that the changing the levels of a varian hormones play.

And one of the most common symptoms, which is hot flashes or vasomotor symptoms.

So hot flashes during the day when you get really really hot and sweaty, or at night when you're asleep, and it's even worse because typically you're under your covers and then you're hot and sweat.

So we know that in the brain is the hypothalamus, which is the part of the brain that's you know, it's getting signals about hormone levels, but body temperature, and you know, have you eaten, You know what's your blood pressure, you know what's your heart rate, et cetera.

It's all those basic biological body functions.

And there's like a thermostat and your hypothalamus with a top level and a bottom level.

You've got one, I've got one.

Everyone's got one for some reason, not entirely sure why.

And women the levels of that thermostat can be tweaked by estrogen, and when the levels start kind of going all over the place, the neurons that are responsible for that don't function in the way that they should, and the thermostat kind of goes a bit narrower.

The bottom can go up so someone can get more susceptible to cold, and the top goes down.

So normally what happens when your body temperature gets too hot and it hits the top level of the thermostat, and you and me and everyone of every age, then you behave in a way to cool down your First there's a physiological response.

So when you're really hot, you get you start to flush, so your body's trying to dissipate heat through your skin, so you get red, your blood vessels dilate, and you're so sweat because it helps that cooling process is the sweet evaporates, and then you might behave in a way where you start going, oh, gosh, i'm a bit hot, I'll take my jacket off whatever, and the opposite when you're cold.

But when you're going through perimenopause and that level has gone down, your body temperature doesn't need to rise very much before it hits that top level, and then your hypothalamus is like wow, panic stations, it's.

Hot in here.

We need to cool down quick.

And it has this almost like a panicked response, So you get this massive, like rapid heat dissipation and sweating.

So women just suddenly get this big like kind of heat all through them and you can feel it all the way down through your legs.

It's because part of that's a sympathetic nervous system response, whereby your sympathetic nervous system is dilating your blood vessels and it's also sending a signal to your adrenal glands and your kidneys to release adrenaline to facilitate that kind of process as well.

So we know that that is set by estrogen because with the hormone replacement therapy or menopause hormone therapy, when you put it back in, the thermostack rises and you become that sensitivity is gone.

So because you can reach is it because the hot temperature the top has gone back up.

Goes back up?

Kind of you've got more range in which you can function normally like how you world or how a teenager world or you know you do when you're you know, young years and we see different that thermostat being tweaked, like particularly postpart when when you're breastfeeding, that thermostat a is tweaked and you get like you can get really really sweaty like when you're breastfeeding because that thermostat is being tweaked.

So we do know it's hormone sensitive.

When you say you get more hormones is because you've got much more estrogen in your system when you're breatfeeding.

For YOUA, no, you've got less estrogen.

You've come off the highs of estrogen that you had when you're pregnant and it's gone down, you're almost kind of withdrawing from estrogen.

So it's more so to do with when you've got the less estrogen.

But through perimenopause you've got this kind of roller coastering, so it's coming and going, so the system's not kind of getting to the point where it can reset yet because it's going up and down.

And up and down.

It's not like it's flat line.

And typically then once estrogen levels flat line, then over time and I don't know why it takes so long, and someone and it can last for seven years, this sort of vasomotors symptoms.

It'd be nice if the brain said a bit quicker, but for some reason it's not.

Once the brain kind of weans off estrogen and gets used to its new state, then the thermostash doesn't require it kind of resets without the estrogen.

But what you can do is use estrogen in the meantime because or else you could have seven years of up to seven years in some woman of these vasomotors symptoms hit, you're putting the hormones back in the knock on effects of I am this is with all these chicken and egg scenarios, and all of this arguing and debating about whether any of the other symptoms that we see as a result of perimenopause, the roller coastering and then the flat line after menopause, things like what we would call brain women describe as brain fog, women just saying they're more feel more vulnerable to anxiety and depression and other kind of emotion emotional instability, just feeling irritable.

Whether that is a direct result of the hormones on the brain or whether it's some knock on effect of the vasomotor problems, and particular how they disrupt sleep.

I'm slightly in the camp of because sleep is just so fundamentally important, and I know that thermoregulation and sleep are really intimately entwined, So we know that hot flashes disrupt sleep significantly.

You could have like ten hot flashes or night sweets overnight and wake up seventy five percent of the time.

And if you're not a I'm a good sleeper, I hope sound like makes me sound like I'm talking about a baby.

But if you're someone who sleeps really well, you may just wake up and go back to sleep.

But papes, you're someone who's always suffered from you know, you're not a good sleeper.

You heave insomnia.

You could wake up once and never get back to sleep.

So if you're having your sleep disrupted by waking up because you're sweating and you have to throw the covers off to cool down, night after night, week after week, month, year, you know, of course, inevitably, almost without question, you're going to be more emotionally unstable.

You're going to feel foggy, your memory is going to be impacted.

You're just not going to feel like yourself.

You're not going to be able to run, you know, as a human the way that you used to.

We've also got women who perhaps aren't necessarily waking up and knowing it at night.

We've got you know, if you are familiar with the idea of when you go to sleep, you go through all these different stages of sleep.

We've got what we call sleep architecture.

We've got quite a nice pattern of sleep architecture ideally that we'd want.

And if you've got like a you know, a tells you, you know, it's going to tell you all that.

You can look at all of that and you see how much deep sleep et cetera.

That's very closely tied up with body temperature, and if your thermoregulation isn't well controlled, that's going to be disrupting sleep architecture.

Even if you're not waking up, you're not going to be going through those nice patterns, it's going to be disrupted.

So even if you're not waking up and knowing it, it's still disrupted.

And so that's perhaps going to have knock on effects.

You might be waking up, but your mind to be having enough sleep.

Or all those all of those different levels of sleep that you you should be getting, So then it's almost inevitable that you're going to perhaps suffer with being able to regulate your emotions and so you feel moody and irritable, You're going to be feeling, you know, foggy and forget.

And then there's another aspect to all of this.

Which is not very well explored, but I'm very interested in and I know there's a couple of research labs, one of them in Santiago and Chalet is looking at this, looking at the role of that sympathetic activation that when you're you know, your bodies, your brain is desperately trying to cool this body down that's asleep under all of these covers, and to do that, you know you have to the vasodilation and the sweating, but then you also get this kind of adrenaline burst which kind of wakes you up to throw the covers off because you have to behave in a way similarly to what we see with people with sleep apnea when they kind of and then they wake up with a start, you get this sort of sympathetic activation.

And when you repeatedly activate your sympathetic nervous system, one, it stresses your cardiovascular system, which has not on negative effects on your health, but two, you become a bit more You've got more sympathetic activation and less parasympathetic activation.

So maybe heart rate variabilities scores are much lower, and we know that women going through menopause and the few studies that have been done have more sympathetic activation that's kind of tilted more towards sympathetic activation than parasympathy.

HIV might be low, lower than what you might ideally expect, and that has this really interesting knock on effect whereby if you're constantly you're slightly you're more sympathetic, you're more hypervigilant.

You're wide and you're tired, and that feels very disruptive to your body, and that feels like anxiety.

And that's almost like there's a biological underpinning there to women feeling I'm wide and tired and I'm worried.

You have a nervous system which is hypervigilant.

Your brain just starts to fill in the gaps if you're kind of feeling and you know, people, if you I don't know whether you drink.

I sometimes drink fashy much, but it's kind of fun too.

But you know, you wake up the next day and you've got like that anxiety.

Yeah, you've got that having over anxiety.

Well you're bright.

You start like, oh my god, what did I do last night?

Did I say?

Because your brain's starting to fill in the gaps, going why does my body feel anxious?

There must have been something I said or did, and so your brain starts to fill in gaps.

So it's almost like you have this generalized low level hypervigilance or anxiety.

And so then your brain starts trying to find something to worry about.

And if you're like fifty, you've probably got teenagers.

You've probably got older parents.

There's plenty things that you can lie there and worry about, Like, it doesn't take long to find to find something to think about to fill in that game in the middle of the night, Yeah, wake up in the middle of the night or even during the day.

So you've got this kind of almost anxiou nervous system.

That's because you've had this constant sympathetic activation from all of the hot flashes.

And that's why some women's first symptoms that they start to report are feeling more anxious and worried.

Yeah, we're not even padic, just like low level kind of worry.

It's almost like you just get to the certain age and you just everything's just feel worried all of the time.

And lots of women would relate to that, and it may be that it is simply due to the sort of the sympathetic activation of your brain trying to cool your body down.

And creating hypervigilance.

Well, yeah, that's the word I'm using for like that kind of sympathetic activation.

I don't really like using the word fight and flight, because sympathetic.

You know, your parasympathetic and sympathetic nervous systems work kind of in a seesaw.

They aren't only on or off when you're in fight or flight.

I mean, your sympathetic nervous system activates to raise your heart before you stand up so you don't faint.

That's not vit or flight.

That's just at an extreme level.

So there may be that may underlie some feelings of anxiety as well.

So there's a whole host of brain body changes that are going on here that we don't and this is you know, we're just beginning to kind of explore and understand what is happening at this point in the life span.

But I think sometimes there's some really interesting physiology that might help women understand a little bit more about why they think, or feel or behave in a certain way.

And if we.

Understand that, it feels less catastrophic, it feels less scary, it feels less Oh it's just me, my husband saying, why are you worrying all the time?

You know it's there's there's a real reason behind that.

And then what are all the things we can do to support our brain and our body and a system.

How does HI meanly is it to you know, the magic pill, so to speak.

I don't think it is for everything and everyone.

But we know it's very good for treating eating vasomotor symptoms because it resets the thermostat.

And if.

I suspect, if you start with the HRT, if you want to and you haven't got respectors, and you've decided it's the right thing, earlier rather than later, less of the Perhaps the brain fog, the anxiety, the depression, the insomnia may become less embedded because once you start getting waking at night constantly, then that can turn into insomnia, which can be reinforced psychologically, and somnia reinforces insomnia.

But if you kind of treat the waking up at night before it turns into something more.

The thing is, we know estrogen works really well to treat the vasomotor symptoms, but we don't have as good as evidence to say every woman that experiences depression needs to be on HIT, everyone with anxiety needs to be, every woman with brain fog needs to be because I think there's the fee back loops and the ecosystem in which we're existing is more complicated than that.

Sarah, can I ask you three questions, like just quick one some what are the top three things that protect our brain as we age.

Gosh, I think sleep, which is hard for some people to come by, but if we can work towards protecting our sleep social connection, I don't think that matters what age we are, that connecting with other people is fundamentally important.

And then I don't know whether you'd find this in the literature, but I sometimes feel like health and wellbeing has got a little bit pious and it's not much fun anymore, and I think we all need like a little bit of a sense of humor and some joy.

And that's really interesting.

Don't take you too seriously.

Yeah, My second question is what's the one thing you wish everyone knew about their brain that I think.

In particular when it comes to the female brain, let's not start from the point that it is broken and we always need to be explaining dysfunction and disregulation and emotional instability and decline.

That brains are flexible and adaptive and responsive across the life span, and the more we can do to support them instead of assuming that there is something wrong, the better off will be brother.

And what's the secret to a long health span?

I guess we're talking about brain wise.

Yeah, I think I think I mean to be completely honest, having a good socioeconomic start to life is probably one of the keys.

And that's not something each of us individually can work towards.

That's kind of a more of a social problem.

But I think throughout the lifespan, social infrastructure, social architecture, the relationships that we have around us, you know, the key indicator in terms of brain health outcomes.

We just covered so much as crazy no no, no, no, no, no, no.

Actually, I want to think because we've actually spoken for a lot longer than I expected we would do, and you was some huge topics, huge topics, and I really appreciate the sort of I know you're your insights and come up the back of all your research in all years doing it.

So let me just say that I am not the researcher.

I'm the science.

But you really indicated I've yet and so much of the work that I have done is because of all of the other sciences, and most of them are women who have done all of the research and I'm just translating their work.

But that's important, which is important.

Yeah, So when I when I say research, I'm not the one at the cold face meeting with the patients working with the rats crunching the numbers.

I'm just translating.

I'm bringing it out into the world.

So I have to thank them for the work that they've done.

Yeah, but sir, they have to thank you for putting their work into the book relationship because, like to be honest with you, that research at an academic level sort of sits in medical publications and a lot of times ever reaches normal people.

There's a few, yeah, and there's a few.

There's a few really good researchers out there, but a lot of them are too busy as well to be doing the translation the science communications.

And I'm just lucky I get to kind of sit in the middle.

But you're bringing it to light.

I mean, I think you know all the research.

Like like you said it, a lot of you said it earlier, a lot early, right in the very beginning.

Sometimes as an academic and as a researcher, you tend to get into such a small space.

You're an expert on nothing.

You're you're you're an expert on something really really really important, but.

You can't connect the dots correct And that's what I love is being able to look that's what I missed and what I get to do now that's the big picture and the concepts and to be able to and that comes with an aging brain as well as that ability to you know, connect the dots between ideas.

That's what wisdom is, that's what experiences and we just to like bring it back to brain health.

Right.

We valorize being able to remember all of the names and all of the dates and the quick, short, sharp thinking, you know, the bang bang bang that we could do in our twenties, and when we can't do that with the same speed as we used to be able to, we feel like we've lost something.

But I think that a midlife brain and an aging brain, you know, we start to see integration between ideas and literally the brain networks start to integrate together.

More as we get older build the whole story.

Yeah, and that's what I feel like.

I'm kind of at the point in my career of being able to do, but like I have to credit the people who have done the work, and we need.

To fund them more.

Yeah.

I have dealt with that.

They need the money.

This world from a remote point of view, but I'm actually involved in this world, and you're right, more funding for those people who are going to help us ultimately live a longer or better life or a more aware life, more aware life, or more educated life.

And I really want to thank you, doctor Sarah Makai for actually being an educator of us and by virtue of these books.

And I'm hopefully going to live give these books behind because I'm definitely going to give this to my son and my daughter in law because the baby is due on the.

Fifth of September.

That's exciting, so I'm looking forward to doctor Seremic.

I thanks very much.

You