Adult Education Materials from the Committee on Older Adult Ministries.

May is Older Americans' Month. In honor of that fact, the Committee on Older Adult Ministries (COAM) of the Diocese of Maryland is providing you this brief book review and discussion questions for adult education. If you would like to have a COAM member help to lead a discussion, please feel free to contact us through the Diocesan Office.

Aging with Grace. What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives , by David Snowdon, Bantam Books, 2001.

Reviewed by Patricia Alt, Ph.D., and Frances Lodder, M.S.W., COAM members

"Many people still believe that, as we age, our minds wear out, and that if we live long enough, we will inevitably become demented. This is a myth. Aging does increase the risk of developing Alzheimer's, which helps explain why Sister Maria did not suffer from the disease until her eighth decade. But clearly Sister Dolores' mind did not deteriorate after eighty years of use. What, then, explains their different fates?" (p. 79)
David Snowdon offers an account of an intriguing, ongoing epidemiological study that examines Alzheimer's disease. The reader gains a new perspective on what might cause Alzheimer's- the disease that robs patients of their memories, their personalities and in the later stages, their cognitive function. Insights are also provided into what might delay the appearance of dementia symptoms. Started in 1986 and referred to as the "Nun Study", the research on which the book is based involves 678 members of the School Sisters of Notre Dame (ranging in age from 74 to 106), including a group in Baltimore.

The study examines the histories of the Sisters, both medical and personal. Snowdon and his researchers have tested the cognitive function of the nuns and upon their deaths, have autopsied their brains searching for clues to the puzzle of Alzheimer's. Some of the nuns who have shown no evidence of dementia in life have brain tissue which is full of Alzheimer's "tangles". Others, who have been quite demented, actually have far fewer "tangles", leading Snowdon's team to search for other factors involved in healthy aging. In the process, Snowdon has identified many predictors or contributors to the manifestation of dementia and/or Alzheimer's disease, including lifestyle, depression, stroke, and head trauma. "Protective" elements identified include faith, attitude, community, heredity, education, diet, and exercise. The story is not only full of facts, but vividly describes real live women and their thoughtful contribution to science.

Discussion Guide:

As you read, consider the answers to these questions. Use them as part of the discussion. It is not necessary that everyone in the group have read the entire book, but it does help if at least one member has. (basic answers to the questions are provided below.)

1. Does a positive outlook early in life contribute to longevity? Why?
2. Is it inevitable that our minds wear out as we age? That we will become demented?
3. Can profound faith and a sense of community reduce the risk of dementia?
4. Stroke, heart disease, and depression: how are they linked with dementia?
5. What are simple activities for mental stimulation to maintain a healthy brain?
6. What about exercise, aluminum, mercury, gingko, vitamin E and folic acid?

Discussion Answers/References

(Note: All references are to chapters in Aging With Grace)

1. Does a positive outlook early in life contribute to longevity? Why?

The sisters whose autobiographies as they entered the convent (written at an average age of 22) were most emotionally positive were significantly more likely to be alive an average six decades or more later. The initial findings (in the chapter titled "Up and Grateful") point toward a naturally positive temperament, reinforced by learning to handle stress in a healthy way, as key protective factors. What are some ways in which you deal with stress?

2. Is it inevitable that our minds wear out as we age? That we will become demented?

There is a higher risk of Alzheimer's disease in older age groups, but dementia doesn't seem at all inevitable, given the evidence in this book. See, in particular, the chapter entitled "Amazing Brains", in which the author discusses the surprising finding that some nuns who showed no overt dementia at all had "Alzheimer's" brain lesions on autopsy. Interesting possibilities explored here are that early language development and idea density protect against Alzheimer's, perhaps by providing backup brain capacity. The chapter "One With the Words" explores these concepts.

3. Can profound faith and a sense of community reduce the risk of dementia?

Two factors not scientifically studied so far, but firmly advocated as important by Dr. Snowdon are the deep spirituality shared by these women and the power of their sense of community. "The Hundred-Year Marathon" chapter cites the experience of sisters in Baltimore to support this claim, providing moving word pictures of delightful centenarian nuns and their intense faith. (The book also contains lovely snapshots of the sisters).

4. Stroke, heart disease, and depression: how are they linked with dementia?

One of the most striking physical findings in the study is the link between evidence of having had a stroke and the manifestation of dementia. Even for nuns whose brains had less evidence of Alzheimer's than others, the presence of strokes almost always predicted dementia. Heart disease, particularly high blood pressure, is closely linked with the likelihood of strokes. Depression also seems to be linked with dementia and is closely associated with heart disease and stroke. "The Heart of the Matter" chapter elaborates on these findings. However, some life changes can help these problems, as discussed below.

5. What are simple activities for mental stimulation to maintain a healthy brain?

Reading, working word puzzles, continuing to learn new things. ("One With the Words")

6. What about exercise, aluminum, mercury, gingko, vitamin E and folic acid?

Exercise seems particularly valuable, as is folic acid. The study didn't find significant evidence of mercury or aluminum contamination as a dementia cause. From his evidence so far, Snowdon recommends exercise, weight control, and "heaping our plates at the salad bar". (In the chapter on "Our Daily Bread").