How menopause affects the brain | Lisa Mosconi

Prevodilac: Milana Popara Lektor: Milenka Okuka

Women are works of art.

Žene su umetnička dela.

On the outside as on the inside.

Kako spolja, tako i iznutra.

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

Ja sam neuronaučnica, i bavim se unutrašnjošću,

especially on women's brains.

pogotovo mozgovima žena.

There are many theories on how women's brains differ

Postoji mnoštvo teorija o tome kako se mozgovi žena razlikuju

from men's brains,

od mozgova muškaraca,

and I've been looking at brains for 20 years

i ja sam se bavim mozgovima 20 godina

and can guarantee that there is no such thing

i mogu da vam garantujem da ne postoje

as a gendered brain.

muški i ženski mozak.

Pink and blue, Barbie and Lego,

Roze i plavo, barbika i lego kocke,

those are all inventions that have nothing to do

ovo su sve izumi koji nemaju nikakve veze

with the way our brains are built.

sa načinom na koji je naš mozak izgrađen.

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

Ipak, mozgovi žena se razlikuju od mozgova muškaraca

in some respects.

u određenim aspektima.

And I'm here to talk about these differences,

I ja sam ovde kako bih pričala o tim razlikama,

because they actually matter for our health.

jer one zapravo imaju uticaj na naše zdravlje.

For example,

Na primer,

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

žene su sklonije od muškarca dijagnozi anksioznog poremećaja

or depression,

ili depresije,

not to mention headaches and migraines.

a da ne pominjemo glavobolje i migrene.

But also, at the core of my research,

Takođe, u srži mog istraživanja,

žene su sklonije od muškaraca da obole od Alchajmerove bolesti.

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

Alzheimer's disease is the most common cause

Alchajmerova bolest je najčešći uzrok demencije na planeti,

of dementia on the planet,

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

i pogađa skoro šest miliona ljudi samo u SAD-u.

But almost two thirds of all those people

Ali skoro dve trećine svih tih ljudi

are actually women.

su zapravo žene.

So for every man suffering from Alzheimer's

Dakle, na svakog muškarca koji pati od Alchajmerove bolesti

there are two women.

dolaze dve žene.

So why is that overall?

Zbog čega je to tako?

Is it age?

Da li je u pitanju starosna dob?

Is it lifespan?

Ili životni vek?

What else could it be?

Šta bi još mogao biti razlog?

A few years ago,

Pre nekoliko godina pokrenula sam inicijativu posvećenu mozgovima žena

I launched the Women's Brain Initiative

at Weill Cornell Medicine in New York City,

u medicinskom centru Vejl Kornel u Njujorku,

exactly to answer those questions.

upravo sa ciljem da nađem odgovore na ova pitanja.

And tonight, I'm here with some answers.

I večeras, donosim vam neke od odgovora.

So it turns out our brains age differently,

Ispada da naši mozgovi stare na različite načine,

and menopause plays a key role here for women.

a menopauza igra ključnu ulogu za žene.

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

Mnogi vide mozak kao crnu kutiju,

isolated from the rest of the body.

izolovanu od ostatka tela.

But in reality, our brains are in constant interaction

Ali u realnosti, naši mozgovi su u stalnoj interakciji

with the rest of us.

sa ostatkom našeg tela.

And perhaps surprisingly,

I možda zvuči iznenađujuće,

the interactions with the reproductive system

ali interakcije sa reproduktivnim sistemom

are crucial for brain aging in women.

su ključne za starenje mozga kod žena.

These interactions are mediated by our hormones.

Naši hormoni posreduju u ovim interakcijama.

And we know that hormones differ between the genders.

A znamo da se hormoni razlikuju kod polova.

Men have more testosterone, women have more estrogens.

Muškarci imaju više testosterona, žene imaju više estrogena.

But what really matters here

Ali ono što je zapravo važno

is that these hormones differ in their longevity.

jeste da se ovi hormoni razlikuju po njihovoj dugotrajnosti.

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

Testosteron kod muškaraca ne istekne do kasne dobi,

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

što je spor proces, i prilično bez simptoma, naravno.

(Laughter)

(Smeh)

Women's estrogens, on the other hand,

Estrogen kog žena, sa druge strane,

start fading in midlife, during menopause,

počinje da nestaje u srednjem dobu, tokom menopauze,

which is anything but symptom-free.

a to je sve samo ne proces bez simptoma.

We associate menopause with the ovaries,

Obično asociramo menopauzu sa jajnicima,

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

ali kada žene kažu da imaju napade vrućine,

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

noćna preznojavanja, insomniju, gubitke memorije, depresiju, nervozu,

those symptoms don't start in the ovaries.

ovi simptomi ne počinju u jajnicima.

They start in the brain.

Oni počinju u mozgu.

Those are neurological symptoms.

Ovo su neurološki simptomi.

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

Mi samo nismo navikli da o njima razmišljamo na taj način.

So why is that?

Zašto je to tako?

Why are our brains impacted by menopause?

Zašto su naši mozgovi pod uticajem menopauze?

Well, first of all,

Pre svega,

our brains and ovaries are part of the neuroendocrine system.

naši mozgovi i jajnici su deo neuroendokrinog sistema.

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

Kao deo sistema, mozak komunicira sa jajnicima

and the ovaries talk back to the brain,

i jajnici komuniciraju sa mozgom,

every day of our lives as women.

svakog dana u životu žena.

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

Prema tome, zdravlje jajnika je povezano sa zdravljem mozga.

And the other way around.

I obrnuto.

At the same time,

U isto vreme,

hormones like estrogen are not only involved in reproduction,

hormoni poput estrogena nisu samo uključeni u procese oplodnje,

but also in brain function.

već i u moždane funkcije.

A posebno estrogen, odnosno estradiol,

And estrogen in particular, or estradiol,

is really key for energy production in the brain.

od ključne je važnosti za proizvodnju energije u mozgu.

At the cellular level,

Na ćelijskom nivou,

estrogen literally pushes neurons to burn glucose to make energy.

estrogen bukvalno tera neurone da troše glukozu sa ciljem proizvodnje energije.

If your estrogen is high,

Ako vam je estrogen visok,

your brain energy is high.

i količina energije u mozgu je visoka.

When your estrogen declines though,

Kada količina estrogena krene da opada,

your neurons start slowing down and age faster.

vaši neuroni počnu da usporavaju i da stare brže.

And studies have shown that this process

Studije su pokazale da ovaj proces

can even lead to the formation of amyloid plaques,

čak može da dovede do formiranja amiloidnog plaka,

or Alzheimer's plaques,

odnosno Alchajmerovog plaka,

which are a hallmark of Alzheimer's disease.

što je zaštitni znak Alchajmerove bolesti.

These effects are stronger in specific brain regions,

Ovi efekti su jače izraženi u određenim delovima mozga,

starting with the hypothalamus,

počev od hipotalamusa,

which is in charge of regulating body temperature.

koji je zadužen za regulaciju telesne temperature.

When estrogen doesn't activate the hypothalamus correctly,

Kada estrogen ne aktivira hipotalamus na ispravan način,

the brain cannot regulate body temperature correctly.

mozak nije u stanju da kontroliše telesnu temperaturu kako treba.

So those hot flashes that women get,

Te su stoga napadi vrućine koje žene imaju,

that's the hypothalamus.

to je hipotalamus u pitanju.

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

Zatim, tu je i moždano stablo, koje je zaduženo za spavanje i buđenje.

When estrogen doesn't activate the brain stem correctly,

Kada estrogen ne aktivira moždano stablo kako treba,

we have trouble sleeping.

imamo problem sa spavanjem.

Or it's the amygdala,

Ili je u pitanju amigdala,

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

emotivni centar mozga, u blizini hipokampusa,

the memory center of the brain.

centra za pamćenje u mozgu.

When estrogen levels ebb in these regions,

Kada nivo estrogena opadne u ovim delovima,

we start getting mood swings perhaps

može da uzrokuje promene raspoloženja i zaboravljanje stvari.

and forget things.

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

To je anatomija mozga u toku menopauze, moglo bi se reći.

Dopustite mi da vam pokažem kako zapravo izgleda mozak žena.

But let me show you

what an actual woman's brain can look like.

So this is a kind of brain scan

Ovo je primer moždanog skena

koji se zove pozitronska emisiona tomografija, odnosno PET.

called positron emission tomography or PET.

It looks at brain energy levels.

Daje prikaz energetskih nivoa mozga.

And this is what you want your brain to look like

Ovo je kako biste želeli da vaš mozak izgleda

when you're in your 40s.

kada ste u četrdesetim.

Really nice and bright.

Veoma lep i svetao.

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

E sada, ovaj mozak pripada ženi koja je bila stara 43 godine

when she was first scanned, before menopause.

kada je po prvi put skenirana, pre menopauze.

And this is the same brain just eight years later,

A ovo je isti taj mozak nakon samo osam godina,

after menopause.

po završetku menopauze.

If we put them side by side,

Ako ih stavimo jedan do drugog,

I think you can easily see how the bright yellow

mislim da lako možete uočiti kako se svetložuta boja

pretvorila u narandžastu, skoro pa ljubičastu boju.

turned orange, almost purple.

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

To predstavlja energetski pad u mozgu od 30%.

Now in general,

Generalno gledano,

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

ovo se ne dešava kod muškaraca iste dobi.

In our studies with hundreds of people,

U našoj studiji, koja obuhvata stotine ljudi,

pokazali smo da muškarci srednje dobi obično imaju visok nivo energije u mozgu.

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

For women, brain energy is usually fine before menopause,

Kod žena, nivo energije u mozgu je obično normalan pre menopauze,

but then it gradually declines during the transition.

ali onda krene postepeno da opada u prelaznom periodu.

And this was found independent of age.

Otkriveno je da je ovo nezavisno od životne dobi.

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

Svejedno je da li žena ima 40, 50 ili 60 godina.

What mattered most was that they were in menopause.

Ono što je najvažnije jeste da je svaka od njih bila u menopauzi.

So of course we need more research to confirm this,

Naravno, moramo dalje istraživati kako bismo ovo potvrdili,

but it looks like women's brains in midlife

ali izgleda da je mozak žena u srednjem životnom dobu

are more sensitive to hormonal aging

osetljiviji na hormonsko starenje

than just straight up chronological aging.

nego na hronološko starenje.

And this is important information to have,

Ovo je važna informacija

because so many women can feel these changes.

jer mnogo žena oseća ove promene.

So many of our patients have said to me

Mnogo naših pacijenata mi je reklo

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

da se osećaju kao da se njihov um poigrava sa njima,

to put it mildly.

blago rečeno.

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

Tako da zaista želim da ovo potvrdim, jer se stvarno dešava,

And so just to clarify, if this is you,

I samo da pojasnim, ako ste vi jedna od njih,

you are not crazy.

niste ludi.

(Laughter)

(Smeh)

(Applause)

(Aplauz)

Thank you.

Hvala vam.

It's important.

Važno je.

Toliko žena se brine da gube razum.

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

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

Ali ono što se dešava jeste da će vaš mozak možda proći kroz promenu

or is going through a transition

ili prolazi kroz promenu,

and needs time and support to adjust.

i potrebno mu je vreme i podrška kako bi se prilagodio.

Also, if anyone is concerned

Takođe, ako se iko pita

that middle-aged women might be underperformers,

da li su žene srednje dobi manje sposobne,

samo ću kratko dodati da smo ispitivali kognitivne sposobnosti.

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

God forbid, right?

Daleko bilo, zar ne?

(Laughter)

(Smeh)

Let's not do that.

Gde to da radimo.

But we looked at cognitive performance,

Ali, pratili smo kognitivne sposobnosti

and we found absolutely no differences between men and women

i nismo našli nikakve razlike između muškaraca i žena

before and after menopause.

pre i posle menopauze.

And other studies confirm this.

Ovo su takođe potvrdile i druge studije.

So basically, we may be tired,

Tako da, možda smo umorne,

but we are just as sharp.

ali smo jednako bistre.

(Laughter)

(Smeh)

Get that out of the way.

Rešili smo taj problem.

That all said,

Kazavši to,

there is something else more serious that deserves our attention.

postoji još ozbiljniji problem koji zaslužuje našu pažnju.

If you remember,

Ako se sećate,

I mentioned that estrogen declines could potentially promote

pomenula sam da pad estrogena može potencijalno da izazove

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

formiranje amiloidnog plaka odnosno Alchajmerovog plaka.

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

Postoji druga vrsta skena mozga koja cilja upravo ovaj plak.

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

Njime smo pokazaili da muškarci srednje dobi praktično nemaju ovaj plak,

which is great.

što je sjajno.

But for women,

Ali kod žena,

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

zabeleženo je povećanje ovog plaka u toku prelaznog perioda ka menopauzi.

And I want to be really, really clear here

I htela bih da budem veoma jasna

that not all women develop the plaques,

da se stvaranje plaka ne javlja kod svih žena,

and not all women with the plaques develop dementia.

kao i da sve žene sa plakom ne razviju demenciju.

Having the plaques is a risk factor,

Posedovanje plaka je rizik,

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

ali ni u kom slučaju ne predstavlja dijagnozu, pogotovu u ovoj fazi.

But still, it's quite an insight

Ipak, veliko je otkriće

to associate Alzheimer's with menopause.

da postoji veza između menopauze i Alchajmera.

We think of menopause as belonging to middle age

Ljudi često pripisuju menopauzu srednjem životnom dobu,

a Alchajmera vide kao nešto što se javlja u starosti.

and Alzheimer's as belonging to old age.

But in reality,

Ali u stvarnosti,

many studies, including my own work,

mnoge studije, uključujući i moj rad,

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

su pokazale da Alchajmerova bolest počinje sa negativnim promenama u mozgu,

years, if not decades, prior to clinical symptoms.

godinama, ako ne i decenijama pre kliničnih simptoma.

So for women,

Kod žena,

it looks like this process starts in midlife,

izgleda da ovaj proces počinje u srednjem životnom dobu,

u toku menopauze.

during menopause.

Which is important information to have,

To je važna informacija

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

jer nam daje vremenski okvir kada da pratimo ove promene.

So in terms of a time line,

U pogledu vremenskog okvira

most women go through menopause in their early 50s.

većina žena prođe kroz menopauzu u ranim pedesetim.

But it can be earlier,

Ali može da se desi i ranije,

often because of medical interventions.

često usled medicinskih zahvata.

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

Tipičan primer je histerektomija i/ili oforektomija,

which is the surgical removal of the uterus

što predstavlja hirurško odstranjivanje materice

and/or the ovaries.

i/ili jajnika.

And unfortunately, there is evidence

I nažalost, postoje dokazi

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

da je odstranjivanja materice, a pogotovo jajnika

prior to menopause

pre menopauze

correlates with the higher risk of dementia in women.

povezano sa povećanim rizikom za demenciju kod žena.

And I know that this is upsetting news,

Razumem da su ovo vesti koje uznemiruju

and it's definitely depressing news,

i koje zasigurno deprimiraju,

but we need to talk about it

ali moramo da pričamo o ovome

because most women are not aware of this correlation,

jer većina žena nije svesna ove povezanosti,

and it seems like very important information to have.

a čini se kao važna informacija koju bi trebalo da znamo.

Also, no one is suggesting that women decline these procedures

Takođe, niko ne sugeriše da žene treba da izbegavaju ove zahvate

if they need them.

ako su im potrebni.

The point here is that we really need to better understand

Suština je da zaista moramo bolje da razumemo

what happens to our brains as we go through menopause,

šta se dešava sa našim mozgovima u toku menopauze,

natural or medical,

prirodno ili medicinski,

and how to protect our brains in the process.

i kako da zaštitimo naš mozak u toku ovog procesa.

So how do we do that?

Kako to možemo učiniti?

How do we protect our brains?

Kako da zaštitimo naš mozak?

Should we take hormones?

Da li da uzimamo hormone?

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

To pitanje ima smisla. To je dobro pitanje.

And the shortest possible answer right now

Najkraći mogući odgovor u ovom momentu

is that hormonal therapy can be helpful

jeste da hormonska terapija može biti od pomoći

to alleviate a number of symptoms, like hot flashes,

kako bi odstranila deo simptoma, poput napada vrućine,

ali trenutno se ne preporučuje za prevenciju demencije.

but it's not currently recommended for dementia prevention.

And many of us are working on testing different formulations

Dosta nas radi na testiranju različitih terapija,

and different dosages and different time lines,

različitih doza i vremenskih okvira,

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

i nadamo se da će sav ovaj rad dovesti do promene u preporukama

in the future.

u budućnosti.

Meanwhile, there are other things that we can do today

U međuvremenu, postoje druge stvari koje možemo već sada učiniti

to support our hormones and their effects on the brain

kako bismo podržali naše hormone i njihov uticaj na mozak,

that do not require medications

a koje ne zahtevaju lekove,

ali zahtevaju da se osvrnemo na naš životni stil.

but do require taking a good look at our lifestyle.

That's because the foods we eat,

Jer hrana koju jedemo,

how much exercise we get,

koliko vežbamo,

how much sleep we get or don't get,

koliko spavamo, a koliko ne,

how much stress we have in our lives,

koliko stresa imamo u životu,

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

ovo su sve stvari koje zapravo utiču na naše hormone,

for better and for worse.

pozitivno ili negativno.

Food, for example.

Hrana, na primer.

There are many diets out there,

Postoji pregršt dijeta,

but studies have shown that the Mediterranean diet in particular

ali studije su pokazale da je posebno mediteranska ishrana

is supportive of women's health.

od pomoći zdravlju žena.

Women on this diet have a much lower risk

Žene sa ovom ishranom imaju znatno manji rizik

of cognitive decline, of depression,

od kognitivnog opadanja ili depresije,

of heart disease, of stroke and of cancer,

srčanih oboljenja, moždanog udara i oboljenja od raka,

and they also have fewer hot flashes.

i ređe imaju napade vrućine.

What's interesting about this diet

Ono što je zanimljivo vezano za ovu ishranu

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

jeste da je prilično bogata namirnicama koje sadrže estrogen

u obliku fitoestrogena, odnosno estrogena iz biljaka,

in the form of phytoestrogens or estrogens from plants

that act like mild estrogens in our bodies.

a koji se ponašaju kao blagi estrogeni u našim telima.

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

Neki fitoestrogeni su povezani sa mogućim rizikom od raka,

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

ali ne i oni koju su zastupljeni u ovoj ishrani. Oni su bezbedni.

Especially from flax seeds,

Posebno oni iz lanenog semena,

susama, suvih kajsija,

sesame seeds, dried apricots,

mahunarki i brojnih voćki.

legumes and a number of fruits.

And for some good news,

A sad dobre vesti,

dark chocolate contains phytoestrogens, too.

tamna čokolada takođe sadrži fitoestrogene.

So diet is one way to gain estrogens,

Dakle, dijeta je jedan način kako dobiti estrogene,

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

ali je jednako važno izbegavati stvari koje potiskuju naše estrogene,

especially stress.

to se posebno odnosi na stres.

Stress can literally steal your estrogens,

Stres bukvalno može da ukloni vaše estrogene,

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

a to je zato što kortizol, koji predstavlja glavni hormon stresa,

works in balance with our estrogens.

funkcioniše u balansu sa estrogenom.

So if cortisol goes up, your estrogens go down.

Tako da, ako kortizol poraste, estrogen opadne.

If cortisol goes down, your estrogens go back up.

Ako koritzol opadne, estrogen poraste.

Prema tome, smanjenje količine stresa je veoma važno.

So reducing stress is really important.

It doesn't just help your day,

Ne samo da će učiniti vaš dan boljim,

it also helps your brain.

već će i pomoći vašem mozgu.

Ovo su samo neke od stvari koje možemo učiniti kako bismo pomogli našem mozgu.

So these are just a few things

that we can do to support our brains

and there are more.

A tu je niz drugih načina.

Ono što je pak važno

But the important thing here

is that changing the way we understand the female brain

jeste da način na koji razumemo mozak žena

menja način na koji se brinemo o njemu,

really changes the way that we care for it,

and the way that we frame women's health.

i način na koji definišemo zdravlje žena.

And the more women demand this information,

I što više žena traži ove informacije,

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

to ćemo pre biti u stanju da razbijemo tabu u vezi sa menopauzom,

and also come up with solutions that actually work,

te ćemo doći do rešenja koja zapravo deluju,

not just for Alzheimer's disease,

ne samo za Alchajmerovu bolest,

but for women's brain health as a whole.

već za zdravlje žena u celosti.

Brain health is women's health.

Zdravlje mozga je zdravlje žena.

Thank you.

Hvala vam.

(Applause)

(Aplauz)

Thank you.

Hvala.

Oh, thank you.

Hvala vam.