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These findings,
like many of Snowdon's earlier conclusions, will undoubtedly
spark a lively debate. As laboratory scientists and clinicians
are quick to point out, cause and effect are notoriously difficult
to tease out of population studies like this one, and exactly
what the emotion-Alzheimer's link means has yet to be established.
But even hard-nosed lab scientists admit that the Nun Study
has helped sharpen the focus of their research. The study
has impressed the National Institutes of Health enough that
it has provided $5 million in funding over the past decade
and a half. "It is," says Dr. Richard Suzman, director of
the National Institute on Aging, "a very innovative, pioneering
study."
Snowdon
wasn't out to change the world when he first began visiting
the convent of the School Sisters of Notre Dame on Good Counsel
Hill in Mankato, Minn. He wasn't even planning to study Alzheimer's
disease. Snowdon was desperately trying to find a research
project that would secure his position at the University of
Minnesota. He was a young assistant professor of epidemiology
at the time - a field he'd been introduced to as a young boy
who raised chickens to earn money. "I learned a lot about
what it takes to stay healthy from taking care of those chickens,"
he recalls. "That's what epidemiology is all about - the health
of the whole flock."
Chicken
studies wouldn't cut it with the Minnesota administration
though, so Snowdon was interested when a graduate student,
an ex-nun, told him about the aging sisters at her former
order, living out their retirement in a convent just two hours
away. He was already familiar with the advantages of studying
religious groups, whose relatively uniform backgrounds mean
fewer variations in lifestyle to confound the data. An order
of nuns whose economic status, health care and living conditions
were especially uniform would be an excellent starting place
for an epidemiological study of the aging process. So he went
out for a series of visits. Both Snowdon and the sisters had
to overcome inhibitions - theirs at becoming research subjects,
his from a Roman Catholic school background that made him
uncomfortable asking personal questions of a nun. But they
finally agreed that he would quiz them periodically to learn
about what factors might be involved in promoting a healthy
old age.
At first,
the study didn't look as if it would reveal much. For one
thing, Snowdon wasn't really sure what aspect of aging to
focus on. For another, he had to count on the nuns to recall
those aspects of their lives, including the years before entering
the order, that had differed - and memory, even among the
mentally competent, is notoriously unreliable. But then, after
several months, he stumbled on two olive-green metal file
cabinets - the personal records of all the young women who
had taken their vows at the Mankato convent. "Everything changed
when we discovered the archives," says Snowdon.
Because
the records were relatively standardized, Snowdon could extend
his study of aging far beyond the few years in late life that
such studies traditionally cover. Most precious of all were
the autobiographies written by each sister on her entry into
the order. They were full of basic information about where
the sisters were born, who their parents and siblings were,
and why each one decided to join the order. With these documents,
moreover, Snowdon now had an objective measure of the sisters'
cognitive abilities while they were still young and in their
prime. An epidemiologist could not have designed a better
way to evaluate them across time. "For many years," says the
National Institute's Suzman, "we had an inadequate sense of
how connected late-life health, function and cognition were
to early life. But in the past decade, spurred by the Nun
Study, there is a growing appreciation for that connectedness."
The first
results, compiled after a year of research, confirmed earlier
studies suggesting that people with the most education were
most independent and competent later in life (most of the
sisters were teachers; many had master's degrees). And breaking
with academic tradition - but establishing one of his own
- Snowdon first presented his conclusions, not through a journal
or a conference but directly to the nuns. Recalls Sister Rita
Schwalbe, then one of the convent's administrators: "He threw
us a thank-you party, and we thought that was it."
Not even
close. Snowdon's study attracted the attention of leading
Alzheimer's researchers, who explained to him that the elderly
women represented an ideal population for studying this mysterious
disease. On average, 10% of people over 65 come down with
Alzheimer's, a number that rises to 50% by age 85. Given the
aging population of the convent, they knew that a significant
proportion of the nuns would have the disease.
The most
serious drawback to studying the sisters for Alzheimer's is
that there's only one sure way to diagnose it: examine the
patient's brain after he or she dies. If he were to proceed,
Snowdon would need written permission to perform autopsies,
not only on the Mankato nuns but also, to get a large enough
sample, on members of the order at six other Notre Dame convents
as well. "They really had to trust us," he says. "We could
have turned out to be Dr. Frankensteins for all they knew."
So one day
in 1990, a nervous Snowdon stood in front of the assembled
sisters in Mankato, many of whom he'd got to know as friends,
and made his pitch. "We sat in our chairs and held our breath,"
recalls Sister Rita Schwalbe, who by then had joined Snowdon's
research team. "Then one of the sisters piped up, 'He can
have my brain, what good is it going to do me when I'm six
feet under?' And that broke the ice."
In all,
more than 90% of the sisters living in the Mankato convent
agreed to donate their brains. After visiting six other convents,
Snowdon ended up with a 68% consent rate overall, one of the
highest in any tissue-donation study. "I didn't really know
what it was going to be about," says Sister Nicolette, an
engaging 93-year-old who is the only one of the 16 girls who
took their vows in 1925 to both survive and remain mentally
intact. "But I thought if science could learn something from
this program, then I was glad to be a part of it." In 1991,
the first participant, a resident of Good Counsel Hill convent,
died, and the Nun Study received its first brain.
MORE
>>
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May 14, 2001 | No. 19
COVER
STORIES
The
Nuns' Stories
Hundreds of Roman Catholic sisters have opened up their lives, their memories
and (when they die) even their brains to researcher David Snowdon so that
all of us can better understand what causes Alzheimer's disease and what
can be done to prevent it
TRAVELER'S
ADVISORY
SOCIETY
BEHAVIOR: The Talking Cure...
Australian schools try shaming troublemakers onto the right path
THE
ARTS
CINEMA: Goodbye, Mrs. Tom Cruise. Hello, Nicole
Kidman, star of a bold new movie... Moulin Rouge awakens the dormant
musical
Samantha Lang, a cinematic connoisseur
of sex
MUSIC: Nick Cave, the gloom rocker, blooms
BOOKS: A slim prayer with sales that are
divine
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