Your Brain at 80 Starts Now: What Women Can Do to Protect Their Brain Health

4 days ago

14 min read

Women tend to live longer than men. According to the CDC in 2024, the average American lifespan for men is 76.5 years. For women, it is 81.4 years! But as you know, living longer doesn't necessarily mean we're living healthier. Throughout my education in geriatrics and my years of clinical practice, I've cared for many older adults dealing with chronic illness, cognitive impairment, physical immobility, and other conditions that strip patients of their autonomy and independence for the rest of their lives. As we age, we become increasingly dependent on our support systems. The tragedy is when this stage arrives far earlier than what we hoped for.

Many of you have experienced this firsthand when caring for aging parents or loved ones. You see clearly how drastically their lives change, as well as the lives of their loved ones and caregivers. One of the most common diseases affecting older adults is dementia. For many of the women I see in my practice, developing dementia is a huge fear. It's something that comes up often in our conversations, especially for women who’ve watched a parent or loved one go through it. I've seen enough to know that I want a different trajectory, not only for myself and the people I love, but for my patients, too. And while there is no single way to prevent dementia, what we eat and how we care for our bodies can play an important role in supporting our health as we age.

I've always been interested in nutrition. In fact, I minored on it during my undergraduate studies. Over the years, I’ve incorporated what I learned into my lifestyle in whatever ways I could. Through reading, researching, and listening to experts in these fields, I've learned so much more about how our hormones, muscles, brain, and overall health are connected. On top of that, my sister Susannah, a registered dietitian in San Francisco, has been a wonderful resource to keep up with evolving science around nutrition and healthy aging. Much of this wasn't something I fully understood earlier in my career, and the more I learn, the more I want to share with my patients.

What can we do now to protect our brain health?

While we can't control everything that happens as we age, there is a great deal we can do now to expand the years of health and independence we get to have. Perimenopause and menopause are particularly important times to start being proactive about long-term health in our later years. The last time I wrote about brain health, I discussed why brain fog during perimenopause and menopause is real and why it usually isn't a sign of dementia. But that brings up an important follow-up question that is especially important for women: What about dementia? And what can we do now to lower our risk of dementia later in life?

Almost two-thirds of Americans living with Alzheimer's disease are women. By age 45, a woman's estimated lifetime risk of developing Alzheimer's is approximately 1 in 5, compared with about 1 in 10 for men. [1]

Before getting too scared about these numbers, approximately 45% of dementia cases worldwide could potentially be prevented or delayed by addressing 14 modifiable risk factors, according to a major 2024 report published in The Lancet.

These risk factors include high blood pressure, elevated LDL cholesterol, diabetes, physical inactivity, hearing loss, and social isolation. [2] Genetics, age, and other factors still matter, but this research demonstrates that we have opportunities to influence our brain health, often decades before symptoms ever show up! The more we learn, the clearer it becomes that what's good for our heart, muscles, and metabolic health is often good for our brain, too.

What does the research actually tell us?

We've known for years that exercise, good nutrition, and cardiovascular health are associated with better brain health as we age. Clinical trials are giving us more evidence that addressing these factors can make a big difference.

The SPRINT MIND trial found that more intensive blood pressure treatment reduced the risk of mild cognitive impairment, although the reduction in dementia itself was not statistically significant. [3]

Another large study involving approximately 34,000 adults in China found that improving blood pressure control reduced dementia risk by about 15% over four years. [4]

In the 2025 U.S. POINTER study, more than 2,100 older adults focused on exercise, nutrition, social connection, cognitive challenges, and cardiovascular health. Both groups improved on cognitive testing, but those receiving more structured guidance and support improved more. [5]

1. Move your body, and make muscle a priority

The more I learn about the importance of muscle in midlife and as we age, the more I encourage women to prioritize strength training. We begin losing muscle mass as early as our 30s, and that loss can accelerate as we get older. This age-related loss of muscle and strength can eventually contribute to sarcopenia: the age-related, progressive loss of skeletal muscle mass. This increases our risk of falls, which ultimately make or break how much autonomy we have.

Muscle does so much more than movement. Skeletal muscle plays an important role in regulating blood sugar, improving insulin sensitivity, and supporting metabolic health. Studies have also found a connection between lower muscle strength and cognitive decline. That doesn't mean losing muscle causes dementia, but it's another good reason to focus on maintaining our strength as we age. [2, 6]

Beyond brain health, maintaining strength and power helps us continue doing everyday things we often take for granted… like carrying groceries, climbing stairs, getting up from the floor, or catching ourselves if we lose our balance. This is why I encourage women to think about exercise as an investment in their future independence.

One often-overlooked measure of strength as we age is grip strength. Studies have linked lower grip strength to an increased risk of disability and cognitive decline. In one large study involving more than 466,000 adults, lower grip strength was associated with a higher risk of developing dementia. [6] That doesn't mean weak hands cause dementia, but grip strength is associated with our risk of cognitive decline (crazy, I know!) and is one way for medical providers to assess overall muscle strength and physical health.

So… what can you do about it, and where should you start? Below I’ve laid out the basics of what I recommend:

Strength train 2–3 times a week. Focus on progressive resistance training, gradually increasing the weight or resistance as you get stronger. Exercises like farmer's carries (walking while holding weights), deadlifts, and rows are great for building overall strength while also improving grip strength.
Cardiovascular exercise. Aim for at least 150 minutes of moderate activity weekly or 75 minutes of vigorous activity. Walking, cycling, and swimming are good options. Consider adding short, higher-intensity intervals as your fitness allows.
Power and balance. We lose the ability to generate force quickly as we age. Appropriate jumping, hopping, or other power exercises can help maintain this ability, while yoga and balance training support stability.
Movement throughout the day. Even if you're exercising regularly, don't underestimate the benefits of walking and reducing prolonged sitting.

If you're new to exercise, start with what you can do and gradually build from there. We want to challenge ourselves and get stronger, but we also need to be smart about it and avoid injuries. Proper technique and knowing when to progress are important.

How does exercise benefit the brain itself?

This is a fascinating question, and the research that’s been conducted to find answers demonstrates fascinating results. In one randomized trial involving 120 older adults, a year of aerobic exercise increased the size of the hippocampus, an area involved in memory, by approximately 2%. [7] 2 percent may not seem like a lot, but the hippocampus is an important area for memory, and maintaining its volume may be meaningful as we age.

Exercise can also influence levels of brain-derived neurotrophic factor, or BDNF, a protein that helps support the survival and connections of brain cells. I think of BDNF as a kind of “fertilizer” for your brain. It plays an important role in learning, memory, and neuroplasticity, which is the brain's ability to adapt and form new connections.

The same exercise study found that increases in hippocampal volume were associated with higher blood levels of BDNF. [7] Although these findings don't prove exercise prevents dementia through causation, they help us understand why physical activity may benefit brain health beyond its effects on blood pressure and blood sugar.

2. What should we actually be eating?

When it comes to eating for brain health, I often recommend the MIND diet as a helpful starting point. The MIND diet combines elements of the Mediterranean and DASH diets, with an emphasis on foods that support cardiovascular and brain health. The Mediterranean diet emphasizes fruits, vegetables, whole grains, beans, nuts, olive oil, and fish. The DASH diet (Dietary Approaches to Stop Hypertension) focuses on nutrient-rich foods that help lower blood pressure, including fruits, vegetables, whole grains, and low-fat dairy, while limiting sodium and saturated fats.

So what does that look like in practice?

Some of the key recommendations include:

Leafy greens: Aim for at least 6 servings a week.
Other vegetables: At least one serving daily.
Berries: At least twice a week.
Nuts: A small handful most days.
Beans and lentils: Several times a week.
Whole grains: Include them regularly.
Fish: At least once a week, preferably fatty fish such as salmon or sardines.
Olive oil: Make this your main cooking oil.

The goal isn't to follow a rigid set of rules. It's to build meals around a variety of nutrient-rich, minimally processed foods.

A few nutrients deserve particular attention as we age:

Healthy fats and omega-3s

The type of fat we eat matters. Omega-3 fatty acids, particularly EPA and DHA found in fatty fish, are important components of brain cell membranes and play an important role in brain health and function.

I also encourage women to replace saturated fats with unsaturated fats from sources like olive oil, nuts, and avocados. This supports cardiovascular health, which is closely connected to brain health.

Colorful fruits and vegetables

Don't underestimate the power of colorful plant foods! Berries, leafy greens, apples, and other fruits and vegetables contain compounds called flavonoids. These have antioxidant and anti-inflammatory properties, and studies have associated higher flavonoid intake with better cognitive health.

Protein

Getting enough protein becomes especially important as we age because it helps us maintain and build muscle, particularly when combined with strength training.

For most women, I recommend aiming for 1.4–1.8 grams of protein per kilogram of body weight daily, depending on activity level and individual needs. [13, 14]

For example, a woman weighing 150 pounds would aim for approximately 95–120 grams of protein daily. Try to spread that protein throughout the day, aiming for roughly 30–40 grams at each meal.

Fiber

Fiber helps lower cholesterol, regulate blood sugar, and support the healthy bacteria in our gut. These bacteria produce substances that may help regulate inflammation and influence brain health. We're still learning exactly what this means, particularly when it comes to dementia, but it's one more reason to make fiber a priority.

What foods should we limit?

The MIND diet also recommends cutting back on processed meats, fried foods, butter, and highly processed snacks. The idea isn't that you can never enjoy these foods, but that they shouldn't make up the foundation of your diet!

What about alcohol?

We do know that heavier drinking can harm the brain and that even small amounts of alcohol can increase the risk of certain cancers, including breast cancer. That doesn't mean you can't enjoy a glass of wine or a cocktail. I just want you to have the information so you can make your own decisions. If you don’t drink, there's no health reason to start. And if you do, being mindful of how much and how often you drink is important!

3. Stay connected and keep challenging your brain

Social isolation is another risk factor for dementia identified in the 2024 Lancet Commission report. [2] It's not just about being around other people, but about having meaningful relationships and staying involved in activities we enjoy. Community is scientifically proven to increase longevity! Don’t overlook it.

What are some things you enjoy doing with others? Maybe it's a walking group, yoga class, volunteering, a book club or simply meeting a friend for coffee every week. Additionally, it's important to keep challenging our brains. Learning something new, whether it's a language, musical instrument or a new skill, keeps our brains stimulated and engaged. The brain is a muscle, too; you have to work it or it will atrophy. Taking a class, playing cards, or trying something creative are other great options.

Sleep

I've written before about how important sleep is during perimenopause and menopause. Getting enough quality sleep is so important for memory, learning, and overall brain function. As most know, poor sleep can also make brain fog and difficulty concentrating worse.

One thing I particularly want women to be aware of is sleep apnea, which becomes more common after menopause. And don't assume you can't have sleep apnea just because you're at a healthy weight. It can affect women of all body types and the symptoms aren't always what we'd expect. Instead of the typical loud snoring or gasping for air, some women experience insomnia, frequent awakenings, morning headaches, or daytime fatigue… all of which may point to sleep apnea.

Untreated, it's associated with cardiovascular problems and may affect cognitive health. If you're getting seven or eight hours of sleep but still waking up exhausted or frequently waking throughout the night, it's important to bring it up with your clinician.

Stress

We also can’t forget about stress. Unfortunately, between careers, families, relationships, and caring for aging parents, many women spend years putting their own needs last. Chronic stress can affect our sleep, mood, and concentration. Finding ways to manage stress is crucial, whether it's through exercise, yoga, spending time outdoors, or simply setting better boundaries for yourself.

Women have some additional risk factors worth knowing about

There are certain aspects of a woman's reproductive and hormonal history that may also influence her long-term brain health.

1. Early menopause

Women who experience menopause before age 45 may have a higher risk of dementia later in life, with some studies suggesting greater risk when menopause occurs before age 40. The research isn't completely consistent, but it's an important association. [8] This is useful information to share with your clinician, because understanding your reproductive history can help guide conversations about your overall health and the steps you can take to support it.

2. Surgical menopause

Having both ovaries removed before natural menopause causes a sudden decline in estrogen.

Some observational studies have linked early removal of both ovaries to an increased risk of dementia, particularly when surgery occurs before age 45. [8, 9] If you've had this surgery, it doesn't mean dementia is inevitable. It does mean your surgical and hormonal history deserves to be part of your long-term health plan.

3. High blood pressure during pregnancy

Women with a history of hypertensive disorders of pregnancy have a higher risk of developing cardiovascular disease and hypertension later in life. Research has also found an association with increased dementia risk, particularly vascular dementia. [10] This is one reason I think it's so important to ask women about their pregnancy history, even when they're in their 50s, 60s, and beyond. None of these risk factors means you're destined to develop dementia, but they're important pieces of your health history and should be part of the conversation when we're evaluating your long-term health, and most importantly, what can be done about it!

What about menopausal hormone therapy?

We know that estrogen does much more than help regulate our menstrual cycles. It plays an important role in how our brain uses energy, memory, learning, and communication between brain cells. As estrogen levels decline during menopause, our brains go through changes, too.

So naturally, the question is whether replacing estrogen might help protect our brains as we age.

One thing I think is particularly important is when hormone therapy is started and what type is used. You may have heard about the Women's Health Initiative Memory Study, which found an increased risk of dementia in women who started certain oral hormone therapies at age 65 or older. But this study is outdated, and was with a very specific population with a specific type of estrogen. The findings don’t apply to women starting hormone therapy around menopause, especially with different formulations, such as transdermal estradiol and micronized progesterone. While research suggests that starting hormone therapy earlier is better for menopause and perimenopause symptoms, we still need more studies to know whether it reduces dementia risk.

For now, The Menopause Society does not recommend hormone therapy specifically to prevent dementia in women who experience menopause at the usual age. [11] That doesn't mean estrogen isn't important for our brains. It simply means we don't have enough research yet to say that hormone therapy prevents diseases like Alzheimer's.

The American College of Obstetricians and Gynecologists (ACOG) recommends that women with primary ovarian insufficiency (POI) take hormone therapy until at least the average age of menopause, around 50–51. But that doesn't mean they automatically need to stop at that age. If a woman is still having symptoms or has other reasons to continue, hormone therapy may still be appropriate. As with any woman using hormone therapy, the decision should be individualized, taking into account her symptoms, medical history, and the potential benefits and risks.

What about the new Alzheimer's blood tests?

You may have heard about newer blood tests, including p-tau217, that can help identify changes associated with Alzheimer's disease. These are exciting developments, particularly for helping diagnose Alzheimer's in people already experiencing memory or thinking problems. Right now, these tests aren't currently recommended for routine screening in people without cognitive impairment outside of research settings, but this screening will likely expand in years to come. [12,15]

If you're noticing changes in your memory or thinking, don't just assume it's menopause or a normal part of aging. Talk with someone on your healthcare team about what might be going on.

Your Brain Health Checklist

Know your numbers

Know your blood pressure and work with your clinicians to manage it.
Know your cholesterol, including LDL and ApoB when appropriate.
Know your blood sugar or A1c.
Address hearing or vision problems.

Build habits that support your brain and body

Strength train 2–3 times a week, progressively challenging your muscles.
Aim for 150 minutes of moderate cardiovascular exercise or 75 minutes of vigorous activity weekly.
Include appropriate higher-intensity intervals, power exercises, and balance training.
Incorporate exercises that challenge your grip strength, such as farmer's carries.
Move regularly throughout the day.
Eat adequate protein and include fiber-rich foods such as vegetables, berries, nuts, beans, and whole grains.
Make time for social connections and activities that challenge your brain.
Prioritize sleep and discuss possible sleep apnea symptoms.
Find ways to manage stress.

Know your women's health history

Know your age at menopause.
Tell your clinician if you had your ovaries removed.
Share any history of preeclampsia or high blood pressure during pregnancy.

And if you're noticing memory problems that are progressively worsening, difficulty managing familiar tasks, or changes that family members are noticing, don't assume it's just menopause. Those symptoms deserve an evaluation.

The Bottom Line

We can't control our age or genetics, and we certainly can't guarantee that making healthy choices will prevent dementia or physical decline. But there is a lot we can do. This is why I spend so much time talking with my patients about blood pressure, cholesterol, blood sugar, muscle, exercise, sleep, and nutrition. These aren't separate conversations, they're all connected.

Menopause is an important time to take a closer look at these factors and make changes that can benefit us for decades to come. At Dreava Health, my goal is to help women understand these connections and make informed decisions about their health, not just during menopause, but for the years that follow. Because it's not just about how long we live. It's about how well we live those years.

References

Alzheimer's Association. (2026). 2026 Alzheimer's disease facts and figures. Alzheimer's & Dementia. https://doi.org/10.1002/alz.71345
Livingston G, et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404, 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
SPRINT MIND Investigators. (2019). Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial. JAMA, 321(6), 553–561. https://doi.org/10.1001/jama.2018.21442
Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: An open-label, blinded-endpoint, cluster-randomized trial. (2025). Nature Medicine, 31, 2054–2061. https://doi.org/10.1038/s41591-025-03616-8
Baker LD, et al. (2025). Structured vs self-guided multidomain lifestyle interventions for global cognitive function: The US POINTER randomized clinical trial. JAMA, 334(8), 681–691. https://doi.org/10.1001/jama.2025.12923
Handgrip strength and all-cause dementia incidence and mortality: Findings from the UK Biobank prospective cohort study. (2022). https://pubmed.ncbi.nlm.nih.gov/35445560/
Erickson KI, et al. (2011). Exercise training increases the size of the hippocampus and improves memory. Proceedings of the National Academy of Sciences, 108(7), 3017–3022. https://doi.org/10.1073/pnas.1015950108
8. Han SL, et al. (2023). Male- and female-specific reproductive risk factors across the lifespan for dementia or cognitive decline: A systematic review and meta-analysis. BMC Medicine. https://pubmed.ncbi.nlm.nih.gov/37996855/
9. Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis. (2019). https://pubmed.ncbi.nlm.nih.gov/30928686/
10. Carey C, et al. (2024). Hypertensive disorders of pregnancy and the risk of maternal dementia: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 231(2), 196–210. https://doi.org/10.1016/j.ajog.2024.01.013
11. The Menopause Society. (2024). Statement on hormone therapy misinformation. https://menopause.org/wp-content/uploads/2024/09/TMS-statement-on-HT-Misinformation.pdf
12. Alzheimer's Association. (2025). Clinical practice guideline: Integrating blood-based biomarkers in Alzheimer's disease specialized care. https://pro.alz.org/files/download/E224A154-A199-4DE6-92DA-0B2F87727B70.pdf

13. Bauer J, et al. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, 14(8), 542–559. https://doi.org/10.1016/j.jamda.2013.05.021 14. Jäger R, et al. (2017). International Society of Sports Nutrition position stand: Protein and exercise. Journal of the International Society of Sports Nutrition, 14, 20. https://doi.org/10.1186/s12970-017-0177-8 15. Jack CR Jr, et al. (2024). Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup. Alzheimer's & Dementia. https://doi.org/10.1002/alz.13859