Brain Health Service: a center for dementia prevention for women and men at Policlinico San Donato

The Brain Health Service is both a clinical and research program designed for adult women and men. It offers a structured pathway for dementia risk assessment and prevention based on scientific evidence and a personalized medical approach.

Women present specific biological, hormonal, and clinical characteristics that significantly influence the risk, onset, and progression of neurodegenerative diseases. For this reason, within a service open to the entire adult population, Policlinico San Donato developed 3D, a pathway dedicated to women’s brain health, designed to address these specific needs.

Dementia risk in women

Women account for approximately 70% of dementia cases, with incidence peaking after menopause, a figure that highlights an important and still underrecognized vulnerability.

Professor Maria Salsone explains that estrogens, particularly estradiol, play a crucial neuroprotective role thanks to their anti-inflammatory and vasodilatory effects in brain areas involved in cognitive functions. With menopause, the decline of these hormones increases the brain’s exposure to factors that promote:

• aging processes
• cognitive deterioration

Genetic factors associated with Alzheimer’s disease risk

An additional important factor is genetic predisposition. Some individuals carry a variant of the APOE gene (APOE-ε4 allele), associated with an increased risk of Alzheimer’s disease.

In women who carry this variant, the risk may rise significantly more than in men, making prevention and monitoring even more relevant.

Disease progression in women

The progression of dementia may also differ between men and women. In women, the transition from early symptoms, such as mild memory or concentration difficulties, to more advanced stages often occurs more rapidly, meaning symptoms may worsen over a shorter period.

Women also more frequently experience impairments in visuospatial functions, including orientation, route recognition, distance perception, and spatial organization. In daily life, this may translate into getting lost in familiar places or increased difficulty with tasks requiring coordination and spatial awareness.

These differences led to the creation of the 3D project, specifically designed for women.

The 3D pathway evaluates all factors necessary for a comprehensive dementia risk assessment, including:

• genetic predisposition analysis (APOE gene)
• evaluation of hormonal changes related to peri- and post-menopause
• assessment of mood disorders and sleep quality
• screening for osteopenia and osteoporosis, visual and hearing deficits, dyslipidemia, periodontal disease, and cardiovascular risk factors

Lifestyle factors, including nutrition, physical activity, and daily habits, are also analyzed to build a fully personalized profile.

The goal is to develop a preventive strategy integrating all these dimensions, supported by digital technologies and artificial intelligence algorithms capable of identifying risk profiles and suggesting tailored interventions.

The 3D project aims to detect early signs of cognitive impairment in women and define prevention strategies based on individual characteristics. The program integrates:

• gender medicine with neurological and neuropsychological assessments
• biomarker analysis and endocrine, metabolic, osteoarticular, and cardiovascular evaluations
• digital tools and AI algorithms for personalized risk profiling

The clinical lead of the 3D project is Dr. Federico Emanuele Pozzi, in collaboration with psychologist Elisa Bortolin, responsible for neuropsychological assessments.

Access to the service begins with a specialized neurological consultation to collect the patient’s clinical history and identify individual risk factors.

Based on this evaluation, the neurologist may recommend further investigations, including:

• a comprehensive neuropsychological assessment conducted by psychologist Elisa Bortolin
• blood tests, genetic or hormonal analyses, imaging studies, and evaluations of lifestyle and cardiovascular and metabolic health when necessary

Some assessments are integrated into dedicated pathways, such as the women-focused 3D program.

Based on the overall results, a personalized prevention plan is developed, which may include recommendations on:

• nutrition
• physical activity
• sleep quality
• stress management
• cognitive stimulation
• cardiovascular risk control

The pathway concludes with targeted follow-up visits to monitor changes and update prevention strategies over time.

Dementia prevention requires awareness, early diagnosis, and personalized care pathways. The Brain Health Service at Policlinico San Donato was created to provide patients, especially women, with a center of excellence capable of identifying early warning signs, addressing modifiable risk factors, and protecting brain health over the long term.