Time has indeed discovered that Franklin was doing good in the 12 years following his 70th birthday. And Franklin is not the only one who has continued to make his mark on society and mankind in his twilight years.

At age 85, John Fenn is sharing the Nobel Prize in chemistry with two other chemists. Other notable elders have not been staying abed either, including former President Jimmy Carter, 78, winner of the 2002 Nobel Peace Prize; former astronaut and U.S. Senator John Glenn and Chairman of the Federal Reserve Board Alan Greenspan, both past retirement age; and the 90-year-old queen of French cuisine, Julia Child.

Why have these and many other older people continued to play important roles and live meaningful lives well into their later years, while others have fallen victim to the ravages of the mind-robbing Alzheimer's disease (AD)? Extensive research has still not found the answer.

Since November is Alzheimer's Disease Month, educational material about the disease will probably proliferate, but most of us are already familiar with the symptoms of AD: gradual mental decline that slowly but steadily robs its victims of the abilities acquired readily as toddlers. But while toddlers are able to recognize and respond to loved ones, late-stage Alzheimer's victims often cannot.

As teenagers, my children had a traumatic introduction to Alzheimer's disease during the happy days of Christmas. As usual, their grandparents had come south for the winter and would be spending Christmas Day with us. Gamma entered the house first, while Gampa unloaded packages from the car. My older son, home from college greeted her, "Merry Christmas, Gamma!" and put his arms around her.

"Christmas?" she replied, looking directly at the lighted 10-foot tree, "Oh, I didn't know it was."

Silence. A few minutes later she was introduced to a young neighbor, also home for the holidays. After the introduction, Gamma removed her coat and turned to the young man she had just met. "And who might you be?" she asked.

Letters had alerted us that the dignified former Phi Beta Kappa had not been well, but we were not prepared for the startling mental decline we encountered. The mood was less festive that year, and after the grandparents had gone, the children wanted to know, "What's wrong with Gamma?"


Increased risk?

Many people that have a parent or grandparent with AD want to know if they are at greater risk of developing the disease that strikes indiscriminately and brings irreversible death to the brain's nerve cells. AD currently affects three to four million older adults in the United States, and that number is expected to become even larger as the baby boom generation reaches advanced old age. So far there is evidence that 25 percent of cases may be due to genetic predisposition. Credible genetic tests to predict risk for AD are becoming more promising and may become available in this decade.

About 3 percent of men and women ages 65 to 74 have AD, although the incidence of the disease increases dramatically after age 85. But the vast majority of people over age 65 do not experience any significant problems in their daily lives due to cognitive decline.

If the mind does grow cloudy with age, it may not be Alzheimer's. The culprit could have a treatable cause—for example, a nutritional deficiency such as vitamin B-12 or folic acid, a thyroid or other health problem, depression, stress, dehydration or alcoholism. What appears to be mental fogginess may also reflect undiagnosed hearing or vision loss, repeated mini-strokes, infection or one of the commonly used medicines that can cause confusion.

In the early stages of AD, people have difficulty learning and retaining new information. They forget important information on a regular basis, ask the same questions repeatedly and are often confused and disoriented, have difficulty balancing the checkbook, preparing a favorite recipe or performing other familiar tasks—but many are good at masking the problem.

Occasional memory lapses are annoying but should not be confused with the early signs of serious cognitive impairment. Forgetting where you left the car keys is not the same as forgetting that you own a car or getting lost when driving home on a familiar route.

As with most diseases, early diagnosis is important. An 11-year study at the Mayo Clinic shows that certain mild cognitive changes appear to mark a transitional stage between normal, age-related memory loss and AD. If memory declines are frequent and exaggerated, it is wise to seek a cognitive evaluation, starting with your primary care physician. Dementia specialists have developed assessment techniques that are 90 percent accurate in diagnosing AD. The assessment process usually includes a complete physical exam, medical history, basic medical tests, cognitive tests, brain scans, diagnosis and family consultation. Early diagnosis enables early intervention.

Seventy percent of AD patients are cared for at home. In later stages, the caretaker's job can be exhausting, as the patient typically experiences agitation, disrupted sleep, delusions, aggression, depression and wandering. Caretakers are advised to reduce household clutter, create a calming environment, encourage a regular schedule and use very specific, brief, repetitive directions when making requests. Adult day centers provide needed respite for the caregiver four to six hours a day, along with transportation, appropriate care and management for AD patients. Services are generally available on an ability-to-pay basis.

For families who cannot care for the AD patient at home, special residential-care homes provide the proper environment and management of AD-afflicted residents. Later-stage AD usually requires 24 hour-care either at home or in an assisted-living facility or nursing home, since affected individuals can no longer bathe, dress or feed themselves.


Prevention advice

There is no firm evidence that AD can be prevented by lifestyle measures, yet prevention advice proliferates. Exercising the mind is important: never stop learning, reading, calculating, planning menus and playing word games. Physical exercise—to keep oxygen flowing to the brain—yoga and meditation may also help. Studies show that from 400 to 800 international units of vitamin E, vitamin B supplements, ginkgo biloba and a diet rich in antioxidants (which includes vegetables, grains, and beans) may have benefits as well. Other reports recommend non-steroidal anti-inflammatory drugs such as Motrin, Advil and other ibuprofens.

There's hope for victims of AD. Hardly a month goes by without the discovery of a new gene, protein or chemical process that contributes to the understanding of the disease. Three drugs are available that might slow the progress and the rate of decline, and scientists are testing other new drugs. Federal research funding is expected to reach $670 million in 2003. And in March 2002 President Bush signed legislation that includes reimbursement for the costs of mental health services, hospice care and home health care for persons with AD.

What can we look forward to in old age—wisdom or senility? The majority of older people continue to absorb new material and information and add it to knowledge, experience and insights gained over a lifetime. The sum and substance of these include life's ups and downs, failures and successes, and the joys and disappointments of a rich and full life. These experiences comprise the essence of that little-discussed but much sought-after quality: wisdom.

This article is not intended to provide medical advice, which should be obtained directly from a physician.

Rita Baum has a master's degree in gerontology and has worked in the field of aging for more than 20 years.

Resources

The Alzheimer's Disease Association has free brochures that give local support group contact phone numbers and describe current treatments and ways to improve the lives of patients and their families. Call 800.660.1993 or visit www.alzheimers.org.

Greater Bay Area AD Chapter Call 650.962.8111.

Stanford/VA Alzheimer's Research Study Healthy volunteers with memory problems and/or persons with diagnosis of AD needed: Call 650.852.3234.

Stanford/VA Diagnostic Clinic (no out-of­pocket costs for AD diagnosis): Call 650.858.3915.

The Alzheimer's Disease Education and Referral (ADEAR) Center (800.438.4380) offers information and publications on diagnosis, treatment, patient care, caregiver needs, long-term care, education, training and research. Visit www.alz.org for information on treatment, research and resources.

Eldercare Locator (800.677.1116) provides information about and referrals to respite care and other home and community services offered by state and community Area Agencies on Aging.

Alzheimer's Activity Center Adult day care: Call 408.279.7515.

Dancing on Quicksand, a book by Marilyn Mitchell
The author is hired as a companion to a once-brilliant elderly man who is in the early stages of dementia. According to an editorial review, the book is not intended as an instructional guide for supporting those who have dementia, but caregivers will find that it contains practical advice. Readers say they learned about trust and love, as well as about helping those with the disease. (Available from Barnes and Noble and Amazon.com)