中英文稿

女性是藝術(shù)品。 外表上是，內(nèi)里亦是。 我是一名神經(jīng)科學(xué)家， 我的研究領(lǐng)域是內(nèi)在， 尤其是女性的大腦。

有很多關(guān)于 男女大腦差異的學(xué)說(shuō)， 我研究大腦有 20 年了， 我可以向大家保證， 大腦根本不存在 性別之分。 粉色與藍(lán)色，芭比娃娃和樂(lè)高積木， 這些發(fā)明都與我們大腦的 工作方式無(wú)關(guān)。

但是，女性大腦 在某些方面與男性的大腦 的確存在差異。 在這里，我會(huì)跟大家 聊一聊這些差異， 因?yàn)檫@些差異 對(duì)我們的健康至關(guān)重要。 比如， 女性比男性更易患上焦慮癥 或者抑郁癥， 除此之外，還有頭痛與偏頭痛。 但同時(shí)，我在一些 主要的研究工作中也發(fā)現(xiàn)， 女性比起男性更易患上 阿爾茲海默癥。 阿爾茲海默癥是世界上 造成癡呆癥狀的 最常見(jiàn)因素， 光是在美國(guó)就有近六百萬(wàn)人 受到該病癥的困擾。 但是，接近三分之二的患者 都是女性。 也就是說(shuō)，每一位 阿爾茲海默癥男性患者， 都對(duì)應(yīng)著兩位女性患者。 那么總的來(lái)說(shuō)，為什么 會(huì)出現(xiàn)這種情況？ 是年齡造成的嗎？ 還是與壽命有關(guān)？ 還是其他的因素？

幾年前， 我在紐約市的威爾·康奈爾醫(yī)學(xué)院 發(fā)起了“婦女大腦倡議”， 旨在回答這些問(wèn)題。 所以今晚，我為大家 帶來(lái)了一些答案。

研究表明，我們的大腦 衰老的方式不同， 對(duì)于女性而言，更年期在其中 扮演了一個(gè)非常重要的角色。 很多人把大腦想象成一個(gè)黑匣子， 把它從人體分離出來(lái)。 但是事實(shí)上，我們的大腦 每時(shí)每刻都在 與身體的其他部分互動(dòng)。 也許你們會(huì)感到驚訝， 它與生殖系統(tǒng)的互動(dòng) 對(duì)于女性大腦的衰老 也起著至關(guān)重要的作用。 這些互動(dòng)都是由我們的 激素來(lái)調(diào)節(jié)的。 我們知道兩性的激素水平 是不同的。

男性有更多的睪酮素， 女性有更多的雌激素。 但是重點(diǎn)在于， 這些激素持續(xù)的時(shí)間不同。 男性的睪酮在晚年時(shí)期 才會(huì)逐漸消失， 當(dāng)然，這整個(gè)過(guò)程 都非常緩慢且沒(méi)有癥狀。

而另一方面，女性的雌激素 在中年時(shí)期，尤其是 更年期時(shí)就開(kāi)始衰減， 這個(gè)過(guò)程也伴隨著明顯的相關(guān)癥狀。 我們把卵巢與更年期建立起了聯(lián)系， 但是當(dāng)女性說(shuō)她們出現(xiàn)了潮熱、 盜汗、失眠、 記憶衰退、抑郁、焦慮， 其實(shí)這些癥狀并不是 由卵巢衰老引起的。 它們開(kāi)始于大腦。 這些都是與神經(jīng)相關(guān)的癥狀。 我們只是從來(lái)沒(méi)有 從這個(gè)角度考慮過(guò)這個(gè)問(wèn)題。 那么為什么這么說(shuō)呢？ 為什么我們的大腦 會(huì)受到更年期的影響？

首先， 我們的大腦和卵巢都屬于 神經(jīng)內(nèi)分泌系統(tǒng)。 作為這個(gè)系統(tǒng)的一部分， 大腦會(huì)與卵巢互動(dòng)， 同時(shí)，卵巢也會(huì)把相關(guān)信息 反饋回大腦， 這樣的過(guò)程女性每天都會(huì)經(jīng)歷。 所以卵巢的健康 與大腦的健康息息相關(guān)。 反之亦然。 同時(shí)， 雌激素之類(lèi)的激素并不僅僅 在生殖過(guò)程中發(fā)揮作用， 同時(shí)也在大腦功能中發(fā)揮作用。 尤其是雌激素，或者說(shuō)雌二醇， 在大腦的產(chǎn)能過(guò)程中 發(fā)揮著非常重要的作用。

在細(xì)胞層面上， 雌激素確實(shí)能夠讓神經(jīng)元 消耗葡萄糖以產(chǎn)生能量。 如果你的雌激素水平很高， 那么你大腦的能量就很高。 而當(dāng)你的雌激素水平降低時(shí)， 你的神經(jīng)系統(tǒng)運(yùn)轉(zhuǎn)會(huì)變慢， 也會(huì)衰老得更快。 相關(guān)研究表明，這個(gè)過(guò)程 甚至能夠?qū)е碌矸蹣影邏K的形成， 即阿爾茲海默斑塊， 它是阿爾茲海默癥的 標(biāo)志性特征。

這些作用在大腦中的 特定區(qū)域會(huì)更強(qiáng)， 首先是在下丘腦區(qū)， 這個(gè)區(qū)域負(fù)責(zé)體溫的調(diào)節(jié)。 當(dāng)雌激素?zé)o法正常地 激活下丘腦區(qū)時(shí)， 大腦就不能準(zhǔn)確地調(diào)控體溫。 所以這些女性所體會(huì)的潮熱癥狀， 就是下丘腦區(qū)失常造成的。 接著是腦干，這個(gè)區(qū)域 負(fù)責(zé)入眠與蘇醒。 當(dāng)雌激素不能正常地 在腦干發(fā)揮作用時(shí)， 我們就會(huì)產(chǎn)生睡眠問(wèn)題。 還有杏仁核， 它是大腦中的情感中心， 挨著海馬體， 海馬體是大腦的記憶中心。 當(dāng)雌激素水平在這些區(qū)域衰退時(shí)， 我們很可能會(huì)開(kāi)始出現(xiàn)情緒的起伏， 記憶力降低。 所以你們可以把這當(dāng)作 更年期階段對(duì)大腦的解析。

下面我們來(lái)看看 一個(gè)真正的女性大腦 是什么樣子。 這是一種腦部掃描技術(shù)， 叫做正電子發(fā)射斷層成像， 簡(jiǎn)稱(chēng) PET。 它能夠顯示大腦能量水平。 這是你在四十歲時(shí) 希望自己的大腦所呈現(xiàn)的樣子。 看上去非常好，色調(diào)很明亮。 這個(gè)大腦屬于一位 43 歲的女性， 這是她在更年期前做的 第一次腦部掃描。 這是八年后， 同一顆大腦的樣子， 這個(gè)時(shí)候她已經(jīng)過(guò)了更年期了。 如果我們把它們并排放在一起， 我覺(jué)得你可以很輕易地看到 這個(gè)明亮的黃色 開(kāi)始變成橘色，越來(lái)越接近紫色。 這表示大腦的能量水平 下降了百分之三十。

一般來(lái)說(shuō)， 這種改變似乎并不會(huì)發(fā)生在 同年齡的男性身上。 通過(guò)對(duì)上百人的大腦進(jìn)行研究， 我們發(fā)現(xiàn)中年男性的 大腦能量值通常很高。 而對(duì)于女性，大腦的能量水平 在更年期前一般是正常的， 但是在更年期過(guò)程中， 其能量水平會(huì)逐漸降低。 這個(gè)過(guò)程跟年齡無(wú)關(guān)。 無(wú)論女性是在四十歲、五十歲 或者六十歲，這都不重要。 真正重要的是她們 是否處于更年期。

當(dāng)然我們需要做更多的研究 來(lái)證明這一點(diǎn)， 但是看起來(lái)，相比單純的年齡衰老， 中年女性的大腦對(duì)隨著年齡改變的 激素衰變會(huì)更加敏感。 這一點(diǎn)非常重要， 因?yàn)楹芏嗯钥梢?感受到這些變化。 很多患者都對(duì)我說(shuō)， 她們覺(jué)得大腦在跟她們鬧別扭， 這還是一種美化了的說(shuō)法。 所以我真的想要證實(shí)這一點(diǎn)， 因?yàn)檫@是真實(shí)發(fā)生的。 所以在這里澄清一下， 如果你也是其中一員， 你并沒(méi)有瘋掉。

謝謝。

這真的非常重要。 很多女性開(kāi)始憂慮她們 是不是正在失去理智。 但真相是，你的大腦可能 正要經(jīng)歷一場(chǎng)轉(zhuǎn)變， 或者說(shuō)正在轉(zhuǎn)變中， 你的大腦需要時(shí)間和支持去適應(yīng)。 另外，如果有的人憂慮 中年女性也許會(huì)能力表現(xiàn)不佳， 我必須快速地補(bǔ)充一下，我們 也關(guān)注了她們的認(rèn)知表現(xiàn)， 但愿不會(huì)真的這樣，是吧？

我們還是不要這么做。 但是當(dāng)我們聚焦到認(rèn)知表現(xiàn)時(shí)， 我們沒(méi)有在男性和女性之中 發(fā)現(xiàn)明顯的差異， 無(wú)論是更年期前還是更年期后。 其他的研究也支持了這一點(diǎn)。 所以基本上來(lái)說(shuō)，我們也許疲倦了， 但是我們依舊很精明。

所以不必杞人憂天。

我們的研究表明， 有一些更加嚴(yán)重的問(wèn)題 值得我們關(guān)注。 如果你們還記得， 我提到過(guò)雌激素的衰退 可能會(huì)促進(jìn) 淀粉樣斑塊的形成，或者說(shuō) 阿爾茲海默斑塊。 然而還有另外一種腦部掃描， 是專(zhuān)門(mén)用來(lái)顯示這些斑塊的。 我們用它掃描了中年男性的大腦， 基本上沒(méi)有發(fā)現(xiàn)斑塊， 這是一件好事。 但是在女性的大腦里， 我們發(fā)現(xiàn)在進(jìn)入更年期時(shí)， 斑塊出現(xiàn)了明顯的增加。 我要明確的一點(diǎn)是， 并不是所有的女性都會(huì)產(chǎn)生這些斑塊， 并不是所有有了這些斑塊的女性 都會(huì)得癡呆。 只能說(shuō)這些斑塊是一個(gè)危險(xiǎn)因素， 無(wú)論如何它都不能作為一種診斷， 尤其是在這個(gè)階段。

但是，這是把阿爾茲海默癥 與更年期聯(lián)系起來(lái)的 一個(gè)很好的切入點(diǎn)。 我們把更年期歸為中年時(shí)期的疾病， 而將阿爾茲海默歸為老年病。 但是事實(shí)上， 很多研究，包括我自己的研究， 都表明阿爾茲海默癥初始于 臨床癥狀出現(xiàn)的幾年前，甚至幾十年前 大腦中就已經(jīng)出現(xiàn)的那些負(fù)面改變。 所以對(duì)于女性而言， 這一過(guò)程似乎在中年時(shí)期， 在更年期階段就開(kāi)始了， 這是非常重要的信息， 因?yàn)樗蛭覀兲峁┝艘粭l 尋找這些改變的時(shí)間線。

說(shuō)到時(shí)間線， 絕大多數(shù)女性在她們 50 多歲 初期開(kāi)始經(jīng)歷更年期。 但更年期可以提前， 這常常是因?yàn)獒t(yī)療的干預(yù)。 比較常見(jiàn)的就是子宮切除術(shù)患者 和/或卵巢切除術(shù)患者， 也就是手術(shù)切除了子宮 和/或卵巢。 不幸的是，有證據(jù)表明 在更年期以前， 子宮，尤其是卵巢就被摘除 和女性患癡呆的風(fēng)險(xiǎn)增加存在相關(guān)性。 我知道這是一個(gè)壞消息， 令人無(wú)法接受， 但我們需要直面這一發(fā)現(xiàn)， 因?yàn)榇蠖鄶?shù)女性并沒(méi)有意識(shí)到 這其中的關(guān)聯(lián)， 而這又是不容忽視的重要信息。

而且，如果女性需要做這些手術(shù)， 沒(méi)人建議她們拒絕。 重點(diǎn)就在于，我們真的 需要更好地理解 當(dāng)我們處于更年期時(shí)， 大腦發(fā)生了什么， 不管是自然的 還是醫(yī)療干預(yù)造成的， 以及在這個(gè)過(guò)程中 我們?nèi)绾伪Ｗo(hù)自己的大腦。

那么我們應(yīng)該怎么做呢？ 我們?cè)鯓觼?lái)保護(hù)自己的大腦？ 我們應(yīng)該補(bǔ)充激素嗎？ 這是一個(gè)很好的問(wèn)題。 目前最簡(jiǎn)潔的答案是， 激素治療可以有助于 緩解如潮熱等一系列癥狀， 但是現(xiàn)在并不推薦 用這一療法預(yù)防癡呆。 我們的研究團(tuán)隊(duì)中有很多人 致力于測(cè)試不同的配方， 不同的劑量和不同的時(shí)間線， 我們期望所有的努力在未來(lái)能引導(dǎo) 一系列建議上的改變。

同時(shí)，我們目前也可以 采取其他的行動(dòng) 來(lái)支持我們的激素 以及它們對(duì)大腦的作用， 不需要治療， 但是確實(shí)需要我們好好 審視自己的生活方式。 這是因?yàn)槲覀兯缘氖澄铮?我們的鍛煉量， 我們的睡眠時(shí)長(zhǎng)， 我們生活中的壓力， 這些都能夠影響 我們的激素水平—— 正面和負(fù)面都有。

比如，食物。 世面上有多種食物， 研究表明，地中海飲食尤其能夠 對(duì)女性的健康起到積極的作用。 處于這種飲食下的女性更不容易 出現(xiàn)認(rèn)知降低，抑郁， 心臟疾病，中風(fēng)和癌癥， 并且她們出現(xiàn)潮熱癥狀的頻率更低。 而且這種飲食有趣的地方在于， 這些食物富含 來(lái)源于植物的雌激素， 就像我們體內(nèi)溫和的 雌激素一樣產(chǎn)生作用。 一些植物雌激素被認(rèn)為 有致癌風(fēng)險(xiǎn)， 但這類(lèi)飲食中的 植物雌激素則相對(duì)安全， 尤其是來(lái)源于亞麻籽、 芝麻、杏干、 豆類(lèi)以及一些水果中的雌激素。 還有更好的消息， 黑巧克力也含有植物雌激素。

所以飲食是一種獲取雌激素的途徑， 但是避開(kāi)那些會(huì)壓抑 雌激素水平的東西也同樣重要， 特別是壓力。 壓力真的能“偷走”我們的雌激素， 這是因?yàn)槠べ|(zhì)醇， 一種主要的壓力激素， 與我們的雌激素相平衡。 所以，如果皮質(zhì)醇水平上升， 雌激素水平就會(huì)下降。 如果皮質(zhì)醇水平降低， 雌激素水平就會(huì)恢復(fù)。 所以減少壓力非常重要。 它并不僅會(huì)讓你的生活變得更好， 還有助于保持大腦健康。

我提到的只是少數(shù)幾種 可以用來(lái)支持我們大腦的方法， 還有很多其他方法值得嘗試。 但是重點(diǎn)在于， 轉(zhuǎn)變我們對(duì)于女性大腦的認(rèn)識(shí) 真的會(huì)改變我們保養(yǎng)大腦的方式， 以及轉(zhuǎn)變我們表述女性 健康的方式。 女性對(duì)這種信息的需求越多， 我們就能越早打破關(guān)于 更年期的禁忌， 并且找出真正有效的應(yīng)對(duì)方法， 不僅是針對(duì)阿爾茲海默癥， 而是為了女性大腦的整體健康。 大腦的健康就意味著女性的健康。

謝謝大家。

謝謝大家。 噢，謝謝大家！

Women are works of art. On the outside as on the inside. I am a neuroscientist, and I focus on the inside, especially on women's brains.

There are many theories on how women's brains differ from men's brains, and I've been looking at brains for 20 years and can guarantee that there is no such thing as a gendered brain. Pink and blue, Barbie and Lego, those are all inventions that have nothing to do with the way our brains are built.

That said, women's brains differ from men's brains in some respects. And I'm here to talk about these differences, because they actually matter for our health. For example, women are more likely than men to be diagnosed with an anxiety disorder or depression, not to mention headaches and migraines. But also, at the core of my research, women are more likely than men to have Alzheimer's disease. Alzheimer's disease is the most common cause of dementia on the planet, affecting close to six million people in the United States alone. But almost two thirds of all those people are actually women. So for every man suffering from Alzheimer's there are two women. So why is that overall? Is it age? Is it lifespan? What else could it be?

A few years ago, I launched the Women's Brain Initiative at Weill Cornell Medicine in New York City, exactly to answer those questions. And tonight, I'm here with some answers.

So it turns out our brains age differently, and menopause plays a key role here for women. Now most people think of the brain as a kind of black box, isolated from the rest of the body. But in reality, our brains are in constant interaction with the rest of us. And perhaps surprisingly, the interactions with the reproductive system are crucial for brain aging in women. These interactions are mediated by our hormones. And we know that hormones differ between the genders.

Men have more testosterone, women have more estrogens. But what really matters here is that these hormones differ in their longevity. Men's testosterone doesn't run out until late in life, which is a slow and pretty much symptom-free process, of course.

Women's estrogens, on the other hand, start fading in midlife, during menopause, which is anything but symptom-free. We associate menopause with the ovaries, but when women say that they're having hot flashes, night sweats, insomnia, memory lapses, depression, anxiety, those symptoms don't start in the ovaries. They start in the brain. Those are neurological symptoms. We're just not used to thinking about them as such. So why is that? Why are our brains impacted by menopause?

Well, first of all, our brains and ovaries are part of the neuroendocrine system. As part of the system, the brain talks to the ovaries and the ovaries talk back to the brain, every day of our lives as women. So the health of the ovaries is linked to the health of the brain. And the other way around. At the same time, hormones like estrogen are not only involved in reproduction, but also in brain function. And estrogen in particular, or estradiol, is really key for energy production in the brain.

At the cellular level, estrogen literally pushes neurons to burn glucose to make energy. If your estrogen is high, your brain energy is high. When your estrogen declines though, your neurons start slowing down and age faster. And studies have shown that this process can even lead to the formation of amyloid plaques, or Alzheimer's plaques, which are a hallmark of Alzheimer's disease.

These effects are stronger in specific brain regions, starting with the hypothalamus, which is in charge of regulating body temperature. When estrogen doesn't activate the hypothalamus correctly, the brain cannot regulate body temperature correctly. So those hot flashes that women get, that's the hypothalamus. Then there's the brain stem, in charge of sleep and wake. When estrogen doesn't activate the brain stem correctly, we have trouble sleeping. Or it's the amygdala, the emotional center of the brain, close to the hippocampus, the memory center of the brain. When estrogen levels ebb in these regions, we start getting mood swings perhaps and forget things. So this is the brain anatomy of menopause, if you will.

But let me show you what an actual woman's brain can look like. So this is a kind of brain scan called positron emission tomography or PET. It looks at brain energy levels. And this is what you want your brain to look like when you're in your 40s. Really nice and bright. Now this brain belongs to a woman who was 43 years old when she was first scanned, before menopause. And this is the same brain just eight years later, after menopause. If we put them side by side, I think you can easily see how the bright yellow turned orange, almost purple. That's a 30 percent drop in brain energy levels.

Now in general, this just doesn't seem to happen to a man of the same age. In our studies with hundreds of people, we show that middle-aged men usually have high brain energy levels. For women, brain energy is usually fine before menopause, but then it gradually declines during the transition. And this was found independent of age. It didn't matter if the women were 40, 50 or 60. What mattered most was that they were in menopause.

So of course we need more research to confirm this, but it looks like women's brains in midlife are more sensitive to hormonal aging than just straight up chronological aging. And this is important information to have, because so many women can feel these changes. So many of our patients have said to me that they feel like their minds are playing tricks on them, to put it mildly. So I really want to validate this, because it's real. And so just to clarify, if this is you, you are not crazy.

Thank you.

It's important. 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, or is going through a transition and needs time and support to adjust. Also, if anyone is concerned that middle-aged women might be underperformers, I'll just quickly add that we looked at cognitive performance, God forbid, right?

Let's not do that. But we looked at cognitive performance, and we found absolutely no differences between men and women before and after menopause. And other studies confirm this. So basically, we may be tired, but we are just as sharp.

Get that out of the way.

That all said, there is something else more serious that deserves our attention. If you remember, I mentioned that estrogen declines could potentially promote the formation of amyloid plaques, or Alzheimer's plaques. But there's another kind of brain scan that looks exactly at those plaques. And we used it to show that middle-aged men hardly have any, which is great. But for women, there's quite a bit of an increase during the transition to menopause. And I want to be really, really clear here that not all women develop the plaques, and not all women with the plaques develop dementia. Having the plaques is a risk factor, it is not in any way a diagnosis, especially at this stage.

But still, it's quite an insight to associate Alzheimer's with menopause. We think of menopause as belonging to middle age and Alzheimer's as belonging to old age. But in reality, many studies, including my own work, had shown that Alzheimer's disease starts with negative changes in the brain years, if not decades, prior to clinical symptoms. So for women, it looks like this process starts in midlife, during menopause. Which is important information to have, because it gives us a time line to start looking for those changes.

So in terms of a time line, most women go through menopause in their early 50s. But it can be earlier, often because of medical interventions. And the common example is a hysterectomy and/or an oophorectomy, which is the surgical removal of the uterus and/or the ovaries. And unfortunately, there is evidence that having the uterus and, more so, the ovaries removed prior to menopause correlates with the higher risk of dementia in women. And I know that this is upsetting news, and it's definitely depressing news, but we need to talk about it because most women are not aware of this correlation, and it seems like very important information to have.

Also, no one is suggesting that women decline these procedures if they need them. The point here is that we really need to better understand what happens to our brains as we go through menopause, natural or medical, and how to protect our brains in the process.

So how do we do that? How do we protect our brains? Should we take hormones? That's a fair question, it's a good question. And the shortest possible answer right now is that hormonal therapy can be helpful to alleviate a number of symptoms, like hot flashes, but it's not currently recommended for dementia prevention. And many of us are working on testing different formulations and different dosages and different time lines, and hopefully, all this work will lead to a change in recommendations in the future.

Meanwhile, there are other things that we can do today to support our hormones and their effects on the brain that do not require medications but do require taking a good look at our lifestyle. That's because the foods we eat, how much exercise we get, how much sleep we get or don't get, how much stress we have in our lives, those are all things that can actually impact our hormones -- for better and for worse.

Food, for example. There are many diets out there, but studies have shown that the Mediterranean diet in particular is supportive of women's health. Women on this diet have a much lower risk of cognitive decline, of depression, of heart disease, of stroke and of cancer, and they also have fewer hot flashes. What's interesting about this diet is that it's quite rich in foods that contain estrogens in the form of phytoestrogens or estrogens from plants that act like mild estrogens in our bodies. Some phytoestrogens have been linked to a possible risk of cancer, but not the ones in this diet, which are safe. Especially from flax seeds, sesame seeds, dried apricots, legumes and a number of fruits. And for some good news, dark chocolate contains phytoestrogens, too.

So diet is one way to gain estrogens, but it's just as important to avoid things that suppress our estrogens instead, especially stress. Stress can literally steal your estrogens, and that's because cortisol, which is the main stress hormone, works in balance with our estrogens. So if cortisol goes up, your estrogens go down. If cortisol goes down, your estrogens go back up. So reducing stress is really important. It doesn't just help your day, it also helps your brain.

So these are just a few things that we can do to support our brains and there are more. But the important thing here is that changing the way we understand the female brain really changes the way that we care for it, and the way that we frame women's health. And the more women demand this information, the sooner we'll be able to break the taboos around menopause, and also come up with solutions that actually work, not just for Alzheimer's disease, but for women's brain health as a whole. Brain health is women's health.

Thank you.

Thank you. Oh, thank you.