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When all isn't enough to foil Alzheimer's

By Nancy Stearns Bercaw

New York Times News Service

Published: Monday, Jan. 17 2011 3:30 p.m. MST

My father knew it was coming.

Alzheimer's disease had been on his radar ever since his own father died of it. Witnessing the catastrophic deterioration of a man who had been sharp enough to work for Gen. Douglas MacArthur, my frightened father was inspired to become a neurologist. Perhaps the pursuit of medicine could stave off what he believed was a genetic inevitability.

As an ever-present reminder of that threat, he kept an atrophied brain in a jar on his desk. That brain, I recently discovered, belonged to his father.

As my father approached middle age he began to experiment on himself, with diet supplements. By age 60 he was taking 78 tablets a day. He tracked down anything that offered the possibility of saving brain cells and killing free radicals: Omega 3s, 6s, 9s; vitamins E and C; ginkgo biloba, rosemary and sage; folic acid; flaxseed.

After retiring from his neurology practice in Naples, Fla., he spent hours a day doing math. Even when I was visiting, he'd sit silently on his leather recliner with a calculator to verify the accuracy of calculations he did by memory.

"What are you saving your mind for, Dad?" I often wondered to myself. "I'm here now, waiting to talk with you."

On one of these occasions, he suddenly looked up from his Sudoku game and stared at me.

"Promise me something, gal," he said.

"Anything," I answered.

"Swear on your grandmother's Bible that you will put a gun to my head if I wind up like my father."

He was dead serious.

How do you answer a man who watched his father wipe feces on the walls of their Virginia farmhouse? A man who took out a second mortgage to buy the first CT scanner in Florida?

"Swear to me," he repeated. He collected guns and kept them under lock and key. He knew I could shoot them, because he'd taught me how. I put my hand on the leather-bound King James Bible that had belonged to my great-grandmother Nannie Dunlap and my grandmother Nancy Scott.

"I swear," I said.

He nodded in approval.

A few years later, my father arrived at my home in Vermont with a suitcase full of supplements. He parceled out his pills for the week into Dixie cups, ready for swallowing with every meal.

"Gal, you should be taking these, too."

"Why?"

"Because you are my genetic clone."

Our physical resemblance and character traits were uncanny: tall, big-lipped, blue-eyed, loose-jointed, freckle-skinned, angst-ridden Bercaws. Except for our male and female chromosomes, nearly everything about us was a perfect match.

My father went on to explain that everyone inherits one copy of the APOE gene from each parent. The gene can indicate a predisposing genetic risk for Alzheimer's. APOE-2 is relatively rare and may even provide some protection against the disease. APOE-3 is the most common and appears to have a neutral role. APOE-4 indicates the highest risk factor.

"I'm only 34! Can't I think about this later?"

He shook his head.

Back in Florida, he sent me a genetic test kit via FedEx, instructing me to have the blood drawn at my physician's office but to have the results sent to him. It turned out that like my father I carry the APOE-3 gene, which means I may or may not get the disease.

But unlike my father, I will have to wait to find out. In 2009, at age 71, he had an MRI that showed "atrophy consistent" with Alzheimer's disease. He looked at the film and was confused by the sight of his own brain.

I recently spent time with my father while his wife had surgery. I took him to visit her at the hospital each day, and when we got home I stopped him from calling her every five minutes. I gave him dinner and pills at the appointed hours. I cleaned up his "accidents."

While he watched a televised baseball game one afternoon, I walked into his den and eyed the wall of supplements he used to take — bookcase after bookcase of pills with names like Memoral and Sharp Mind. Won't be needing them anymore.

I rested my hand on his gun cabinet. Won't need you, either.

My father walked to the coffee shop with me every morning. The only thing he'd say on these walks was, "The hibisci are in full bloom." Every time he said it — which was dozens — I wondered whether the plural of hibiscus is, in fact, hibisci.

On the final morning of my visit, he didn't mention the blooms. But when we passed a particularly flourishing tree, he stopped to look at me.

"Gal," he said, then paused to find the words.

His voice quivered. "I sure appreciate you coming down to take care of me."

I composed myself long enough to say: "It was a pleasure, especially after all you have done for me. Besides, you don't need so much taking care of."

As we walked on, my father would repeat this latest sentence every few minutes — the same quiver in his voice at the exact same place.

Each time, my response got shorter and shorter, until I was the one who had nothing left to say.

Nancy Stearns Bercaw is a writer in Vermont.

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