The Alzheimer's Prevention Plan for Women: Hormones, Sleep, and Nutrit

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lisa Mosconi, a neuroscientist and associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine, New York Presbyterian Hospital. Dr. Mosconi directs the Alzheimer's Prevention Program, including the NIH-funded Women's Brain Initiative and the Alzheimer's Prevention Clinic, and was recently named director of the $50 million Program in Women's Health, Cutting Alzheimer's Risk Through Endocrinology. She is also the author of the bestselling book The Menopause Brain.

This conversation is about prevention. Dr. Mosconi has spent decades building the science that shows Alzheimer's risk in women is neither inevitable nor untreatable and that the choices women make in midlife around hormones, sleep, and nutrition have a direct, and measurable, impact on the brain's long-term health. Together, they explore why two thirds of all Alzheimer's patients are women and what role menopause plays in that disparity. Dr. Mosconi explains the difference between the rare genetic mutations that directly cause Alzheimer's, found in roughly 2% of patients, and the risk factors that shape outcomes for the other 98%, including the distinction between early and late onset disease and between sporadic and familial Alzheimer's. Both share their own family histories with dementia and what that means for their personal risk.

The conversation covers what brain fog is neurologically, why it can be severe enough to trigger fears of early onset dementia, and how to tell the difference between cognitive fatigue from the hormonal transition and something requiring clinical evaluation. Dr. Mosconi explains the concept of subjective cognitive decline, when a woman feels a real change in her cognitive performance, but standard testing still shows she is within normal range, and why that distinction matters. Her framework for when to seek evaluation: forgetting where you put your keys is not Alzheimer's. Not knowing what your keys are for is a different conversation. The episode also addresses creatine, why women have lower creatine reserves than men, and whether supplementation could support brain energy and reduce brain fog, an area Dr. Mosconi sees as genuinely worth studying.

Dr. Mosconi explains what brain imaging shows as women move through perimenopause and into postmenopause, including a surprising U-shaped pattern of brain connectivity that reorganizes into something stronger on the other side. She details why estrogen receptors in the hippocampus, amygdala, frontal cortex, and brainstem help explain the rage, anxiety, memory lapses, and sleep disruption so many women experience, not as character flaws, but as neuroscience.

On sleep, Dr. Mosconi breaks down the glymphatic system, he brain's overnight clearing mechanism, and why protecting deep sleep is one of the most powerful tools available for Alzheimer's prevention. She explains how chronic stress depletes pregnenolone, suppresses melatonin, and worsens menopause symptoms through the cortisol pathway, and why magnesium glycinate may help interrupt that cycle.

On nutrition, she walks through what the brain actually requires: omega-3 fatty acids, antioxidants including vitamin C, B vitamins especially B12, and adequate glucose, not just for energy, but for the synthesis of glutamate and GABA, the brain's most abundant neurotransmitters. She also explains why ultra-processed foods drive neuroinflammation and oxidative stress, and why what is bad for the heart is equally bad for the brain.

The episode also covers the 14 modifiable risk factors that account for over 40% of all Alzheimer's cases globally, the discovery of irisin and how muscle contraction directly supports brain health, and a candid breakdown of the Women's Health Initiative Memory Study — what it actually showed, what it did not show, and why the absence of the right research is not the same as evidence that hormone therapy doesn't work.

Guest links: