Women's brain health, at the turning point.
Why are women's brains vulnerable at midlife — and what can we actually do about it?
Professor of Medicine (Neurology), University of Toronto
Jay & Sari Sonshine Chair in Stroke Prevention & Cerebrovascular Brain Health
Founder, HER PRISM™
"Midlife is the window where vulnerability becomes wisdom."
— Aleksandra Pikula, MDEverything I do — one centre.
Six surfaces, one through-line: women's brain health.
Selected research.
Midlife is the decisive, modifiable window for women's brain health — where vascular risk, the menopause transition, and lifestyle converge to shape lifelong stroke and dementia risk.
This convergence is my clinical passion —
the through-line of my research, teaching, and care.
Click a title to read the paper ↗
- Stroke · 2026Midlife as the critical window for women's stroke and dementia prevention.
- Menopause · 2026When biology meets burnout: retaining midcareer women in academic medicine.
- Front Glob Women's Health · 2024Understanding gender inequity in brain health outcomes: missed stroke and intersectionality.
- BMJ Open · 2023Sex differences in neurology: a scoping review.
- Can J Neurol Sci · 2023Women's neurology: why we need a subspecialty for half the population.
- Stroke · 2017Serum insulin-like growth factor 1 and the risk of ischemic stroke: the Framingham Study.
- JAMA Neurol · 2014Serum BDNF and the risk for dementia: the Framingham Heart Study.
- Stroke · 2013Serum BDNF & VEGF and risk of stroke and vascular brain injury: the Framingham Study.
Up to 80% of strokes and 45% of dementia are preventable.
The midlife years are our best chance to change that trajectory — for women most of all.
Collaborators & partners.
Working across institutions on women's brain health, stroke and dementia prevention.
Speaking.
Keynotes and workshops on women's brain health, the midlife transition, and physician burnout.
Click any title to open its outline ↓
From Depletion to Bio-Harmony: Brain Health & Burnout in Women in Medicine›
Keynote · women in medicine · physician wellbeing- The convergence of four perspectives on one question — as scientist, clinician, woman in medicine, and physician-coach
- What happens to women's brain health when chronic stress in medicine meets the menopause transition
- How midlife depletion reshapes both personal and professional life and outcomes
- Bio-Harmony as the ultimate way forward — developed through self-healing and with others
- The HER PRISM framework — a structured way back from depletion
The Convergence Window — Burnout, Perimenopause & the Midlife Brain in Women Physicians›
Women in medicine · physician wellbeing- Why burnout, perimenopause, and cerebrovascular risk converge in midlife
- The biology beneath "resilience" — HPA axis, sleep architecture, estrogen withdrawal
- What the evidence shows about stroke and dementia risk in this window
- Individualized levers — sequencing, not a checklist
The Midlife Brain — Every Woman's Guide to Stroke & Dementia Prevention›
General public · women's-health & longevity audiences- Midlife as the critical, modifiable window for women's brain health
- The vascular roots of cognitive aging — the brain as a vascular organ
- The lifestyle pillars and how they work together
- What every woman can start doing now
Why Women's Brain Health Has Been Understudied — and What the Evidence Now Shows›
Scientific & clinical conferences- The historical research gap in women's neurology
- Sex differences in stroke, dementia, and the menopause transition
- The new evidence reshaping prevention
- Where the field must go next
The Brain at Work — Cognitive Capital & Retaining Midlife Talent›
Corporate & organizational leadership- Cognitive capital as an organizational asset
- Why midlife women are a high-value, at-risk segment of the workforce
- Organization-led vs individual-led wellbeing — the 80/20
- Practical workplace levers for brain health
Bio-Harmony — A Framework for Sustainable Leadership in Medicine›
Executives, academic chairs & healthcare leaders- The Bio-Harmony framework — biology, values, systems, integration
- Leading without depleting the nervous system
- Building a sustainable practice and culture
- From individual recovery to system change
From Vulnerability to Wisdom — A Vascular Neurologist's Sabbatical›
Keynote · fireside · TED-style- The personal story behind the science
- What stepping back revealed about burnout and recovery
- Translating lived experience into a framework
- The window where vulnerability becomes wisdom
Two engagements confirmed for Fall 2026.
Through HER Prism.
Long-form essays and notes on women's brain health and the lived experience of being a woman in medicine — on Substack, with a companion newsletter on LinkedIn.
Get in touch.
Speaking, media, and research collaboration. For coaching, visit herprism.co.