How menopause affects the brain | Lisa Mosconi

翻译人员: Yu Xie 校对人员: Ethan Huang

Women are works of art.

女性是艺术品。

On the outside as on the inside.

外表上是，内里亦是。

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

我是一名神经科学家， 我的研究领域是内在，

especially on women's brains.

尤其是女性的大脑。

There are many theories on how women's brains differ

有很多关于

男女大脑差异的学说，

from men's brains,

and I've been looking at brains for 20 years

我研究大脑有 20 年了，

and can guarantee that there is no such thing

我可以向大家保证， 大脑根本不存在

as a gendered brain.

性别之分。

Pink and blue, Barbie and Lego,

粉色与蓝色，芭比娃娃和乐高积木，

those are all inventions that have nothing to do

这些发明都与我们大脑的

with the way our brains are built.

工作方式无关。

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

但是，女性大脑 在某些方面与男性的大脑

in some respects.

的确存在差异。

And I'm here to talk about these differences,

在这里，我会跟大家 聊一聊这些差异，

because they actually matter for our health.

因为这些差异 对我们的健康至关重要。

For example,

比如，

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

女性比男性更易患上焦虑症

or depression,

或者抑郁症，

not to mention headaches and migraines.

除此之外，还有头痛与偏头痛。

But also, at the core of my research,

但同时，我在一些 主要的研究工作中也发现，

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

女性比起男性更易患上 阿尔兹海默症。

Alzheimer's disease is the most common cause

阿尔兹海默症是世界上 造成痴呆症状的

of dementia on the planet,

最常见因素，

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

光是在美国就有近六百万人 受到该病症的困扰。

But almost two thirds of all those people

但是，接近三分之二的患者

are actually women.

都是女性。

So for every man suffering from Alzheimer's

也就是说，每一位 阿尔兹海默症男性患者，

there are two women.

都对应着两位女性患者。

So why is that overall?

那么总的来说，为什么 会出现这种情况？

Is it age?

是年龄造成的吗？

Is it lifespan?

还是与寿命有关？

What else could it be?

还是其他的因素？

A few years ago,

几年前，

I launched the Women's Brain Initiative

我在纽约市的威尔·康奈尔医学院

at Weill Cornell Medicine in New York City,

发起了“妇女大脑倡议”，

exactly to answer those questions.

旨在回答这些问题。

And tonight, I'm here with some answers.

所以今晚，我为大家 带来了一些答案。

So it turns out our brains age differently,

研究表明，我们的大脑 衰老的方式不同，

and menopause plays a key role here for women.

对于女性而言，更年期在其中 扮演了一个非常重要的角色。

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

很多人把大脑想象成一个黑匣子，

isolated from the rest of the body.

把它从人体分离出来。

But in reality, our brains are in constant interaction

但是事实上，我们的大脑 每时每刻都在

with the rest of us.

与身体的其他部分互动。

And perhaps surprisingly,

也许你们会感到惊讶，

the interactions with the reproductive system

它与生殖系统的互动

are crucial for brain aging in women.

对于女性大脑的衰老 也起着至关重要的作用。

These interactions are mediated by our hormones.

这些互动都是由我们的 激素来调节的。

And we know that hormones differ between the genders.

我们知道两性的激素水平 是不同的。

Men have more testosterone, women have more estrogens.

男性有更多的睾酮素， 女性有更多的雌激素。

But what really matters here

但是重点在于，

is that these hormones differ in their longevity.

这些激素持续的时间不同。

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

男性的睾酮在晚年时期 才会逐渐消失，

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

当然，这整个过程 都非常缓慢且没有症状。

(Laughter)

（笑声）

Women's estrogens, on the other hand,

而另一方面，女性的雌激素

start fading in midlife, during menopause,

在中年时期，尤其是 更年期时就开始衰减，

which is anything but symptom-free.

这个过程也伴随着明显的相关症状。

We associate menopause with the ovaries,

我们把卵巢与更年期建立起了联系，

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

但是当女性说她们出现了潮热、

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

盗汗、失眠、 记忆衰退、抑郁、焦虑，

those symptoms don't start in the ovaries.

其实这些症状并不是 由卵巢衰老引起的。

They start in the brain.

它们开始于大脑。

Those are neurological symptoms.

这些都是与神经相关的症状。

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

我们只是从来没有 从这个角度考虑过这个问题。

So why is that?

那么为什么这么说呢？

Why are our brains impacted by menopause?

为什么我们的大脑 会受到更年期的影响？

Well, first of all,

首先，

our brains and ovaries are part of the neuroendocrine system.

我们的大脑和卵巢都属于 神经内分泌系统。

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

作为这个系统的一部分， 大脑会与卵巢互动，

and the ovaries talk back to the brain,

同时，卵巢也会把相关信息 反馈回大脑，

every day of our lives as women.

这样的过程女性每天都会经历。

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

所以卵巢的健康 与大脑的健康息息相关。

And the other way around.

反之亦然。

At the same time,

同时，

hormones like estrogen are not only involved in reproduction,

雌激素之类的激素并不仅仅 在生殖过程中发挥作用，

but also in brain function.

同时也在大脑功能中发挥作用。

And estrogen in particular, or estradiol,

尤其是雌激素，或者说雌二醇，

is really key for energy production in the brain.

在大脑的产能过程中 发挥着非常重要的作用。

At the cellular level,

在细胞层面上，

estrogen literally pushes neurons to burn glucose to make energy.

雌激素确实能够让神经元 消耗葡萄糖以产生能量。

If your estrogen is high,

如果你的雌激素水平很高，

your brain energy is high.

那么你大脑的能量就很高。

When your estrogen declines though,

而当你的雌激素水平降低时，

your neurons start slowing down and age faster.

你的神经系统运转会变慢， 也会衰老得更快。

And studies have shown that this process

相关研究表明，这个过程

can even lead to the formation of amyloid plaques,

甚至能够导致淀粉样斑块的形成，

or Alzheimer's plaques,

即阿尔兹海默斑块，

which are a hallmark of Alzheimer's disease.

它是阿尔兹海默症的 标志性特征。

These effects are stronger in specific brain regions,

这些作用在大脑中的 特定区域会更强，

starting with the hypothalamus,

首先是在下丘脑区，

which is in charge of regulating body temperature.

这个区域负责体温的调节。

When estrogen doesn't activate the hypothalamus correctly,

当雌激素无法正常地 激活下丘脑区时，

the brain cannot regulate body temperature correctly.

大脑就不能准确地调控体温。

So those hot flashes that women get,

所以这些女性所体会的潮热症状，

that's the hypothalamus.

就是下丘脑区失常造成的。

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

接着是脑干，这个区域 负责入眠与苏醒。

When estrogen doesn't activate the brain stem correctly,

当雌激素不能正常地 在脑干发挥作用时，

we have trouble sleeping.

我们就会产生睡眠问题。

Or it's the amygdala,

还有杏仁核，

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

它是大脑中的情感中心， 挨着海马体，

the memory center of the brain.

海马体是大脑的记忆中心。

When estrogen levels ebb in these regions,

当雌激素水平在这些区域衰退时，

we start getting mood swings perhaps

我们很可能会开始出现情绪的起伏，

and forget things.

记忆力降低。

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

所以你们可以把这当作 更年期阶段对大脑的解析。

But let me show you

下面我们来看看

what an actual woman's brain can look like.

一个真正的女性大脑 是什么样子。

So this is a kind of brain scan

这是一种脑部扫描技术，

called positron emission tomography or PET.

叫做正电子发射断层成像， 简称 PET。

It looks at brain energy levels.

它能够显示大脑能量水平。

And this is what you want your brain to look like

这是你在四十岁时

希望自己的大脑所呈现的样子。

when you're in your 40s.

Really nice and bright.

看上去非常好，色调很明亮。

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

这个大脑属于一位 43 岁的女性，

when she was first scanned, before menopause.

这是她在更年期前做的 第一次脑部扫描。

And this is the same brain just eight years later,

这是八年后， 同一颗大脑的样子，

after menopause.

这个时候她已经过了更年期了。

If we put them side by side,

如果我们把它们并排放在一起，

I think you can easily see how the bright yellow

我觉得你可以很轻易地看到 这个明亮的黄色

turned orange, almost purple.

开始变成橘色，越来越接近紫色。

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

这表示大脑的能量水平 下降了百分之三十。

Now in general,

一般来说，

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

这种改变似乎并不会发生在 同年龄的男性身上。

In our studies with hundreds of people,

通过对上百人的大脑进行研究，

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

我们发现中年男性的 大脑能量值通常很高。

For women, brain energy is usually fine before menopause,

而对于女性，大脑的能量水平 在更年期前一般是正常的，

but then it gradually declines during the transition.

但是在更年期过程中， 其能量水平会逐渐降低。

And this was found independent of age.

这个过程跟年龄无关。

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

无论女性是在四十岁、五十岁 或者六十岁，这都不重要。

What mattered most was that they were in menopause.

真正重要的是她们 是否处于更年期。

So of course we need more research to confirm this,

当然我们需要做更多的研究 来证明这一点，

but it looks like women's brains in midlife

但是看起来，相比单纯的年龄衰老，

are more sensitive to hormonal aging

中年女性的大脑对随着年龄改变的

than just straight up chronological aging.

激素衰变会更加敏感。

And this is important information to have,

这一点非常重要，

because so many women can feel these changes.

因为很多女性可以 感受到这些变化。

So many of our patients have said to me

很多患者都对我说，

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

她们觉得大脑在跟她们闹别扭，

to put it mildly.

这还是一种美化了的说法。

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

所以我真的想要证实这一点， 因为这是真实发生的。

And so just to clarify, if this is you,

所以在这里澄清一下， 如果你也是其中一员，

you are not crazy.

你并没有疯掉。

(Laughter)

（笑声）

(Applause)

（掌声）

Thank you.

谢谢。

It's important.

这真的非常重要。

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

很多女性开始忧虑她们 是不是正在失去理智。

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

但真相是，你的大脑可能 正要经历一场转变，

or is going through a transition

或者说正在转变中，

and needs time and support to adjust.

你的大脑需要时间和支持去适应。

Also, if anyone is concerned

另外，如果有的人忧虑

that middle-aged women might be underperformers,

中年女性也许会能力表现不佳，

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

我必须快速地补充一下，我们 也关注了她们的认知表现，

God forbid, right?

但愿不会真的这样，是吧？

(Laughter)

（笑声)

Let's not do that.

我们还是不要这么做。

But we looked at cognitive performance,

但是当我们聚焦到认知表现时，

and we found absolutely no differences between men and women

我们没有在男性和女性之中 发现明显的差异，

before and after menopause.

无论是更年期前还是更年期后。

And other studies confirm this.

其他的研究也支持了这一点。

So basically, we may be tired,

所以基本上来说，我们也许疲倦了，

but we are just as sharp.

但是我们依旧很精明。

(Laughter)

（笑声）

Get that out of the way.

所以不必杞人忧天。

That all said,

我们的研究表明，

there is something else more serious that deserves our attention.

有一些更加严重的问题 值得我们关注。

If you remember,

如果你们还记得，

I mentioned that estrogen declines could potentially promote

我提到过雌激素的衰退 可能会促进

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

淀粉样斑块的形成，或者说 阿尔兹海默斑块。

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

然而还有另外一种脑部扫描， 是专门用来显示这些斑块的。

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

我们用它扫描了中年男性的大脑， 基本上没有发现斑块，

which is great.

这是一件好事。

But for women,

但是在女性的大脑里，

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

我们发现在进入更年期时， 斑块出现了明显的增加。

And I want to be really, really clear here

我要明确的一点是，

that not all women develop the plaques,

并不是所有的女性都会产生这些斑块，

and not all women with the plaques develop dementia.

并不是所有有了这些斑块的女性 都会得痴呆。

Having the plaques is a risk factor,

只能说这些斑块是一个危险因素，

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

无论如何它都不能作为一种诊断， 尤其是在这个阶段。

But still, it's quite an insight

但是，这是把阿尔兹海默症

to associate Alzheimer's with menopause.

与更年期联系起来的 一个很好的切入点。

We think of menopause as belonging to middle age

我们把更年期归为中年时期的疾病，

and Alzheimer's as belonging to old age.

而将阿尔兹海默归为老年病。

But in reality,

但是事实上，

many studies, including my own work,

很多研究，包括我自己的研究，

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

都表明阿尔兹海默症初始于 临床症状出现的几年前，甚至几十年前

years, if not decades, prior to clinical symptoms.

大脑中就已经出现的那些负面改变。

So for women,

所以对于女性而言，

it looks like this process starts in midlife,

这一过程似乎在中年时期，

during menopause.

在更年期阶段就开始了，

Which is important information to have,

这是非常重要的信息，

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

因为它向我们提供了一条 寻找这些改变的时间线。

So in terms of a time line,

说到时间线，

most women go through menopause in their early 50s.

绝大多数女性在她们 50 多岁 初期开始经历更年期。

But it can be earlier,

但更年期可以提前，

often because of medical interventions.

这常常是因为医疗的干预。

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

比较常见的就是子宫切除术患者 和/或卵巢切除术患者，

which is the surgical removal of the uterus

也就是手术切除了子宫

and/or the ovaries.

和/或卵巢。

And unfortunately, there is evidence

不幸的是，有证据表明

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

在更年期以前，

子宫，尤其是卵巢就被摘除

prior to menopause

correlates with the higher risk of dementia in women.

和女性患痴呆的风险增加存在相关性。

And I know that this is upsetting news,

我知道这是一个坏消息，

and it's definitely depressing news,

令人无法接受，

but we need to talk about it

但我们需要直面这一发现，

because most women are not aware of this correlation,

因为大多数女性并没有意识到 这其中的关联，

and it seems like very important information to have.

而这又是不容忽视的重要信息。

Also, no one is suggesting that women decline these procedures

而且，如果女性需要做这些手术，

if they need them.

没人建议她们拒绝。

The point here is that we really need to better understand

重点就在于，我们真的 需要更好地理解

what happens to our brains as we go through menopause,

当我们处于更年期时， 大脑发生了什么，

natural or medical,

不管是自然的 还是医疗干预造成的，

and how to protect our brains in the process.

以及在这个过程中 我们如何保护自己的大脑。

So how do we do that?

那么我们应该怎么做呢？

How do we protect our brains?

我们怎样来保护自己的大脑？

Should we take hormones?

我们应该补充激素吗？

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

这是一个很好的问题。

And the shortest possible answer right now

目前最简洁的答案是，

is that hormonal therapy can be helpful

激素治疗可以有助于

to alleviate a number of symptoms, like hot flashes,

缓解如潮热等一系列症状，

but it's not currently recommended for dementia prevention.

但是现在并不推荐 用这一疗法预防痴呆。

And many of us are working on testing different formulations

我们的研究团队中有很多人 致力于测试不同的配方，

and different dosages and different time lines,

不同的剂量和不同的时间线，

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

我们期望所有的努力在未来能引导

in the future.

一系列建议上的改变。

Meanwhile, there are other things that we can do today

同时，我们目前也可以 采取其他的行动

to support our hormones and their effects on the brain

来支持我们的激素 以及它们对大脑的作用，

that do not require medications

不需要治疗，

but do require taking a good look at our lifestyle.

但是确实需要我们好好 审视自己的生活方式。

That's because the foods we eat,

这是因为我们所吃的食物，

how much exercise we get,

我们的锻炼量，

how much sleep we get or don't get,

我们的睡眠时长，

how much stress we have in our lives,

我们生活中的压力，

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

这些都能够影响 我们的激素水平——

for better and for worse.

正面和负面都有。

Food, for example.

比如，食物。

There are many diets out there,

世面上有多种食物，

but studies have shown that the Mediterranean diet in particular

研究表明，地中海饮食尤其能够

is supportive of women's health.

对女性的健康起到积极的作用。

Women on this diet have a much lower risk

处于这种饮食下的女性更不容易

of cognitive decline, of depression,

出现认知降低，抑郁，

of heart disease, of stroke and of cancer,

心脏疾病，中风和癌症，

and they also have fewer hot flashes.

并且她们出现潮热症状的频率更低。

What's interesting about this diet

而且这种饮食有趣的地方在于，

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

这些食物富含

in the form of phytoestrogens or estrogens from plants

来源于植物的雌激素，

that act like mild estrogens in our bodies.

就像我们体内温和的 雌激素一样产生作用。

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

一些植物雌激素被认为 有致癌风险，

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

但这类饮食中的 植物雌激素则相对安全，

Especially from flax seeds,

尤其是来源于亚麻籽、

sesame seeds, dried apricots,

芝麻、杏干、

legumes and a number of fruits.

豆类以及一些水果中的雌激素。

And for some good news,

还有更好的消息，

dark chocolate contains phytoestrogens, too.

黑巧克力也含有植物雌激素。

So diet is one way to gain estrogens,

所以饮食是一种获取雌激素的途径，

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

但是避开那些会压抑 雌激素水平的东西也同样重要，

especially stress.

特别是压力。

Stress can literally steal your estrogens,

压力真的能“偷走”我们的雌激素，

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

这是因为皮质醇， 一种主要的压力激素，

works in balance with our estrogens.

与我们的雌激素相平衡。

So if cortisol goes up, your estrogens go down.

所以，如果皮质醇水平上升， 雌激素水平就会下降。

If cortisol goes down, your estrogens go back up.

如果皮质醇水平降低， 雌激素水平就会恢复。

So reducing stress is really important.

所以减少压力非常重要。

It doesn't just help your day,

它并不仅会让你的生活变得更好，

it also helps your brain.

还有助于保持大脑健康。

So these are just a few things

我提到的只是少数几种

that we can do to support our brains

可以用来支持我们大脑的方法，

and there are more.

还有很多其他方法值得尝试。

But the important thing here

但是重点在于，

is that changing the way we understand the female brain

转变我们对于女性大脑的认识

really changes the way that we care for it,

真的会改变我们保养大脑的方式，

and the way that we frame women's health.

以及转变我们表述女性 健康的方式。

And the more women demand this information,

女性对这种信息的需求越多，

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

我们就能越早打破关于 更年期的禁忌，

and also come up with solutions that actually work,

并且找出真正有效的应对方法，

not just for Alzheimer's disease,

不仅是针对阿尔兹海默症，

but for women's brain health as a whole.

而是为了女性大脑的整体健康。

Brain health is women's health.

大脑的健康就意味着女性的健康。

Thank you.

谢谢大家。

(Applause)

（掌声）

Thank you.

谢谢大家。

Oh, thank you.

噢，谢谢大家！