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Scott Graber

There is reason for optimism, hope 

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It is Saturday, and I’m in Port Royal. This morning I’m sitting in my dining room writing, drinking my coffee and listening to Scott Simon on Weekend Edition. But this morning my thoughts are focused on the School Sisters of Notre Dame. 

Now, before we really get into the weeds with the Sisters of Notre Dame, let me say that I was taught by nuns when I was in elementary school. Although we were a transient military family, moving from Fitzsimmons to Brooke to Landstuhl Army Hospitals, I spent my elementary years in parochial schools. But if you’re expecting a dewy-eyed retrospective piece about early morning Mass, and the benefits of corporal punishment this is not that piece. 

This article is actually about Alzheimer’s Disease and a study that followed the medical history of the Sisters of Notre Dame that began in the 1990s. Not only were these nuns examined and interrogated about their cognitive health over the years, but when they died their brains were autopsied. The principal researcher, Dr. David Snowdon, tells the story of his now famous “Nun Study” in his book “Aging With Grace.” 

Snowden begins by saying that a problem with many Alzheimer’s trials is the fact that they usually occur after the patient is showing signs of dementia. In many studies the participant’s brains have “atrophied” (diminished) and the plaque and tangles have formed. There is no way to know what these brains looked-like when they were 21. 

But this wasn’t the case with the nuns. 

Just before these particular nuns took their vows, the Sisters of Notre Dame had to write a short essay about themselves, their family, their education. Dr. Snowden discovered these essays after his study had commenced and had a hunch that these long-ago written essays might have value in his research. 

He discovered that there were striking differences between many of these essays. Some were simple, straight-forward recitations of names, dates, events. Others were grammatically complex and dense with ideas. Snowden wondered whether this difference in “grammar and idea density” was any kind of predictor of those nuns who would get Alzheimer’s disease. 

With the help of Susan Kemper — a psycholinguist — and his cohort of 93 nuns, Snowden discovered that the level of “idea density” (in the early essays) strongly correlated with the cognitive tests that the nuns took every year. As the study progressed — and the bank of autopsied brains grew in number — it confirmed his hunch that those nuns who developed Alzheimer’s disease had low levels of “idea density” in those long-ago essays. 

Dr. Snowden concluded that “An amazing 90% of the nuns with Alzheimer’s disease had low idea density in the autobiographies as compared with only 13% of the healthy sisters.” 

But beyond this “predictor” and the Sisters at Notre Dame, what pathology actually causes this disease? 

There is the school who believe that a beta-amyloid protein, the sticky substance Dr. Alois Alzheimer called “senile plaque” in 1906, is responsible for the memory loss, disorientation and brain death. But there is a competing theory that a protein, called Tau, creates rope-like tangles that kill the neurons in the brain. 

Now NPR reports that there are doubts about the role of the “sticky substance” called beta-amyloid, and whether this plaque is the actual culprit that ultimately destroys the brain. 

NPR says that even though experimental drugs have removed the sticky beta-amyloid from the brains of some patients, the decline in memory and thinking continues. This continuation has “eroded support for the idea that amyloid is responsible for the cascade of events that eventually lead to the death of brain cells.” 

However, many believe that the anti-amyloid drugs have failed because they were given to people who already had plagues in their brains. At that point, Dr. Randall Bateman says, “It may not be possible to stop the process, …” 

And so another study — this one done by Dr. Eric McDade at Washington University — will enroll 160 people from families with dominantly inherited Alzheimer’s disease and treat people now in their 20s. They will get the anti-amyloid drug, Gantenerumab, and we will see if the plaques appear. 

“My prediction is it will work, and will work fantastically,” says Dr. Bateman. “If we can really prevent the plaques from starting and taking off and those downstream changes from going. My prediction is those people will never get Alzheimer’s” 

And so, on this Saturday morning, there is reason for optimism. Hope. 

Scott Graber is a lawyer, novelist, veteran columnist and longtime resident of Port Royal. He can be reached at cscottgraber@gmail.com. 

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