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Earlier this month, Bloomberg reported out on how researchers have uncovered how the body's own immune system may be driving the progression of als, a breakthrough that could reshape treatment of the fatal disease. But what's key? In a big, broader way, the findings could lead to therapies that target the immune system and may have implications for the treatment of other neurodegenerative diseases. And that includes things like Alzheimer's and Parkinson's. So let's get to our weekly BusinessWeek women's health segment. We focus on key issues in developing technologies impacting the present and future of women's health around the world. Our focus today is on Alzheimer's, which affects over 7 million Americans today. By 2050, that number is projected to rise to nearly 13 million, according to the Alzheimer's Association. With us is Dr. Fanny Alahi. She's associate professor of neurology and neuroscience at the Icahn School of Medicine at Mount Sinai, and she joins us right here in New York City. Dr. Alahi, thank you so much for being with us. I am curious, when it comes to neurological problems, what Are the difference in what affects women versus men.
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It's a pleasure to join you. The short answer to that is that we know the statistics of what are the diseases that afflict women at a higher prevalence than men, and one of them is Alzheimer's disease. But to say that it would not be correct to say that we understand the why. And I think this is exactly why we need to be doing research, because getting the answer to why are women's brains more vulnerable to Alzheimer's disease? And other kinds of neurodegenerative disorders may hold the key to understanding how these diseases strike the vulnerable brain. And so that knowledge will definitely help women. But I think beyond that would help us understand what are the key factors that make the aging brains vulnerable to.
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Alzheimer's disease At this point, do we know what do we know what are the clues or what are the hypotheses that medical professionals have established?
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A central hypothesis that we and others are following is that in women's lives, there is a huge physiological transition in midlife due to menopause. That shift in hormones that the brain and other organs see is unique to women. It happens in men, but at a much later stage in their life. And so what we are doing at Mount Sinai is to specifically query the impact that lower levels of estrogen may have on the cells that form the vasculature of the brain, the protective barriers of the brain and other cells within the brain.
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So is a fix, an easy fix, just keeping the hormone levels higher? And I know that there are consequences to doing that potentially. Like, how do we think about, or how do you guys think about R and D and what can be done to help women, since they are certainly. It sounds like more vulnerable as a result when it comes to Alzheimer's.
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Absolutely. We certainly hope that for those who can get hormone replacement therapy, that may diminish their risk to a certain extent. But the question is, when do those hormones need to be started? And we think it needs to be perimenopause. You cannot wait too long before starting them. The second question is, how long do you. Do you keep those hormones? As you alluded to it, those hormones also increase the risk of other things, such as cancers, and those risks increase as women age. So how long do you keep someone on hormones in order to decrease their risk for Alzheimer's disease, which is a late life phenomenon? And then the third question is, for the many women who actually cannot be on those hormones, what can we discover about what those hormones do and just go ahead and develop drugs and interventions that activate or deactivate those pathways.
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What about genetic components? If somebody else in the family has had Alzheimer's, that trait being passed down, does that happen?
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That's an excellent question. And in fact, one of the most prevalent genetic risk factors for Alzheimer's disease, the APOE4ille, we think, interacts with hormones in exerting its effect on Alzheimer's disease. Now, the question of heritability of Alzheimer's goes beyond just Apoe 4, and that in of itself is a really big area of research. There are other components of the disease, such as metabolism and mitochondria that we inherit from the maternal side, for instance, that could be contributing to this heritability. But. But even beyond that, there are aspects of our ancestry that continue within us in forms that we currently don't fully grasp, and I hope we will understand in the future to again contribute to better therapeutic developments.
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So talk to us a little bit about. You've done a lot of work when it comes to blood biomarkers. Why might this be important here?
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Blood biomarkers are very exciting because similar to other disorders such as cardiovascular disease, cancer, kidney, liver disease, you really want to detect disease before individuals have prominent symptoms that bring them to the medical attention. And in the case of Alzheimer's and other kinds of neurodegenerative disorders, those are cognitive impairment and ultimately dementia. At the point that someone has very significant cognitive changes, we think we could potentially slow down disease progression. But to say that we can stall it or have game changing treatments completely change someone's brain trajectory would be not, not realistic. So these blood biomarkers can detect risk of future symptoms with increasingly better predictive ability. One thing that I should mention is that we don't think that the pathologies that eventually lead to dementia start at the time that symptoms present. They really start decades before.
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Wow.
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And these blood biomarkers for Alzheimer's, Alzheimer's disease are detecting that? My lab works on expanding that panel because right now we are detecting only a few aspects of the disease. We think a key component of Alzheimer's and other neurodegenerative diseases are the changes that happen to the blood vessels of the brain. And at the moment, we have no biomarkers that detect vascular pathologies with great precision.
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Dr. Lahy, we just have about 30 seconds left. Are you optimistic that during your career we will see a major breakthrough in either treatment or prevention of Alzheimer's?
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Absolutely. I'm going to go further in saying that I hope that it's not at the end of my career. I have great hope for the decade that is to come. We already have two FDA approved treatments that slow down disease progression and many other game changing treatments are in the pipeline.
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Well, we so appreciate getting a chance to talk to you and you really like laying it out so clearly and specifically. Dr. Fanny Elahi. She's Associate professor of Neurology and Neuroscience at the Icahn School of Medicine at Mount Sinai. Bloomberg businessweek is brought to you by Evolving Money, a podcast that explores how cryptocurrency is the next logical evolution of the financial system. The program investigates how traditional finance firms are integrating crypto into their operations now that Washington has begun to pass much needed regulations. Follow the podcast, which is sponsored by Coinbase. Wherever you get your audio programs, support.
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Podcast: Bloomberg Businessweek
Episode: The Fight Against Alzheimer’s Disease
Date: November 3, 2025
Hosts: Carol Massar and Tim Stenovec
Guest: Dr. Fanny Elahi, Associate Professor of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai
This episode of Bloomberg Businessweek focuses on the fight against Alzheimer's Disease, highlighting the higher prevalence in women, emerging scientific hypotheses, the role of hormones and genetics, and promising advances in early detection and treatment. The conversation, led by Carol Massar and Tim Stenovec, centers on Women's Health and features expert insights from Dr. Fanny Elahi.
Timestamp: 01:28–03:24
"One of them is Alzheimer's disease. But to say that it would not be correct to say that we understand the why. And I think this is exactly why we need to be doing research, because getting the answer to why are women's brains more vulnerable... may hold the key to understanding how these diseases strike the vulnerable brain."
Understanding women’s heightened risk could unlock broader insights into neurodegeneration.
Timestamp: 03:24–05:43
Central Hypothesis: The drastic hormonal transition during menopause may influence women’s risk. Estrogen loss is unique to women’s mid-life, while in men it occurs later.
Q&A: Could hormone replacement be the fix?
Quote (Dr. Elahi at 04:41):
"You cannot wait too long before starting them... As you alluded to, those hormones also increase the risk of other things, such as cancers, and those risks increase as women age."
While hormone therapy could help, it's a complex tool requiring careful timing and risk assessment, and more targeted treatments are urgently needed.
Timestamp: 05:43–06:52
APOE4 allele: A major genetic risk factor, possibly acting through interaction with hormones.
Beyond APOE4:
Quote (Dr. Elahi at 05:53):
"One of the most prevalent genetic risk factors for Alzheimer's disease, the APOE4 allele, we think, interacts with hormones in exerting its effect on Alzheimer's disease."
Genetics, especially when intertwined with hormonal changes, plays a significant but still only partly understood role in disease development.
Timestamp: 06:52–08:40
Early is crucial: Blood biomarkers can spot risk decades before symptoms appear, just as in cancer or heart disease.
State of the field:
Quote (Dr. Elahi at 07:01):
"Blood biomarkers are very exciting because similar to other disorders... you really want to detect disease before individuals have prominent symptoms."
Quote (Dr. Elahi at 08:10):
"We think a key component of Alzheimer's and other neurodegenerative diseases are the changes that happen to the blood vessels of the brain. And at the moment, we have no biomarkers that detect vascular pathologies with great precision."
Developing accurate blood tests for early detection and vascular changes is a pivotal next step.
Timestamp: 08:40–09:07
"Absolutely. I'm going to go further in saying that I hope that it's not at the end of my career. I have great hope for the decade that is to come. We already have two FDA approved treatments that slow down disease progression and many other game changing treatments are in the pipeline."
There is tangible progress and justified hope for significant therapeutic breakthroughs within the next decade.
This episode succinctly clarifies the intricate interplay of sex, hormonal change, genetics, and early detection in Alzheimer’s Disease, especially for women. With candid, hopeful guidance from Dr. Elahi, listeners gain a clear view of current challenges, ongoing research paths, and the brightening outlook for meaningful progress in both treatment and prevention in the coming years.