Dr. David Snowdon

DATE May 8, 2001 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. David Snowdon talks about the completion of his
15-year study of elderly nuns and Alzheimer's disease and discusses
results of the study
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest, Dr. David Snowdon, is an epidemiologist who has just published the
initial results of his 15-year study of the symptoms, causes and progression
of Alzheimer's disease. The results made the front page of The New York
Times
yesterday and the cover of Time magazine.

The focus of Snowdon's study was a group of 678 elderly nuns. He chose to
study nuns because they live carefully regulated lives and that reduces the
variables of the study. Over the past 15 years, Dr. Snowdon repeatedly
tested
the nuns' short-term memories, measuring the amount of memory loss they
experienced over time. He administered various other mental and physical
tasks and after the deaths of nuns who had given their permission, he
performed autopsies on their brains.

In the new book "Aging with Grace," Dr. Snowdon discusses his study and what
it can tell us about the mysteries of Alzheimer's disease. One of Dr.
Snowdon's more interesting findings came from studying the autobiographical
essays each nun was required to write when she joined the order. He found
these personal histories in the convent archive. I asked what the nuns'
essays enabled him to study.

Dr. DAVID SNOWDON (Professor of Neurology, University of Kentucky): Well,
this really gave us a window into their early life, their early family life,
characteristics of their parents, kind of their personal orientation and,
more
specifically, just their ability to handle language; their ability to
express
themselves. And that was, really, one of our first kind of insights that we
could see that sisters with not much content in the autobiography; that they
tended to be at high risk 60 years later for the pathology of Alzheimer's in
the brain, as well as the symptoms. And so, again, to--kind of tapping both
probably language and short-term memory very early on in life.

GROSS: You started to ask some really interesting questions, such as do
grammatically complex sentences with lots of embedded clauses predict that
you
are any less likely to get Alzheimer's and if your sentences are really
simple, does that mean you're more likely to get Alzheimer's? What led you
to
even ask those questions?

Dr. SNOWDON: Well, about a dozen years ago I was in the library and I found
an article on short-term memory testing in college freshmen. And they found
that the college freshmen who could write grammatically complex sentences;
they tended to score very high on what's called working memory, which is
what
just happened seconds ago. And it makes sense. In order to complete a
complicated idea-dense sentence, you've got to remember what you just did a
few seconds ago for it all to hang together. And so this one particular
study showed that this very--the short-term memory and the ability to pack a
lot of ideas in a sentence was highly correlated in college freshmen. And I
thought that that was--might give us a window into, to some extent, their
short-term memory abilities, as well as other cognitive abilities.

GROSS: What did you find when studying the grammar and the complexity of
the
sentences in these early autobiographies that the nuns wrote?

Dr. SNOWDON: Well, we found that grammatical complexity had a correlation
with mental function, but what we--the most striking finding was that the
amount of ideas that they could pack into a sentence was strongly correlated
with a very low risk of Alzheimer's disease and a very low amount of
Alzheimer's pathology. So it wasn't that you necessarily had to do verbal
gymnastics. It's just could you get across a lot of ideas?

GROSS: You reprint a sentence from the nun with the highest idea density
and
grammatical complexity and the nun with the lowest idea density and
grammatical complexity. So let me compare them. This is the nun with the
lowest idea density and grammatical complexity. She wrote, `My father, Mr.
L.M. Halliker(ph), was born in the city of Ross, County Cork, Ireland, and
is
now a sheet metal worker in Eau Claire.' And here's the sister with the
highest idea density and grammatical complexity. `My father was an
all-around
man of trades, but his principle occupation is carpentry, which trade he had
already begun before his marriage with my mother.'

Now what kind of outcome did both of these women have, in terms of their
memory?

Dr. SNOWDON: Well, the sister with the low idea density who's really kind
of
monotone, very linear in her description of her father, developed
Alzheimer's,
both in her brain--she had the pathology and she had very severe symptoms.
The sister with very high idea density, who was, really, kind of speaking
almost in high fidelity, she had very, very high mental function and, you
know, she's still alive. We haven't looked at her brain, yet. So it's
really
kind of the difference between writing in monotone kind of linear listing of
facts to this high fidelity, where you've got ideas that are interconnected
with each other. I mean, to some extent, it's also maybe marking how
interconnected the brain is and how well developed the brain is.

GROSS: Well, as you point out in your study, there has, for a long time,
been
thought to be a link between education and Alzheimer's. The more educated
you
are, the less likely you are to get the disease. But then the
chicken-and-egg
question comes in, you know. Is it that you are more likely to comprehend
the
education if you have the kind of mind that isn't prone to Alzheimer's, or
is
it the education is actually preventing Alzheimer's?

Dr. SNOWDON: You're right. I would lean toward that those with really good
mental abilities, with good language abilities, good short-term memory in
early life have--that that's marking very, very well-developed brains and
that that brain tissue, during the next fif--five decades or so--or six
decades, would be more resistant to the growth of the lesions of Alzheimer's
in the brain. And so it's clear that--I mean, from our--not just our work,
but from many other studies, now, that Alzheimer's is a lifelong disease
process and that there are changes in the brain going on before the symptoms
show up. So Alzheimer's is going to be like cancer and heart disease and
stroke; that one has to take a lifelong view of it and now be concerned
about
it only when you're old, but throughout your life.

GROSS: But for now, your theory is the more that you engage with your
brain;
the more you use your brain for complex things, the less likely you are to
get the symptoms of Alzheimer's?

Dr. SNOWDON: Right. And the earlier you start the better because people
tend to track at a certain ranking. If you have high blood pressure or high
language ability when you're a young child, you're likely to be that high
ranking when you're middle-aged and old aged. So I think Alzheimer's is
going
to end up being like coronary heart disease. It really wasn't until the
Korean War that young men were dying who were very healthy that the surgeons
could see that they already had the hardening of the arteries, the
atherosclerotic plaques that were developing. And now we know that the
atherosclerotic plaques of heart--leading to heart disease and stroke are
actually occurring in infancy. And I think the same thing, now, is
happening
in Alzheimer's; that we're tracking back decades and decades. And brain
autopsy studies done in Germany show that the classic lesions or protein
deposits of Alzheimer's are occurring in people as young as 20.

GROSS: You convinced the nuns to--or at least many of the nuns to donate
their brains, after death, for examination. One of the things you did, you
know, with the neurologists you were working with--one of the things that
you
did with these brains, after death, was to weigh them. What does it tell
you
to weigh a brain?

Dr. SNOWDON: Well, it's been known by pathologists for decades that, at
least for a female--an adult female brain, that if it weighs less than 1,000
grams, or about two and a quarter pounds, that that would mean that it's a
high likelihood that it's Alzheimer's, because, basically, Alzheimer's
destroys tissue and it shrinks the brain. It's--that's what causes
Alzheimer's. It's actual damage and destruction of the brain. So something
as simple as weighing the brain can give you a pretty high indication of
whether there's been a lot of pathology. And, certainly, scanning the brain
and looking at the actual damage at the microscopic level can tell you even
more about how much damage has occurred.

GROSS: Were there any surprising findings in weighing the brains?

Dr. SNOWDON: Well, we had one sister that we called Sister Mary who was the
first centenarian to die in the study. And I knew her and she was really a
remarkable person from our Baltimore province of the convent. And when
we--when she died--when we looked at her brain, we were surprised that it
was
about--I think about 800 grams, so she was really a very, very light brain
and should have had Alzheimer's disease. But, in fact, she had no symptoms
and was really quite a remarkable statement for--even when the pathology is
present in the brain, that some of these sisters--and we know from other
studies, other people can resist showing the expression of the symptoms.

So it's kind of like a study--in many ways kind of like studying people who
have been in a car accident. And if you just study people who died in the
car
or, in this case, got the symptoms of Alzheimer's, you might come to certain
conclusions. But she's someone who actually was, if you will, kind of in a
car accident, but walked away and really didn't hardly have a scratch. So,
I
think, in a lot ways, that's very hopeful that even when the pathology is
present; that even when the genes are present, that there are some sisters
in
our study and other studies who resist showing the symptoms. And that's
good
news for all of us.

GROSS: Something else that you were looking for is what connection is there
between the symptoms of Alzheimer's disease and stroke? So tell us the
correlation you found between Alzheimer's disease and stroke?

Dr. SNOWDON: Well, ever since Dr. Alzheimer first described Alzheimer's
disease in a 52-year-old patient at the beginning of last century, it's been
an issue about whether strokes and hardening of the arteries in the brain
might be playing a role. In fact, in the '50s and '60s in the United
States,
Alzheimer's was called hardening of the arteries. And more recently, in the
last several years, the importance of strokes and even heart disease and the
health of the blood vessels has become very important as a contributing
cause
to Alzheimer's disease.

And, basically, what we found is when we look at--we looked at 102 sisters,
all of whom were teachers and had a bachelor's degree or higher--that we had
autopsies on. And we found that those sisters who had an Alzheimer's brain
and stroke, particularly small strokes--that they had the combination of an
Alzheimer's brain and small strokes in strategic regions of the brain; that
they had a very, very high risk of showing the symptoms. Now the sisters
who
had just an Alzheimer's brain and were stroke-free had a dramatically
reduced
risk of showing the symptoms. So stroke, among other things, may be a
trigger
that may push an Alzheimer's brain over the edge. Head trauma is another
thing. Head injuries may be another factor that will trigger or push an
Alzheimer's brain over the edge to where you will show the symptoms.
Depression--there's a variety of factors.

GROSS: So part of your advice is do whatever you can to reduce the
possibility of stroke.

Dr. SNOWDON: Reduce the possibility of stroke; reduce the risk of head
trauma. You know, buck--something as simple as buckling your seat belt; eat
a
prudent diet; not smoke. I mean, when you're a child you want your--you
know, in the ideal, parents and grandparents and family, friends and
teachers would help you develop your brain and mind to its optimal ability.
But after that point, you really have to maintain whatever function you've
got. And there's lots of--because the brain can, basically, handle a lot of
disease and destruction before it starts to show symptoms. It's got great
resilience and adaptive abilities. But you can't overwhelm it. It's very
easy to make Alzheimer's worse. It's hard to treat it. It's hard to make
it
better.

GROSS: How do you make it worse?

Dr. SNOWDON: Well, I mean, certainly, depression, stroke, a confusing
environment can make it worse; poor diet, medication problems. I mean, the
way the health-care system is now, you are almost really need a patient
advocate. And that's one of the thing with the sisters in some of the
convents. They've had to place them in nursing homes and they actually have
a
sister who was a full-time patient--sister patient advocate who is always
trying to optimize the environment and the health care and whether it's
trying
to keep the noise level down; trying to give an Alzheimer's patient visual
reminders.

The visual part of the brain is--you know, is--visual memory is much more
longer lasting. So, for example, if you had an Alzheimer's patient who
wanted to talk to his brother or the brother wanted to talk to him,
something
as simple as putting a picture of the brother by the phone might help the
patient realize who they're talking to because the visual part of memory
goes
much later than just the use of words.

GROSS: My guest is Dr. David Snowdon. His new book is called "Aging with
Grace." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is epidemiologist Dr. David
Snowdon. For the past 15 years he's been studying a group of elderly nuns
looking for clues to the mysteries of Alzheimer's disease, like who is
mostly--most likely to get it and why. He's just written a book about the
study called "Aging with Grace."

Another clue that you were investigating is depression. Is depression
linked
with Alzheimer's disease? How did you investigate that question?

Dr. SNOWDON: Well, this has been looked at for decades and it's always
another kind of chicken-or-egg proposition that did the person develop the
symptoms of Alzheimer's and then become depressed over it or did the
depression predate the development of the symptoms of Alzheimer's? And
recent brain studies are now starting to show that this region of the brain
called the hippocampus, which is damaged and shrinks in Alzheimer's; that
the
hippocampus also may shrink in depression. And that, again, may go back to
early-life influences.

But probably with depression Alzheimer's the arrows go both ways; that
depression can increase the age and onset, but Alzheimer's, itself, probably
can increase the depression. About a quarter of Alzheimer's patients have
untreated depression. And this is, again, another simple way of trying to
make life easier for someone with Alzheimer's is simply treating their
depression.

GROSS: How did you measure for depression in your study?

Dr. SNOWDON: Well, we have a list of questions. I mean, they are very kind
of classic symptoms of crying and sleeping problems and, in fact, you know,
our sense is that the--that while some of the nuns do have depression, that
we
think there's probably a really low prevalence of depression in our
population. It's not easy for a nun to get away with sleeping all day or
crying. It's just not part of the culture. But there may be other ways in
which it's expressed. But depression is a big-time problem for the rest of
the older population--in particular, women--that's--you know, that is
treatable.

GROSS: So what are the findings from your study that you think will be most
important in our future knowledge of Alzheimer's disease.

Dr. SNOWDON: Well, I think, number one is that whether it be the education
findings or the linguistic findings, as well as other studies that are
looking
at early-life factors, that one wants to develop that brain to its fullest
capacity; that the language ability, reading ability, memory ability. And
so
we want to develop it; the brain and the mind to its optimal level in early
childhood, probably, particularly during the first few years of life; even
before you get to school. Language acquisition is extremely important.

But once you become an adult, then I think you want to follow a prudent
lifestyle, be it exercise, not smoking, keeping mentally active. And you
want
to, basically, maintain that level. It's not really so much use it or lose
it. It's develop it and keep it. And even in old age when impairments do
start to develop, one wants to try to just work with what you've got. I
mean,
I was at the convent last week and one of my friends there, Sister
Nicolette(ph). She always goes up several times a day to see her sibling,
who
also is a nun, Sister Ursula(ph). And Ursula has got the symptoms of
Alzheimer's. And Nicolette goes up there very patiently and is--quizzes her
every--several times a day about what's the day and has her go through
stories
from their childhood and tries to work with what she's got.

It's very easy when you have Alzheimer's to just withdraw.
It's--Alzheimer's
is not a disease that you suffer in silence and that you're in some kind of
bliss that you don't know what's happening to you. For years, you can--you
know very well what's happening to you. And it's easy for an Alzheimer's
patient to kind of withdraw and not say anything because they'll--they can
kind of embarrass themselves because they have a hard time remembering what
was just said.

GROSS: Where there any foods, vitamins or supplements that you found to be
useful in preventing or slowing Alzheimer's and were there any--are there
any
vitamins or supplements that have been discussed in that context that you
found really weren't doing anything at all?

Dr. SNOWDON: Well, there's been a lot of interest in vitamin E and the
antioxidants in Alzheimer's disease. And there are some studies that
suggest
that vitamin E intake and other antioxidant intake may reduce the risk of
Alzheimer's disease. To some extent, the jury is still out on that
question.
On the other hand, there's other good reasons to take vitamin E.

And in our study we were surprised and disheartened to see that we couldn't
see vitamin E's level in the blood, related to the symptoms. What we did
see
is we replicated a study that was done in Oxford where we could see that
sisters who had high folic acid levels in their blood, a vitamin found in
leafy, green vegetables like spinach, as well as in multivitamin pills--we
could see that those who had high folic acid that they had less damage to
their brain; even when they had an Alzheimer's brain, that there was less
damage or shrinkage of the brain.

And I think, in a lot of ways, I'm sure that they'll be other nutrients
that'll be found to be important because Alzheimer's is a brain-wasting
disease and it makes sense that probably the last thing you want to do is
nutritionally deprive your brain when it's under a brain-wasting condition.
And there may be specific nutrients, like folic acid--maybe vitamin E and
probably others--that may help to fortify the tissue against destruction.
And
folic acid makes sense because it's important in the development of the
spinal
cord and the brain during fetal development. So folic acid and, I'm sure
other nutrients, may be important to both the development of the brain
tissue
and its maintenance throughout life.

GROSS: Have you been taking folic acid supplements since doing the study?

Dr. SNOWDON: I take, you know, multivitamin pills. You know, I'll take one
on one day and on alternative days I'll take two, so I get, you know, about
maybe 50 percent more. More importantly, I try to eat as much fruits and
vegetables as I can because I'm absolutely convinced they'll be many other
factors that are found in plants that will have protective value against
Alzheimer's and stroke and other diseases. And so, you know, while the
scientists wrestle with, `Is it folic acid? Is it vitamin E?' by eating
fruits and vegetables, you tend to--it's kind of like investing in a mutual
fund. You've got lots of different nutrients there and, you know, some
multivitamin pills and lots of fruits and vegetables is just, I think, a
good,
overall general health practice.

GROSS: Dr. David Snowdon's new book about the nun study and Alzheimer's
disease is called "Aging with Grace." He'll be back in the second half of
the show.

I'm Terry Gross and this is FRESH AIR.

(Soundbite of music)

(Credits)

GROSS: Coming up, more with Dr. David Snowdon on what the nun study tells
us
about the causes and symptoms of Alzheimer's disease. Also, linguist Geoff
Nunberg on words and expressions that only recently entered our vocabulary.
And Kevin Whitehead considers the music of saxophonist Albert Ayler as his
Avant-Garde Made Easy series continues.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross back with epidemiologist Dr.
David Snowdon. He's just published the results of his study of the
symptoms,
causes and progression of Alzheimer's disease. His study is based on
tracking
678 elderly nuns over the course of 15 years, testing their short-term
memories at regular intervals, administering other mental and physical tasks
and autopsying the brains of nuns who died. His new book about his study is
called "Aging with Grace."

There's been some speculation that for women, estrogen might help stave off
Alzheimer's disease, and that's been one of the arguments for taking hormone
replacement therapy...

Dr. SNOWDON: Yes.

GROSS: ...after menopause. Did you investigate that and reach any
conclusions?

Dr. SNOWDON: The sisters really aren't of the generation that would have
taken estrogen during menopause and so we have not directly looked at that,
but, you know, unfortunately, to our disappointment and scientists,
probably,
throughout the world, the evidence on estrogen protecting against
Alzheimer's
has really been weakened over the last several years. I think it's pretty
well accepted now that taking estrogen replacement, estrogen pills in
Alzheimer's patients does not slow down the development of the symptoms in
patients who have Alzheimer's. The jury still is out on whether
Alzheimer's--the onset of the symptoms--the first onset might be delayed by
estrogen. So it's the Women's Health Initiative, which the National
Institute
of Health is conducting, which will give us, I think, the best evidence of
whether taking estrogens may postpone.

There's good biologic reasons to think that estrogen should protect the
brain
tissue, as well as other tissue from destruction, but we're--all of us, I
think, are pretty disappointed that the evidence for estrogen is starting to
weaken. I mean, I think what happened over years ago is that very, very
smart
women who were very well read who had really good minds and short-term
memory
and were good thinkers, they were the very ones who asked their doctors
about
estrogen, so it kind of got confounded that smart women, years ago, probably
were the ones who were predominantly taking the estrogen and something else
was protecting them from Alzheimer's; their smartness and--rather than the
estrogen, so...

GROSS: Because of all the tests you were administering over this 15-year
period, you were able to see the gradual development of Alzheimer's disease
in
some of the nuns. Would you tell them, `Look, looks like you're developing
Alzheimer's disease'?

Dr. SNOWDON: Boy, that's a tough one and we wrestle with that every day and
we are now in the process of talking to the sisters and their leaders about
what information can we share that might help identify people in the early
phases of Alzheimer's, 'cause once you get Alzheimer's symptoms, you know,
there may be some small things that can be done, but the real hope in
Alzheimer's is trying to identify people at very high risk when they don't
have symptoms and either drugs or nutrition or other things that could be
done
for them so that they protect the brain or they don't get the damage. We
certainly--these are very dear women and we don't want to withhold any
information from them, but we also get very concerned about if we tell them
they're at high risk, what will happen to them? I mean, one of the sisters
that has become a dear friend over the last several years, she was falsely
diagnosed with Alzheimer's. And for two years she thought that she had
Alzheimer's and every time she couldn't remember someone's name, she kind of
beat herself up and the sisters around her kind of dealt with her
differently.

It's not like telling someone that they have a high risk of heart disease or
colon cancer. You're talking about the brain and that's what makes us who
we
are. Our ability to touch and communicate and love other people is encoded
into our very personality. That's what makes Alzheimer's such a devastating
disease, but that's also the other part of the double-edged sword that makes
it difficult to do early intervention because you can label people and it
can
be tough going, so we think we have a really good chance with the nuns
because
we want to work with them and there's some really smart sisters there who,
hopefully, will help us deal with doing early intervention and in trying to
make information useful to them.

GROSS: So does this mean you didn't tell the nuns who you suspected were in
the early stages of Alzheimer's disease?

Dr. SNOWDON: That's correct. We did--those sisters that we could--that we
can see--I mean, it's really in the last--even in the last 12 months that we
now can see in our study that the sisters who have a short-term memory
problem have very, very high risk of developing full-blown dementia within
five to 10 years. And it's taken us, you know, 10 or 15 years to get to
that
point, but now it's--we have pretty much overwhelming evidence, based on the
sisters, that the presence of a memory impairment--short-term memory
impairment is highly predictive. A study done a couple weeks ago that was
released showed--from St. Louis--Washington University showed very much the
same thing that the patients in their study that they followed over the
years--that if they had a memory impairment, that, I think, somewhere near
80
to 90 percent of them ultimately developed dementia. So we're now starting
to see that short-term memory problems aren't just benign forgetfulness or
kind of something that comes with aging; that it's--more and more scientists
and clinicians are believing that short-term memory problems are not normal
in aging and that that's a bellwether of impending dementia and,
particularly, Alzheimer's disease.

GROSS: Dr. David Snowdon is my guest. He's an epidemiologist and for the
past 15 years he's been studying a group of elderly nuns looking for clues
to
the mysteries of Alzheimer's disease; who's most likely to get it and why.
He's just written a book about the study called "Aging with Grace."

One of the things that all the nuns in your study have in common is that
they
live in a community of prayer and reflection, which most of us don't. And
I'm wondering if you think that that connects at all to the fact that a lot
of the nuns who you've studied live to a much older age than the average age
in America. And I don't know how the percentage of Alzheimer's compares to
the larger population.

Dr. SNOWDON: Well, the sisters definitely live longer. We suspect that
they
are at slightly lower risk of Alzheimer's. They may get the symptoms later,
but I think the big thing is that we--my personal view of this is that their
spiritual life and, I think, as important is the community that they live
in--the social support, the friendship--that that does a lot to promote the
quality of life and the length of life. I mean, imagine for yourself that
you actually would end up retiring and you could be surrounded by people
that
you went to high school and college with, that you worked for 50 years with.
In 20 percent of the cases, you'd have a sibling who was down the hall who
also was, in this case, a nun. But to actually retire in a situation where
you're surrounded by your friends who knew you 50, 60, 70 years is a
phenomenal opportunity.

I think that's clearly one thing that I've taken away that I really give a
lot of thought to. How am I going to live in my old age? It's not just
about mental fitness and physical fitness, which, you know, we're studying.
This social component, the spiritual component is, I think, very, very
important and, you know, I'm convinced that it leads to a longer life and a
better life.

GROSS: My guest is Dr. David Snowdon. His new book is called "Aging with
Grace." More after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is epidemiologist Dr. David
Snowdon. For the past 15 years he's been studying a group of elderly nuns,
looking for clues to the mysteries of Alzheimer's disease, who's most likely
to get it and why. He's just written a book about the study called "Aging
with Grace."

Did doing the study make you any more or less scared about your old age?

Dr. SNOWDON: I'm a little more concerned about it now, only--I'd say my
biggest concern is the social part, you know. Every day I try to exercise.
I
try to eat well, so I'm doing the things for the--you know, keeping my
mental
and physical health. You know, I'm a bachelor and I'm thinking, `Boy, I've
got to get busy here,' 'cause I--you know, I want to have that community
life; that warm, you know, human relations that we're--what it's all about.
That's clearly one of the things that we've never studied that has had the
greatest personal impact on me; the importance of being surrounded, probably
at any age, but particularly old age, by the people that love you. I mean,
old age can be a time of great promise. And I want that. I want a little
piece of that for myself, so I guess I'd better get busy dating.

GROSS: But don't divorce, though, because it'll ruin the whole experiment.

You've done previous studies with religious orders investigating health.
What were those studies about?

Dr. SNOWDON: Well, I got my start studying Lutherans in Minnesota, of all
places, looking at diet and cancer in Lutherans. And after I finished my
PhD, I went out to Loma Linda Medical College out in Southern California and
was involved in some large studies of Seventh Day Adventists, who--many of
them are vegetarians and they don't smoke or drink. And we were looking at
dietary components of the long life and low cancer risk in the Seventh Day
Adventists. And that's really where the light bulb went on in my head that
studying religious groups, particularly for a population scientist. That's
what an epidemiologist really is. We're a population scientist. And we
would
rather work with a population that's already been identified and enumerated,
'cause we don't want to just study sick people. We also want to study
healthy
people. So when I came back to Minnesota, I decided that I was, you know,
pretty convinced that studying religious populations was a good choice.

And then when I stumbled into the archives at the convent, then I realized
not only were they identified, but you could trace them back 60, 70 years
and
you could see the sisters who had a worse outcome than, say, getting a
disability when you're 80 or 90; that we could also study sisters who had a
worse outcome--that they died when they were 20 or 30 'cause aging, really
is--it's a lifelong process. It's a telescopic process throughout the whole
life and those convent archives offered us a window into their early and
midlife.

GROSS: You're proud that you were able to get to know many of the nuns who
you've studied. The problem is that some of them developed Alzheimer's
disease and they would forget you because of the disease.

Dr. SNOWDON: Right.

GROSS: That must have been very upsetting.

Dr. SNOWDON: Well, that's the hardest part of all this. I--you know, when
they die I feel sad for myself that I'm not going to be able to spend time
with them anymore, but it's pretty short-lived. What's hard, though,
is--I'm
sure other family members of Alzheimer's patients feel this--is that when
you
see them start to lose themselves, that's very difficult; and particularly
trying to gauge whether their--they know, you know, how much of their
personality and their essence of their being is still there.

One of my favorite sisters, Sister Debrido(ph), a few days ago, had her 90th
birthday. And over the 15 years that I've known her, particularly the last
five years, I've seen a real loss in function. And a couple of years ago
she
could kind of get my name out and then maybe a year ago she physically acted
as if she recognized me and I can occasionally, now, get a smile out of her,
but that's the hard part. And particularly not knowing; that's the language
component of the communication part of this--of--and you never will know. I
mean, you'll never know if--how much of their essence is still there,
regardless of whether they can communicate. The main thing is, you know,
you
just never want to assume that they're gone. It just--I'm convinced there
are
several incidents that you'll just never know. And you just--meanwhile...

GROSS: Give me an example of one of those incidents that gives you that
impression.

Dr. SNOWDON: Well, Valentine's Day several years ago we were in the
Milwaukee convent and were giving out Valentines. And I remember walking
down the hallway and there was a sister in full habit who was sitting in a
wheelchair. And I came up to her and she was kind of articulating kind of a
word soup. There were words that I could understand what the words meant,
but
they were not threaded together in any coherent way that--at least that I
could understand. And I took the Valentine out and I showed her the
envelope.
And it said, `Center on Aging, University of Kentucky.' And I pointed at it.
And I said, `This is where I'm from.' And the building I'm in--I was in at
the time at the convent probably had about 200 nuns in it. So I pointed at
the envelope and said, `Sister, this is where I'm from, the Center on
Aging.'
And she stopped her babbling and she clearly said, `No, this is the Center
on
Aging.' She laughed and then immediately went back to her babbling. And
she
had her--you know, her moment there. And I'm absolutely convinced. I've
seen other evidence, you know, since then that you just never know. And
that's kind of the heartbreaking part but that's why you just--you never
want
to treat someone with Alzheimer's as if they're children or they're dumb or
whatever. You want to treat them with respect because you just--you never
know. And she was the first one who taught me that lesson and, you know,
with
a joke.

GROSS: Dr. Snowdon, I want to thank you very much for talking with us.

Dr. SNOWDON: Well, thank you. It's been a--it's a great pleasure. Thank
you.

GROSS: Dr. David Snowdon's new book about the nun study and Alzheimer's
disease is called "Aging with Grace."

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Commentary: Anachronisms in books and films often necessary to
impart meaning in today's language
TERRY GROSS, host:

When we watch a period film, we're usually quick to spot an object, an item
of
clothing or a hairstyle that doesn't fit with the period. But linguist
Geoff
Nunberg says linguistic anachronisms are sometimes more difficult to detect.

GEOFF NUNBERG:

Umberto Eco's novel, "The Island of the Day Before," is the tale of a 17th
century Italian who's marooned on a wrecked ship. When Eco started the
novel,
he decided that he would only use nautical terms that were current in that
period and he insisted that his translators do likewise when they rendered
the
story into other languages. The exercise was only for his personal
satisfaction, of course. Most readers wouldn't have blinked an eye if Eco
had
stuck a poop deck on his 17th century vessel, even if it turns out that the
phrase didn't appear until 200 years later.

But linguistic anachronisms can be hard to spot, even when the time period
is a
lot more recent. The other night I rented "Almost Famous," Cameron Crowe's
autobiographical movie about a teen-aged rock journalist touring with a band
in the early '70s. The movie opens with a couple of scenes set in 1969 when
the hero is 11 and living in a San Diego suburb. At one point, his mother
says to his sister, `Don't be such a drama queen.' It struck me that that
was
about 15 years too early for that phrase. And when I checked, it turned out
that `drama queen' didn't appear in print until 1987. The phrase was
probably
in use in gay circles earlier than that, but it certainly wasn't a kind of
thing that a straight, suburban mother would have called her daughter in
1969.
And I had the same reaction when the mother uses finger quotes around a
word.
Nobody was doing that in the '60s, either.

Granted, the anachronisms probably didn't trouble many moviegoers, no more
than I would have been bothered to discover a poop deck on Eco's 17th
century
ship. For that matter, most of the people in the movie's target audience
wouldn't know who `humble pie' was without a footnote. But it does point
out
how hard it is to remember when we started to talk the way we do.

Here's an item for Regis Philbin to use to screen contestants for "Who Wants
to be a Millionaire." `List the following four phrases in the order in
which
they first appeared in the language: A, put it on the back burner; B,
counterproductive; C, out of the loop; D, hard news.' OK. Here are the
answers in the correct order. `Hard news' first appeared in print in 1948.
`Counterproductive' was in vogue in 1961. `Put it on the back burner'
started to pop up in 1975. And `out of the loop' first showed up in 1983.
Those dates are only approximate, since dictionaries don't usually nail down
the very first occurrence of a word. But the fact is that I wouldn't have
guessed any of them within a decade.

It's an odd feeling when you can't remember when you started using a word.
It's like forgetting how you used to think. A while ago I was talking to a
friend who was writing an article about her discovery of American Jewish
writers when she was a college student in the 1950s. She kept finding
herself
using terms like `WASP' and `ethnic' only to realize that those words hadn't
figured in her psyche in the period she was talking about. In fact, `WASP'
didn't come into the language until the early 1960s. In the end, she
decided
to use the anachronisms, along with qualifiers like, `as we would now call
them.' It wasn't just that she had trouble recalling the words she used to
use, but that they wouldn't have meant much to her now.

That conversation came to mind when I was watching a later scene in "Almost
Famous," this one set in 1973. The members of the band are in a plane that
looks as if it's about to crash and they start to exchange confessions. The
manager confesses that he took a few extra dollars and one of the band
members says that he slept with another member's wife. And then, in what's
supposed to be the capper, one of them announces, `I'm gay.' It's a good
line, but it isn't the way anybody would have come out of the closet back
then, when gay was still a few years off from being a mainstream word. But
then, what other would could Crowe have used, here. Before `gay' came into
the language, there wasn't any way for a mainstream movie to refer to
homosexuals in a familiar and sympathetic way. It wasn't just the word that
was anachronistic, but the scene. There was no way you could have played it
as a comedy if the movie had been made in 1973.

That's why we can forgive Blake Edwards, when he had characters describing
themselves as gay in his movie, "Victor Victoria," even though that was set
in the 1930s. That wasn't how it was, of course, but maybe it's the way it
should have been. Sometimes the past makes more sense speaking in
anachronisms that it does in its own words.

GROSS: Geoff Nunberg is a linguist at Stanford University and the Xerox
Palo
Alto Research Center.

Coming up, Avant-Garde Made Easy. This is FRESH AIR.

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Review: Kevin Whitehead reviews the work of jazz saxophonist
Albert Ayler
TERRY GROSS, host:

Our jazz critic, Kevin Whitehead, is playing and discussing the music of a
half-dozen modern jazz mavericks in his series Avant-Garde Made Easy.
Today,
in Part Five, saxophonist Albert Ayler. He was born in Cleveland in 1935
and began recording in 1962. Eight years later he was an apparent murder
victim; his body dredged from New York's East River. During those eight
years, Ayler recorded unorthodox versions of standards, respectful readings
of
spirituals, early jazz rock records and some of the most radical free jazz
ever. His fans included John Coltrane, whose own late recordings reflect
Ayler's influence.

This is Ayler's most famous composition, "Ghosts."

(Soundbite from "Ghosts")

KEVIN WHITEHEAD:

No one in jazz was as far out and far in as Albert Ayler; far out in terms
of
how he improvised; far in in terms of the songs he wrote to improvise on.
They sounded like a jumble of bugle calls, national anthems, nursery rhymes
and drinking songs.

(Soundbite of Albert Ayler song)

WHITEHEAD: Tenor saxophonist Albert Ayler with his trumpet-playing brother,

Donald, a frequent collaborator. Music ran in the family. As a boy,
Albert had studied music and listened to jazz with his father. They'd also
played saxophone duets in church. As a momento, Albert later recorded an
album of spirituals.

(Soundbite of Albert Ayler song)

WHITEHEAD: Gospel saxophonists typically use a wide vibrato to make their
sound more voicelike and unworldly. Ayler took that lesson to heart. His
exaggerated vibrato also echoes old New Orleans jazz musicians when they'd
play spirituals.

(Soundbite of music)

WHITEHEAD: Trumpeter Kid Howard and clarinetist George Lewis.

Albert Ayler also liked slow-drag tempos, but he'd stretch time even
further.
He stretched everything; time, pitch, and the very fabric of a saxophone's
sound.

(Soundbite of Albert Ayler song)

WHITEHEAD: Once Ayler had developed that sound, the problem was deciding
what
went with it; what context might be suitable for it.

In Denmark in 1963, he made a perversely memorable record of standards with
a
straight, local rhythm section--big mistake; worlds in collision.

(Soundbite of Albert Ayler song)

WHITEHEAD: What Ayler needed was a band that could stretch time and
tonality
the way he did. In 1964, he led a trio, which remains one of the great,
radical jazz groups. Like their boss, bassist Gary Peacock and drummer
Sonny
Murray stretched the roles of their instruments almost to the breaking
point. The trio's music has an intensity and fervor that are hard to match,
but it had shape, too. Ayler's tunes have such clear outlines. Even a
suggestion of the melody yokes the improvising to the material.

(Soundbite of Albert Ayler song)

WHITEHEAD: Albert Ayler's folksy tunes and abstract improvising may seem
contradictory, but you could trace both to his church upbringing. He always
saw music as having a spiritual dimension. Think of his meandering solos on
basic tunes as a kind of meditation on sacred texts or speaking in tongues,
to
use an analogy writers invoked in the 1960s.

(Soundbite of Albert Ayler song)

WHITEHEAD: As for his plainspoken melodies with titles like "Spirits
Rejoice," "Holy, Holy" and "A Little Prayer," it helps to remember that
bugle
calls, national anthems, nursery rhymes and drinking songs are all designed
to
bring people together. Prayer, testifying and fostering a sense of
community
are what Ayler's music, as well as churchgoing, is about.

In that light, even his amusingly misguided jazz rock records of the late
'60s
make sense, reflecting his ecumenical vision and will to reach everyone.
Albert Ayler's raucous sound and populist leanings may give cultural
conservatives the blues, but his initiatives were always faith-based.

(Soundbite of Albert Ayler song)

Unidentified Singers: ...God's love. Baby, you've had it without God's
love.
Baby, we've got it. We've got God's love. Baby, we've had it. We've got
God's love. Baby, we've had it. We've got God's love. Baby, we've had it.
We've got God's love.

GROSS: Kevin Whitehead is based in Chicago. For more on his series, go to
our Web site, freshair.com. I'm Terry Gross.

(Credits)

(Soundbite of music)

GROSS: On the next FRESH AIR we talk about that famous drum line with the
musician who played it, Hal Blaine, one of the greatest session drummers in
rock 'n' roll history. Also, former Boston Celtics star Bill Russell
discusses his illustrious basketball career. I'm Terry Gross. Join us for
the next FRESH AIR.

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