Whether you are in your twenties, or your nineties, or anywhere in between, a high-performance brain that is protected from degeneration is your most important possession — especially if it comes with a lifetime guarantee. Until very recently, that has simply not been feasible. But times have changed — dramatically — and in this book I’ll show you how to keep your brain youthful for a very long lifetime. I’ll also explain why, if you work proactively to protect your brain, Alzheimer’s disease can now be an optional life experience. (Yes, really, and we have the data to prove it.) I’ll describe how to enhance the performance of your brain every day. And I’ll tell you why the relationship between your brain and your mind is truly, well, mind-blowing. So, please strap in, take a deep breath, and enjoy this ride through previously uncharted brain territory. Our destination is Better Living Through Neurobiology. Younger and wiser — that is the goal.
To get there, we must achieve brain performance and protection, not simply one or the other. Performance without protection is easy — cocaine, Adderall, and sugar can all give quick performance bursts at the expense of long-term protection. Conversely, protection without performance is also easy — you could simply have your brain frozen in liquid nitrogen, where you’ll have no risk of neurodegeneration but likely won’t be pleased with your neural performance. So, the real trick is achieving enhanced performance with a lifetime of protection with no compromises.
But one of the most under-appreciated facts about brain performance and protection is that compromise sneaks up on you…One of the most common refrains I hear is that “memory loss is just part of normal aging.” This belief is both outdated and dangerous, leading many people to delay evaluation and treatment. That’s what nearly happened to my patient Nina, whom I first met at an immersion weekend — an opportunity for people with concerns about brain aging and disease to engage in comprehensive testing aimed at understanding their state of neurological health. Nina had come not because she was deeply concerned about her health, but because she was inquisitive. Indeed, she figured she was being exceedingly proactive.
“There’s been a lot of Alzheimer’s in my family,” she explained to me. “I think I’m probably OK. But there are a few things — just little things. I’m sure it’s nothing.” “What do you mean by little?” I asked her. “You know, the silly stuff,” she said. “Misplacing things occasionally. A bit of brain fog. Losing focus. That’s just sort of what happens when we get older, right?”
I glanced down at her report. She was only in her forties. “It can be,” I said, drawing out the verb for emphasis. “But maybe, you know, it doesn’t have to be. So, let’s see if we can figure out what’s going on with you.”
It has become clear over the years that what is referred to as “normal age-related memory loss” is anything but normal. It’s a bit like saying “normal age-related hypertension” or “normal age-related insulin resistance.” Are these conditions common? Sure, and tragically so. But that doesn’t make them normal. All of these illnesses are reflections of underlying problems that can and should be treated, but in nearly all cases, they could have also been prevented.
The immersion weekend intake process included a version of the Montreal Cognitive Assessment, also known as the MoCA test. The 30-point examination is quick and easy to administer and has been demonstrated in hundreds of peer-¬reviewed studies to reflect quite accurately a person’s slide toward cognitive impairment and dementia, with each question accessing a different part of the brain’s capacity to acquire knowledge quickly, process that information, and respond accurately. It’s not a perfect tool, but for a ten-minute investment of time, doctors get a pretty good snapshot of the cognitive health of the patient sitting before them. The creator of the test, a Canadian neurologist named Ziad Nasreddine, designed the exam with the intent that a person with a fundamental education— an average high school graduate, for instance — would generally score in the range of 26 to 30 points. A score between 19 and 25 is associated with mild cognitive impairment. And anything below 20 — especially when accompanied by problems with daily activities such as dressing, personal hygiene, or the ability to use and care for assistive devices like glasses or contact lenses — is indicative of dementia, a range of conditions characterized by progressive degradation of intellectual functioning, loss of memory, and changes in personality, the most common cause being Alzheimer’s disease.
I looked back down at the chart, flipped a page, and found Nina’s score.
It was a 23. [Over the following year, with treatment, it improved to a perfect 30.]
Excerpted from THE AGELESS BRAIN. Copyright © 2025 by Dale E. Bredesen.