By Dale Bredesen, M.D., Chief Science Officer for Apollo Health

“My Maserati does 185, I lost my license, now I don’t drive.” — Joe Walsh.

You may have heard the old song, “Life’s Been Good,” by Joe Walsh — but imagine for a moment that you are driving a Maserati, and imagine that it has a “supercharged” mode for extra-high performance, and that it also has some luxuries such as moving your seat to its optimal place for comfort, handling all of your calls, music, etc. Now imagine that you are driving along and you realize that energy is critically low — in gasoline and battery charge — and you need to do whatever you can to make it to the next charging or gasoline station. What would you do?

The first thing you would probably do is to shut down the high-demand, energy-guzzling “supercharged” mode — and you certainly wouldn’t be driving 185 (maybe 25?) — so that you could conserve fuel. That is exactly what happens as we begin cognitive decline — the energetic support is no longer sufficient, so we shut down the supercharger. What this means in practical terms is that we shut down the locus coeruleus, which is the group of neurons in the brainstem that provides norepinephrine (which is also called noradrenaline, so it’s essentially the adrenaline of the brain, keeping your eyes wide open and your mind focused) to the cerebral cortex. This basically dims our lights — our attention is decreased, memory is compromised, and there is a degree of passivity — so that we can keep the essential functions going. So, not surprisingly, the locus coeruleus neurons are the first to go as Alzheimer’s is developing, and therefore you may notice people appearing somewhat lost and disengaged. It’s also why drugs like Adderall will give short-term improvements in cognition for patients with early-stage Alzheimer’s — it’s like turning on the supercharger briefly.

What’s next? Well, to go back to the Maserati analogy, conserving energy will mean shutting down luxuries next — and what does this mean for the brain? Well, your brain has spent decades learning all of the crucial functions, from how to survive to how to speak, work, read, write, move, calculate, recognize friend from foe, navigate, and on and on. So we don’t actually have to be able to learn new things to survive, thus this is a luxury that is suspended when energetics are critically low (and which may or may not return, depending on how long it takes to restore energy) — and therefore the entorhinal cortex, which is required for acquiring new information, is the next to go as Alzheimer’s develops.

The good news is that we can increase energetic support for the brain, and decrease the drag (inflammation and toxicity) in order to ensure best function. We should all be able to keep our brains functioning like Maseratis doing 185 throughout our years.

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