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In my twenties I was already experiencing significant cognitive dysfunction, and I wondered in the back of my mind if I was on track for developing Alzheimer’s. When I was in business school in the 1990s, my performance on tests was horrible. On exams with math questions, my grades showed a linear decline in per-question scores—100 percent on the first question, 70 percent on the next, 30 percent on the next, and directly downhill from there. My brain got fatigued so easily, even when I studied and knew the answers.

This experience led me to imagine what would happen if I couldn’t rely on my brain to earn a living. I’d had a successful career so far, but suddenly I wondered if I wasn’t as smart as I thought I was. I decided to undergo a then controversial brain imaging technique called a SPECT scan to see what was really going on in my brain. It showed that my prefrontal cortex—the part of the brain involved in complex thinking and decision-making—had essentially no activity when I tried to concentrate. Dr. Daniel Amen, who was one of the first people in this country to use SPECT scans, was shocked that I had been even remotely successful in my career with such clear cognitive dysfunction.

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