How stress becomes a post-menopausal Alzheimer’s trigger

There doesn’t seem to be one definitive cause of Alzheimer’s disease.

Some believe genetic makeup is a factor, but the truth is, in less than one percent of people, Alzheimer’s is caused by specific genetic changes that almost guarantee they will develop the disease.

For the rest of us, the answer seems to lie in a combination of genetics, other health conditions and lifestyle and environmental risk factors that impact the brain over time — including sleep patterns, lack of exercise, diet, metabolic syndrome, type 2 diabetes, depression, alcohol and air pollution, to name a few.

But there is one lifestyle-related element that scientists are just beginning to focus on: stress.

A previous study found that having chronic stress or depression more than doubled the risk of Alzheimer’s. And in those who had both chronic stress and depression, the Alzheimer’s risk was four times as high!

This is only one study. But there is more research that indicates the stress connection should be taken seriously — especially for women…

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The role of cortisol in Alzheimer’s

A team of researchers led by The University of Texas Health Science Center at San Antonio (UT Health San Antonio) notes that so-called “sporadic” Alzheimer’s is the leading cause of cognitive decline in older adults. During this prolonged asymptomatic phase, amyloid beta accumulates into amyloid plaques, ultimately leading to progressive cognitive decline.

Unfortunately, these biological changes are already well-established by the time symptoms appear, which is why effective early interventions are needed.

Some investigators have zeroed in on cortisol, also known as the “stress hormone.” Cortisol is necessary for maintaining cellular balance and triggering the stress response, also known as the fight-or-flight response.

But when the release of cortisol in the body becomes chronically elevated, it can cause all kinds of problems.

Some studies have already indicated that higher blood cortisol levels are linked to an increased likelihood of developing Alzheimer’s.

Stress, Alzheimer’s and post-menopausal women

To shed further light on these findings, researchers from the University of Texas Health San Antonio led a comparison of cortisol levels in 305 cognitively unimpaired, middle-aged participants from the Framingham Heart Study. A little under half of the participants were women.

Approximately 15 years later, they assessed the burden of amyloid beta and tau protein using PET scans. This allowed them to investigate cortisol’s impact at an earlier stage in Alzheimer’s development, when interventions might be most effective.

The findings were sobering. The researchers discovered high levels of cortisol in midlife were linked to increased deposits of amyloid in post-menopausal women. No significant associations were observed in men.

The researchers theorized that post-menopausal hormone changes may amplify cortisol’s effects on amyloid buildup. Both estrogen and testosterone have neuroprotective effects that might mitigate cortisol’s negative impact on neural tissues, but levels of both hormones drop dramatically in menopause. This indicates that both stress reduction and hormonal interventions may help prevent Alzheimer’s in at-risk women.

Dr. Arash Salardini, a professor at UT Health San Antonio and first author of the study, adds that follow-up of the study cohort is necessary to determine whether these early amyloid changes translate into clinical symptoms, as well as to clarify the causal role of cortisol in Alzheimer’s development.

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Women and their higher burden of Alzheimer’s

None of this is really surprising. More than two-thirds of people living with Alzheimer’s are women, and hormones have been indicated previously.

But understanding the involvement of yet another hormone, cortisol, gives us one more target to focus on to reduce the odds.

If you’re a woman and you find yourself constantly stressed out, talk to your doctor about testing your cortisol levels. Certain medical conditions, including Cushing’s syndrome, adrenal fatigue, adrenal tumors and pituitary tumors, can cause chronically elevated cortisol levels.

Depression and anxiety have been linked to elevated cortisol levels due to the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates cortisol production. 

 If outside stressors are the problem, lifestyle interventions, like these, may help:

• Yoga. With its emphasis on slow, deliberate movement and breathing, yoga not only helps mellow you out but has also been shown to help build up the brain’s left prefrontal cortex, an area responsible for critical mental functions such as learning and memory.
• Meditation. Research has shown that practicing meditation regularly can increase brain density, boost connections between neurons, decrease symptoms of depression and anxiety, provide clarity of thought and increase positive mood endorphins.
• Emotional regulation. By purposely changing your focus and heading off negative emotions and stress before they arise, you can reduce ruminating — which is linked to cognitive decline and brain aging.
• L-theanine. A 250 to 400 mg dose of this amino acid daily can help lower your cortisol levels and sharpen your focus and attention.

Sources:

Stress can lead to Alzheimer’s disease in women who are post-menopausal, UT Health San Antonio study finds — EurekAlert!

Elevated serum cortisol associated with early-detected increase of brain amyloid deposition in Alzheimer’s disease imaging biomarkers among menopausal women: The Framingham Heart Study — Alzheimer’s & Dementia

Alzheimer’s disease — Mayo Clinic