Pat Brannan remembers well the early signs of Alzheimer's disease in her dear friend, John Persico. A civil engineer and math whiz, he was suddenly asking her advice about how much of a tip to leave the waiter.
"I'd say, 'Look at the tax, that's 5 percent, and multiply by three.' And he couldn't do it. His math skills just went," she says. "He was always very punctual, accurate; he was a military-minded person, very neat. He loved precision: 'A place for everything and everything in its place.' Now he just throws things around."
Mr. Persico, who just turned 60, was diagnosed as having Alzheimer's disease two years ago. The Towson resident will soon retire from his state job as a civil engineer with a full disability. He still lives independently and drives his car to the grocery store, says Ms. Brannan, also 60, who serves as his primary caregiver. Although his life is restricted, she says, he still finds much to enjoy.
Since former President Ronald Reagan announced on Saturday that he has Alzheimer's disease, toll-free Alzheimer's hot lines have been ringing around the nation, with Americans anxious to find out more about this irreversible dementia.
"With the president coming forward, it's almost as if Alzheimer's disease is being rediscovered," says Ed Truschke, president of Alzheimer's Disease & Related Disorders Association Inc., based in Chicago. "There's a lot of denial about this disease, which sometimes prevents people from getting help."
Roughly 4 million Americans suffer from Alzheimer's, a degenerative disease of the brain that leads to impaired memory, reasoning and behavior and, ultimately, to death. No one is sure of the causes of most cases -- some forms appear to be inherited -- and the disease cannot be cured.
Although it is primarily a disease of aging -- 25 percent to 40 percent of Americans ages 85 and over can expect to get the disease -- it also afflicts people in their 40s and 50s.
About 70,000 Marylanders have the disease, according to statistical projections by the central Maryland chapter of the Alzheimer's Association. Although patients can live for 20 years after the onset of symptoms, the average life expectancy is eight years.
Symptoms include gradual memory loss, disorientation, loss of language skills, decreased ability to perform routine tasks, impaired judgment and personality changes.
"As people get older, they joke that they have Alzheimer's when they have trouble remembering things," says Richard Wright, director of the inpatient psychiatric unit at Sinai Hospital. "Even though a 65-year-old person might forget where they put the keys down, a person with Alzheimer's will forget that they cooked supper and that they need to serve it. Or they'll put the iron in the refrigerator and the milk in the closet."
The earlier people are diagnosed with Alzheimer's, the easier it is to plan for the disease's progression, says Michael Gloth, chief of geriatrics at Union Memorial Hospital.
"That way, the family and patient are not faced with a panic situation where living situations have to be suddenly changed," Dr. Gloth says.
There is no one test to identify Alzheimer's disease. Physicians diagnose it through a process of elimination, performing complete physical and mental evaluations.
The first step is to determine that a person has dementia, rather than another physical condition or mental illness.
Doctors must rule out such conditions as vitamin deficiencies, the effects of medications, brain tumors and strokes as possible causes of the patient's problem. Next, they must determine that the dementia is irreversible.
"There are probably 100 conditions that can cause memory loss or confusion," says Cass Naugle, executive director of the local chapter of the Alzheimer's Association. "It's important for people not to explain away behavior by saying, 'It's old age or normal aging.' If someone is having some kind of memory loss that is interfering with their daily living, then it should be checked out.
"Things to look for would be if a friend or relative is having difficulty balancing the checkbook; if they're suddenly not keeping their house up; or not bathing frequently; or starting to lose weight because they're not eating properly . . ."
Dr. Gloth recommends that patients have complete geriatric assessments. Often geriatric social workers will work with physicians and geriatric consultants in nutrition, and physical and occupational therapy.
"The public is tremendously biased that the elderly are going to be demented merely because of their age. It's just not true," he says. "Alzheimer's is a disease. Not everybody who lives to be 85 or 90 is going to be demented."
After he was diagnosed with Alzheimer's disease, Mr. Persico decided to let his grown children manage his finances. They also have durable power of attorney.
Because of Ms. Brannan's job -- she works as an administrative assistant in the disabilities office of Baltimore County's department of community development -- she cannot stay with Mr. Persico during the day. However, she calls regularly to remind him to take his medication.
On weekends, they spend time at the Baltimore Yacht Club, where he keeps his 42-foot powerboat. He still enjoys dancing and socializing and dining out with friends. With a lot of support, Mr. Persico is making the best out of a grim situation. It isn't always easy, he says.
"Once you get diagnosed," he says, "you know how you're going to end up."
DO YOU KNOW SOMEONE WITH ALZHEIMER'S?
Here's a list of common symptoms of Alzheimer's disease, prepared by the Alzheimer's Association:
* Memory loss on the job: It's normal to occasionally forget assignments, colleagues' names or a telephone number. Those with dementia may forget things more often and may repeatedly ask the same question not remembering the answer.
* Difficulty performing familiar tasks: Busy people can leave carrots on the stove at dinner without serving them. People with Alzheimer's could prepare a meal, forget to serve it and forget they made it.
* Problems with language: Everyone has trouble finding the right word sometimes, but a person with Alzheimer's may forget simple words or substitute inappropriate words.
* Disorientation of time and place: It's normal to forget temporarily the day or the week or your destination. People with Alzheimer's can become lost on their own street or in a familiar mall.
* Poor or decreased judgment: People can become so immersed in a telephone conversation they temporarily forget the child they're watching. People with Alzheimer's could forget the child entirely and leave to visit a friend.
* Problems with abstract thinking: People who balance their checkbooks may feel disconcerted if it is more complicated than usual, but someone with Alzheimer's could forget what the numbers are and what needs to be done with them.
* Changes in mood or behavior: Everybody has a bad day or feels sad or moody sometimes. Someone with Alzheimer's can exhibit rapid mood swings, moving from tears to calm to anger in a few moments.
* Loss of initiative: Everyone tires of housework, business activities or social obligations, but most people regain their initiative. Persons with Alzheimer's may become passive and require prompting to get them involved in activites.
For additional details and help, call the Alzheimer's Association Baltimore/Central Maryland chapter at (800) 443-2273 or (410) 435-4933.