Last month, Dr. Zeina Chemali of the McCance Center volunteered at the Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. Dr. Chemali’s journey comes out of a growing collaboration between the McCance Center the Indian Health Service and is the first of many such endeavors.
This month we talked with Randi (not her real name), a 50-year-old clinical psychologist from the Boston area who contacted the McCance Center for Brain Health because she wanted to get ahead of her familial risk of Alzheimer’s disease.
Randi has always maintained a very healthy lifestyle, and wasn’t worried about her mental acuity. But turning 50 and learning about the possible associations between menopausal changes in the brain and the later onset of dementia, as well as going through the stress of the pandemic, were eye-opening, and made her feel more vulnerable, despite her good health.
Now she has visited twice with neurologist Dr. Jonathan Rosand, McCance Center Co-Founder and Managing Co-Director.
We talked with her about the steps she took to do something more proactive and mitigate her family risk.
Thanks for talking with us. Tell us a little about your family risk factors, and why you contacted the McCance Clinic.
I have a family history of Alzheimer's disease on both sides. My maternal grandmother and my paternal grandfather both died from complications associated with Alzheimer's. So that's the backdrop for why I reached out.
What made you reach out now — you’re young, and you seem very healthy!
Well, the backdrop for me to schedule my appointment with Dr. Rosand, and my motivation, began with an article I read in 2019 entitled “What Menopause Does to Women's Brains,” detailing the author’s experience both personally and based on her conversations with a neuroscientist who specialized in the field of women’s aging brains. The article focused primarily on the association between the depletion of estrogen in women's brains as they enter and move through menopause, and the development of Alzheimer's.
Learning that this association between menopause and dementia existed was enlightening and resulted in me beginning to look for providers or resources that could help to address my concern about the fact that my brain would start to be experiencing changes, and a decrease in estrogen, which I understand is a neuroprotective hormone.
I came away with the understanding from this article, and subsequent reading, that, for me, menopause could make me more vulnerable, and put me at even greater risk for Alzheimer’s than my genetic risk alone.
One of the things mentioned in the article I read in 2019 is how waiting for the actual signs or symptoms of Alzheimer's to appear is too late. And so beginning prevention at the time of perimenopause is actually the most effective approach for someone like me.
The article quoted Dr. Rudy Tanzi, a world-renowned neuroscientist, who founded the McCance Center with Dr Rosand, which led me to the McCance Center Clinic.
Tell us a little about your background.
I’ve been married for about 10 years. My husband and I are avid hikers and backpackers. I work full time and my profession is very demanding. My parents are in their seventies, both very healthy and thriving. So I wasn’t expecting to have a lot of room for improvement in my McCance Brain Care ScoreTM. But from the initial testing, and talking with Dr. Rosand, I actually was really surprised to learn I had some work to do to be in optimal health.
What areas of focus came out of your meeting with Dr. Rosand at the McCance Clinic?
Blood pressure: The first time Dr. Rosand and I met we talked through the dimensions of the Brain Care Score, and he took my blood pressure which I hadn’t had done in a while. I have never gotten a high blood pressure reading, so I was very surprised to learn that my blood pressure was above what it is normally, and he explained that perhaps one third of all cases of dementia could be prevented if blood pressure were controlled around the world.
Understanding what that meant just totally derailed me, as someone with longstanding pride in being a healthy person. Being healthy was sort of central to my sense of identity, I guess. And so in a way, as devastating as it was to learn this blood pressure result, it was also incredibly eye-opening for me.
Exercise: Historically, for a large part of my adult life, I've been very physically active but in the six weeks leading up to the visit with Dr. Rosand, I had not done any exercise. I think the pandemic sort of broke me, psychologically, emotionally, like so many people. By the time I met Dr. Rosand I was just sort of beginning to get my legs back under me, and then the next wave of COVID happened — it was just too much. I think that in the early weeks of 2022, I was just sort of back in that dark and lost place, and I stopped going to the gym.
Did you leave that first appointment with a clear sense of what you wanted to work on?
While I have been a physically active person, I embarrassingly did not appreciate that just as you can be developing your muscle strength by lifting weights, I could also be developing my heart or blood pressure strength by making sure that the cardiovascular part of my workouts was raising my heart rate. I realized that by working on my cardiovascular fitness, I could turn my blood pressure around.
What progress were you making when you went in six months later?
When I went back to see Dr. Rosand, I had lost about 11 pounds, so my BMI had improved. And my blood pressure had come down to a very healthy number. But there was more I could work on.
Managing Stress and Emotional Well-Being: Managing my mental health psychopharmacologically was something I wasn’t familiar with. I had never been on an antidepressant before, and had been thinking my emotional state was part of my “normal” response to the pandemic. My feeling was these were really abnormal circumstances, and it was natural to feel sad.
But my meeting with Dr. Rosand was transformative — so eye opening. The way that Dr. Rosand explained it to me was that new or recurrent depression can be caused by the same factors that cause dementia and stroke. I did not know that depression causes neuroinflammation in the brain and that that's also one of the pathways that can trigger dementia. He referred me to a psychiatrist who specializes in women’s health through perimenopause. The psychiatrist helped me realize I was susceptible to depression under certain circumstances, and prescribed medication which has been working very well.
Most importantly, I learned that treating depression could help to protect me from dementia, and if I am someone who biologically is susceptible to depression, I'm completely on board with treating it.
So what were the big takeaways at your most recent appointment?
Well number one, now I know there are things I can be doing to manage my own risk of dementia and also stroke and even future depression. I didn't know that things like blood pressure, exercise, BMI, and managing depression were gaps for me. That part was eye-opening for me. All the things we talked about are very actionable. It felt incredibly empowering.
As I said, I consider myself to be healthy — it’s part of my self-concept. My first meeting was such a source of dissonance with how I felt about myself that it created the motivation I needed to change. It was very encouraging.
So now, on this last visit, we measured my Brain Care Score again, and it was 22 — Dr. Rosand (and I) were very pleased!
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