How menopause affects the brain | Lisa Mosconi

Prevoditelj: Kate Perak Recezent: Sanda L

Women are works of art.

Žene su umjetnička djela.

On the outside as on the inside.

Kako izvana tako i iznutra.

I am a neuroscientist, and I focus on the inside,

Ja sam neuroznanstvenica i usredotočujem se na nutrinu,

especially on women's brains.

posebno na ženski mozak.

There are many theories on how women's brains differ

Postoje brojne teorije o tome kako se ženski mozak

from men's brains,

razlikuje od muškog.

and I've been looking at brains for 20 years

Promatram mozgove već 20 godina

and can guarantee that there is no such thing

i mogu vam jamčiti

as a gendered brain.

da mozak nema spol.

Pink and blue, Barbie and Lego,

Ružičasta i plava, Barbie i Lego kocke,

those are all inventions that have nothing to do

to su sve izumi koji nemaju nikakve veze

with the way our brains are built.

s načinom na koji je izrađen naš mozak.

That said, women's brains differ from men's brains

Ipak, ženski se mozgovi razlikuju od muških

in some respects.

u nekim aspektima.

And I'm here to talk about these differences,

I ovdje ću vam govoriti o tim razlikama

because they actually matter for our health.

jer su jako važne za naše zdravlje.

For example,

Na primjer,

women are more likely than men to be diagnosed with an anxiety disorder

ženama se češće nego muškarcima dijagnosticira anksiozni poremećaj

or depression,

ili depresija,

not to mention headaches and migraines.

a naročito glavobolje i migrene.

But also, at the core of my research,

Također, moje istraživanje pokazuje

women are more likely than men to have Alzheimer's disease.

da su žene sklonije Alzheimerovoj bolesti.

Alzheimer's disease is the most common cause

Alzheimerova bolest najčešći je uzrok demencije

of dementia on the planet,

na svijetu,

affecting close to six million people in the United States alone.

pogađajući blizu šest milijuna ljudi samo u Sjedinjenim Državama.

But almost two thirds of all those people

Ali gotovo dvije trećine tih ljudi

are actually women.

čine žene.

So for every man suffering from Alzheimer's

Na svakog muškarca koji boluje od Alzheimera

there are two women.

postoje dvije žene.

So why is that overall?

Zbog čega je to tako?

Is it age?

Je li u pitanju starost?

Is it lifespan?

Ili životni vijek?

What else could it be?

Što bi drugo moglo biti?

A few years ago,

Prije nekoliko godina

I launched the Women's Brain Initiative

pokrenula sam Inicijativu

at Weill Cornell Medicine in New York City,

na Medicinskom fakultetu u New Yorku

exactly to answer those questions.

da bih mogla odgovoriti na ta pitanja.

And tonight, I'm here with some answers.

I večeras vam nudim neke odgovore.

So it turns out our brains age differently,

Ispostavilo se da naši mozgovi drugačije stare

and menopause plays a key role here for women.

i da menopauza igra ključnu ulogu za žene.

Now most people think of the brain as a kind of black box,

Mnogi ljudi mozak zamišljaju poput crne kutije,

isolated from the rest of the body.

izolirane od ostatka tijela.

But in reality, our brains are in constant interaction

Ali u stvarnosti, naš je mozak u stalnoj interakciji

with the rest of us.

s ostatkom tijela.

And perhaps surprisingly,

Iznenađuje to što je

the interactions with the reproductive system

veza s reproduktivnim sustavom

are crucial for brain aging in women.

ključna za starenje mozga kod žena.

These interactions are mediated by our hormones.

Ovim interakcijama posreduju hormoni.

And we know that hormones differ between the genders.

A znamo da se hormoni razlikuju među spolovima.

Men have more testosterone, women have more estrogens.

Muškarci imaju više testosterona, žene imaju više estrogena.

But what really matters here

A važno je napomenuti

is that these hormones differ in their longevity.

da se ti hormoni razlikuju u svojoj dugovječnosti.

Men's testosterone doesn't run out until late in life,

Muški se testosteroni ne troše do kasne starosti,

which is a slow and pretty much symptom-free process, of course.

što je prilično spor proces bez simptoma, naravno.

(Laughter)

(Smijeh)

Women's estrogens, on the other hand,

S druge strane, ženski estrogeni

start fading in midlife, during menopause,

počinju se gubiti tijekom menopauze,

which is anything but symptom-free.

što svakako nije proces bez simptoma.

We associate menopause with the ovaries,

Menopauzu povezujemo s jajnicima,

but when women say that they're having hot flashes,

ali kada žene kažu da im je iznenada jako vruće,

night sweats, insomnia, memory lapses, depression, anxiety,

da se znoje noću, imaju nesanicu, gubitak pamćenja, depresiju, anksioznost,

those symptoms don't start in the ovaries.

ti simptomi ne započinju u jajnicima.

They start in the brain.

Započinju u mozgu.

Those are neurological symptoms.

To su neurološki simptomi.

We're just not used to thinking about them as such.

Samo nismo naviknuti razmišljati o njima tako.

So why is that?

Zbog čega je to tako?

Why are our brains impacted by menopause?

Zbog čega menopauza utječe na naš mozak?

Well, first of all,

Prije svega,

our brains and ovaries are part of the neuroendocrine system.

naš mozak i jajnici dio su neuroendokrinog sustava.

As part of the system, the brain talks to the ovaries

U tom sustavu mozak razgovara s jajnicima

and the ovaries talk back to the brain,

i jajnici razgovaraju s mozgom,

every day of our lives as women.

svaki dan tijekom života žene.

So the health of the ovaries is linked to the health of the brain.

Stoga je zdravlje jajnika povezano sa zdravljem mozga.

And the other way around.

I obratno.

At the same time,

Istovremeno,

hormones like estrogen are not only involved in reproduction,

hormoni poput estrogena nisu samo uključeni u reprodukciju,

but also in brain function.

već i u funkciju mozga.

And estrogen in particular, or estradiol,

A posebno je estrogen, ili estradiol,

is really key for energy production in the brain.

zaista ključan za proizvodnju energije u mozgu.

At the cellular level,

Na staničnoj razini,

estrogen literally pushes neurons to burn glucose to make energy.

estrogen doslovno gura neurone da sagorijevaju glukozu za energiju.

If your estrogen is high,

Ako vam je razina estrogena visoka,

your brain energy is high.

visoka vam je i razina energije u mozgu.

When your estrogen declines though,

Kad vam opadne razina estrogena,

your neurons start slowing down and age faster.

vaši neuroni počinju usporavati i brže stare.

And studies have shown that this process

Istraživanja su pokazala da taj proces

can even lead to the formation of amyloid plaques,

može dovesti do formacije amiloidnih plakova,

or Alzheimer's plaques,

odnosno Alzheimerovih plakova,

which are a hallmark of Alzheimer's disease.

što je znak Alzheimerove bolesti.

These effects are stronger in specific brain regions,

Ovi su učinci jači u određenim dijelovima mozga,

starting with the hypothalamus,

počevši od hipotalamusa,

which is in charge of regulating body temperature.

koji je odgovoran za regulaciju tjelesne temperature.

When estrogen doesn't activate the hypothalamus correctly,

Kada estrogen ne aktivira pravilno hipotalamus,

the brain cannot regulate body temperature correctly.

mozak ne može pravilno regulirati tjelesnu temperaturu.

So those hot flashes that women get,

Onaj iznenadni osjet vrućine kod žena,

that's the hypothalamus.

to je hipotalamus.

Then there's the brain stem, in charge of sleep and wake.

Postoji i moždano deblo zaduženo za san i budnost.

When estrogen doesn't activate the brain stem correctly,

Kada estrogen ne aktivira pravilno moždano deblo,

we have trouble sleeping.

imamo problema sa spavanjem.

Or it's the amygdala,

Postoji i amigdala,

the emotional center of the brain, close to the hippocampus,

emocionalni centar mozga, u blizini hipokampusa,

the memory center of the brain.

središte mozga za memoriju.

When estrogen levels ebb in these regions,

Kada na tom području opadne razina estrogena,

we start getting mood swings perhaps

počinjemo mijenjati raspoloženje

and forget things.

i zaboravljamo stvari.

So this is the brain anatomy of menopause, if you will.

To je anatomija mozga menopauze, bolje rečeno.

But let me show you

Dopustite da vam pokažem

what an actual woman's brain can look like.

kako zapravo može izgledati ženski mozak.

So this is a kind of brain scan

Ovo je svojevrsna snimka mozga

called positron emission tomography or PET.

nazvana Pozitronska emisijska tomografija ili PET.

It looks at brain energy levels.

Snimljene su energetske razine mozga.

And this is what you want your brain to look like

Željeli biste da vam mozak ovako izgleda

when you're in your 40s.

u četrdesetima.

Really nice and bright.

Lijepo i osvijetljeno.

Now this brain belongs to a woman who was 43 years old

Ovo je snimka mozga žene od 43 godine,

when she was first scanned, before menopause.

pri prvom skeniranju, prije menopauze.

And this is the same brain just eight years later,

A ovo je isti mozak samo osam godina poslije,

after menopause.

nakon menopauze.

If we put them side by side,

Ako ih stavimo jedan pored drugog,

I think you can easily see how the bright yellow

s lakoćom možete vidjeti kako svijetložuta

turned orange, almost purple.

prelazi u narančastu, gotovo ljubičastu.

That's a 30 percent drop in brain energy levels.

Riječ je o padu od 30 % u energetskoj razini mozga.

Now in general,

Na koncu ipak,

this just doesn't seem to happen to a man of the same age.

to se ne događa muškarcu iste dobi.

In our studies with hundreds of people,

U istraživanjima na stotinama ljudi,

we show that middle-aged men usually have high brain energy levels.

pokazujemo kako sredovječni muškarci obično imaju visoku energetsku razinu.

For women, brain energy is usually fine before menopause,

Ženama je energetska razina mozga obično u redu prije menopauze,

but then it gradually declines during the transition.

a zatim postupno opada tijekom prijelaza.

And this was found independent of age.

Pokazalo se da ne ovisi o dobi.

It didn't matter if the women were 40, 50 or 60.

Nije važno imaju li žene 40, 50 ili 60 godina.

What mattered most was that they were in menopause.

Najvažnije je da su u menopauzi.

So of course we need more research to confirm this,

Naravno da trebamo dodatna istraživanja,

but it looks like women's brains in midlife

ali izgleda da je ženski mozak u srednjoj dobi

are more sensitive to hormonal aging

osjetljiviji na hormonsko starenje

than just straight up chronological aging.

nego na uobičajeno kronološko starenje.

And this is important information to have,

A ta nam je informacija vrlo važna

because so many women can feel these changes.

jer jako puno žena osjeća te promjene.

So many of our patients have said to me

Brojne su mi pacijentice rekle

that they feel like their minds are playing tricks on them,

da osjećaju kako se njihov um poigrava njima,

to put it mildly.

najblaže rečeno.

So I really want to validate this, because it's real.

Zaista želim potvrditi tu tezu, jer je stvarna.

And so just to clarify, if this is you,

I da razjasnimo, ako ste vi u pitanju,

you are not crazy.

niste ludi.

(Laughter)

(Smijeh)

(Applause)

(Pljesak)

Thank you.

Hvala.

It's important.

Važno je.

So many women have worried that they might be losing their minds.

Toliko se žena brinulo da možda gubi razum.

But the truth is that your brain might be going through a transition,

Ali istina je da ti mozak možda doživljava prijelaz,

or is going through a transition

ili se to već događa

and needs time and support to adjust.

i potrebno mu je vrijeme za prilagodbu.

Also, if anyone is concerned

Također, ako se itko pita

that middle-aged women might be underperformers,

ostvaruju li žene srednjih godina slabije rezultate,

I'll just quickly add that we looked at cognitive performance,

dodat ću samo da smo provjerili kognitivne sposobnosti.

God forbid, right?

Ne daj Bože, zar ne?

(Laughter)

(Smijeh)

Let's not do that.

Radije ne.

But we looked at cognitive performance,

Provjerili smo kognitivne sposobnosti

and we found absolutely no differences between men and women

i nismo pronašli baš nikakve razlike između muškaraca i žena

before and after menopause.

prije i poslije menopauze.

And other studies confirm this.

I druga istraživanja to potvrđuju.

So basically, we may be tired,

Ukratko, možda smo umorne,

but we are just as sharp.

ali i dalje smo bistre.

(Laughter)

(Smijeh)

Get that out of the way.

To smo zaključili.

That all said,

U svemu tome

there is something else more serious that deserves our attention.

postoji nešto još ozbiljnije što zaslužuje našu pozornost.

If you remember,

Ako se sjećate,

I mentioned that estrogen declines could potentially promote

spomenula sam da opadanje estrogena može potaknuti

the formation of amyloid plaques, or Alzheimer's plaques.

stvaranje amiloidnih plakova, odnosno Alzheimerovih plakova.

But there's another kind of brain scan that looks exactly at those plaques.

Postoji još jedna snimka mozga koja prati upravo te plakove.

And we used it to show that middle-aged men hardly have any,

Koristimo je kako bismo pokazali da ih sredovječni muškarci imaju malo,

which is great.

što je odlično.

But for women,

Ali kod žena,

there's quite a bit of an increase during the transition to menopause.

veliki je porast tijekom prijelaza u menopauzu.

And I want to be really, really clear here

I željela bih biti vrlo, vrlo jasna.

that not all women develop the plaques,

Ne razviju sve žene plakove,

and not all women with the plaques develop dementia.

niti sve žene s plakovima razviju demenciju.

Having the plaques is a risk factor,

Plakovi su rizični faktor,

it is not in any way a diagnosis, especially at this stage.

ni u kojem slučaju nisu dijagnoza, posebno u ovoj fazi.

But still, it's quite an insight

Ipak, prilično je zanimljivo

to associate Alzheimer's with menopause.

povezati Alzheimera s menopauzom.

We think of menopause as belonging to middle age

Smatramo da menopauza pripada srednjoj dobi

and Alzheimer's as belonging to old age.

a Alzheimer starosti.

But in reality,

Ali zapravo,

many studies, including my own work,

brojne su studije, uključujući moj rad,

had shown that Alzheimer's disease starts with negative changes in the brain

pokazale da Alzheimerova bolest započinje s negativnim promjenama u mozgu

years, if not decades, prior to clinical symptoms.

godinama, ako ne i desetljećima prije kliničkih simptoma.

So for women,

Za žene,

it looks like this process starts in midlife,

čini se da taj proces započinje u srednjim godinama,

during menopause.

tijekom menopauze.

Which is important information to have,

Ta nam je informacija važna

because it gives us a time line to start looking for those changes.

jer nam pruža vremenski okvir za početak traženja tih promjena.

So in terms of a time line,

Kada je riječ o vremenskom okviru,

most women go through menopause in their early 50s.

mnoge žene ulaze u menopauzu u ranim pedesetima.

But it can be earlier,

Može biti i ranije,

often because of medical interventions.

najčešće zbog medicinskih intervencija.

And the common example is a hysterectomy and/or an oophorectomy,

Uobičajen je primjer histerektomija i/ili ovariektomija,

which is the surgical removal of the uterus

odnosno kirurško uklanjanje maternice

and/or the ovaries.

i/ili jajnika.

And unfortunately, there is evidence

Nažalost, postoje dokazi

that having the uterus and, more so, the ovaries removed

da je uklanjanje maternice i jajnika

prior to menopause

prije menopauze

correlates with the higher risk of dementia in women.

u uskoj vezi s većim rizikom od demencije kod žena.

And I know that this is upsetting news,

Znam da su ovo uznemirujuće vijesti

and it's definitely depressing news,

i svakako su depresivne,

but we need to talk about it

ali moramo razgovarati o njima

because most women are not aware of this correlation,

jer većina žena nije svjesna ove korelacije,

and it seems like very important information to have.

a riječ je o vrlo važnoj informaciji.

Also, no one is suggesting that women decline these procedures

Nitko ne predlaže da žene odbiju te medicinske postupke

if they need them.

ako su im potrebni.

The point here is that we really need to better understand

Smisao je ovoga bolje razumijevanje

what happens to our brains as we go through menopause,

onoga što se događa s našim mozgom za vrijeme menopauze,

natural or medical,

prirodne ili nametnute,

and how to protect our brains in the process.

i kako zaštititi svoj mozak u procesu.

So how do we do that?

Kako ćemo to učiniti?

How do we protect our brains?

Kako ćemo zaštititi mozak?

Should we take hormones?

Trebamo li uzimati hormone?

That's a fair question, it's a good question.

To je dobro pitanje.

And the shortest possible answer right now

I trenutno je najkraći mogući odgovor

is that hormonal therapy can be helpful

da hormonska terapija može pomoći

to alleviate a number of symptoms, like hot flashes,

ublažiti simptome, poput naleta vrućine,

but it's not currently recommended for dementia prevention.

ali trenutno se ne preporuča za sprječavanje demencije.

And many of us are working on testing different formulations

Mnogi od nas rade na testiranju različitih formula,

and different dosages and different time lines,

različitih doziranja i vremenskih okvira,

and hopefully, all this work will lead to a change in recommendations

i nadamo se da će sav taj trud dovesti do promjena

in the future.

u budućnosti.

Meanwhile, there are other things that we can do today

Za to vrijeme postoje druge stvari koje možemo učiniti danas

to support our hormones and their effects on the brain

kako bismo zaštitili hormone i njihov utjecaj na mozak,

that do not require medications

a koje ne zahtijevaju lijekove,

but do require taking a good look at our lifestyle.

već pomno promatranje vlastitog stila života.

That's because the foods we eat,

Jer hrana koju jedemo,

how much exercise we get,

redovito vježbanje,

how much sleep we get or don't get,

višak ili manjak sna,

how much stress we have in our lives,

stres u svojem životu,

those are all things that can actually impact our hormones --

sve su to stvari koje zaista mogu utjecati na naše hormone --

for better and for worse.

nabolje i nagore.

Food, for example.

Na primjer, hrana.

There are many diets out there,

Postoje brojni načini prehrane,

but studies have shown that the Mediterranean diet in particular

ali istraživanja su pokazala da je posebno mediteranska prehrana

is supportive of women's health.

dobra za žensko zdravlje.

Women on this diet have a much lower risk

Žene ovim načinom prehrane imaju manji rizik

of cognitive decline, of depression,

od kognitivnog pada, depresije,

of heart disease, of stroke and of cancer,

srčanih bolesti, srčanog udara ili raka,

and they also have fewer hot flashes.

a i manje osjećaju nalete vrućine.

What's interesting about this diet

Zanimljivo za ovu prehranu jest

is that it's quite rich in foods that contain estrogens

to što je bogata namirnicama koje sadrže estrogen

in the form of phytoestrogens or estrogens from plants

u obliku fitoestrogena, odnosno biljnih estrogena,

that act like mild estrogens in our bodies.

koji se ponašaju kao blagi estrogeni u našim tijelima.

Some phytoestrogens have been linked to a possible risk of cancer,

Neki se fitoestrogeni povezuju s mogućim rizicima od raka,

but not the ones in this diet, which are safe.

ali ne i oni iz ove prehrane, oni su sigurni.

Especially from flax seeds,

Posebno iz lanenih sjemenki,

sesame seeds, dried apricots,

sezamovih sjemenski, suhih marelica,

legumes and a number of fruits.

mahunarki i voća.

And for some good news,

A dobra je vijest

dark chocolate contains phytoestrogens, too.

da tamna čokolada također sadrži fitoestrogene.

So diet is one way to gain estrogens,

Estrogene možemo dobiti iz prehrane,

but it's just as important to avoid things that suppress our estrogens instead,

ali je jednako važno izbjegavati stvari koje potiskuju naše estrogene,

especially stress.

posebno stres.

Stress can literally steal your estrogens,

Stres vam doslovno krade estrogene,

and that's because cortisol, which is the main stress hormone,

a to je zbog toga što kortizol, glavni hormon stresa,

works in balance with our estrogens.

radi u ravnoteži s našim estrogenom.

So if cortisol goes up, your estrogens go down.

Kad se kortizol podiže, estrogen se spušta.

If cortisol goes down, your estrogens go back up.

Kad se kortizol spušta, estrogen se podiže.

So reducing stress is really important.

Stoga je vrlo važno umanjiti stres.

It doesn't just help your day,

Ne samo da vam uljepšava dan,

it also helps your brain.

već pomaže i vašem mozgu.

So these are just a few things

To su samo neke od stvari

that we can do to support our brains

kojima možemo pomoći mozgu,

and there are more.

ali ima ih još.

But the important thing here

Ovdje je vrlo važno

is that changing the way we understand the female brain

da promjena u načinu razumijevanja ženskog mozga

really changes the way that we care for it,

zbilja mijenja način na koji brinemo o njemu,

and the way that we frame women's health.

i način na koji gradimo žensko zdravlje.

And the more women demand this information,

Što žene više potražuju ove informacije,

the sooner we'll be able to break the taboos around menopause,

prije ćemo razbiti tabue u vezi s menopauzom

and also come up with solutions that actually work,

i pronalaziti rješenja koja djeluju,

not just for Alzheimer's disease,

ne samo za Alzheimerovu bolest,

but for women's brain health as a whole.

već za kompletno žensko zdravlje.

Brain health is women's health.

Zdravlje mozga jest zdravlje žene.

Thank you.

Hvala.

(Applause)

(Pljesak)

Thank you.

Hvala.

Oh, thank you.

Hvala vam.