WASHINGTON -- Christine Collins settles herself in front of the television with her daughter Joyce Wise beside her. In a moment, a woman's face appears on the screen.
"Hi, Mom," she says. "I want to show you some pictures and bring you up-to-date with all your grandchildren and great-grandchildren."
Mrs. Collins, 87, a tiny woman who struggles with Alzheimer's disease, appears transfixed. She smiles uncertainly.
"Who is this?" prompts Ms. Wise. "Do you know this lady? That's Catherine!"
As Mrs. Collins' daughter Catherine narrates, images begin to unfold -- beloved faces and scenes, a bouquet of the memories that have been slipping out of Christine Collins' mind.
The videotape is an experimental "treatment" for Alzheimer's disease being studied at the Washington Home, a long-term care facility in northwest Washington where Mrs. Collins is a resident. Psychiatrist Gene D. Cohen of George Washington University Medical School is trying to learn whether fragments of the past, presented in the form of video biographies, can help anchor Alzheimer's patients in the present -- by orienting them, triggering memories and making it easier for them to interact with family members and caregivers. As Mrs. Collins views the tape, Dr. Cohen and a few other visitors eagerly watch her reactions.
Here she is in a black and white uniform, in a photo taken sometime during the 25 years she worked as a maid and housekeeper at Washington's Mayflower Hotel. Here she is as a young girl, newly arrived in town from Columbia, S.C., her hair tucked fashionably into a hairnet.
"How old were you when you came to Washington?" Ms. Wise asks.
"You were! And you look 16. Look, you have a waistline! You never gave me that waistline."
Here's a handsome man, his grin filling the screen. "That's J.C.!" Mrs. Collins cries, pointing eagerly to a framed photo in the corner of her room containing the same portrait. "He worked on the train. That's my father!"
And here's Mrs. Collins holding three of her five daughters, the smallest still an infant. "Who are those girls?" teases Ms. Wise. "That's Catherine. That's Millie. That's Dot."
"I know 'em all. That's my babies!" Mrs. Collins beams as a memory suddenly floats to the surface. "Dot -- she weighed one little bitty pound. They thought she was going to die, but she lived. They were so little! I ain't never thought I would have seen these pictures!"
This videotape is a first draft, part of an effort by Dr. Cohen, medical student Somya Verma and Mrs. Collins' daughters to create a work that the family will be able to show repeatedly, mining what Dr. Cohen calls "pockets of memory" in the elderly woman's ailing brain. Already, her delighted response has exceeded their hopes.
Dr. Cohen, director of George Washington University's Center on Aging, Health and Humanities, got the idea of making video biographies of Alzheimer's patients about seven years ago. At that time, he was desperately looking for a way to maintain an emotional connection with his father, Ben Cohen, who had Alzheimer's disease and who, in his lucid moments, would sometimes ask his son to throw him in front of a car. Dr. Cohen found a way to reach his father by making a videotape, focusing especially on scenes from Mr. Cohen's Navy career, that always seemed to bring a smile.
When his father saw the tape for the first time, Dr. Cohen recalled, "He said, `Oh, I must be important.' It was very, very powerful."
Although experimental, the idea apparently strikes a chord with relatives of people with Alzheimer's disease and with health-care workers who care for such patients. In the first five months of Dr. Cohen's study, he said, 20 families of residents of the Washington Home's Alzheimer's unit have signed up to be part of the research, which aims to recruit 40 Alzheimer's patients from three long-term care facilities in Washington.
Doctors, nurses and staff members at the Washington Home are enthusiastic about the project.
"The reason people don't think about (such approaches) is that everybody is busy saying you can't treat Alzheimer's," said Jerry M. Earll, the facility's medical director. "You can't cure it, but you sure can treat it."
With help from family members, the team of researchers plans to make a videotape about each patient, drawing on photos, film clips, newspaper articles, interviews, favorite music and any other materials that relatives want to include. Before showing a patient the videotape, Dr. Cohen will record a typical interaction between the patient and a family member. He will then record them as they watch a program with no particular emotional resonance for the patient, such as a talk show. Finally, he will record the responses and interactions of the patient and family member as they watch the videotape about the patient's life.
Trained observers will then watch all three tapes and rate such factors as the patient's involvement, mood and degree of agitation. "What it comes down to is how engaged they are and how comfortable they seem to be," Dr. Cohen said.
An estimated 4 million Americans have Alzheimer's disease, and the number is projected to rise in coming decades as the fraction of elderly people in the population increases. The degenerative brain disorder causes great anguish for families of affected individuals because they must watch the gradual, inexorable deterioration of a loved one's personality and memory. Ultimately, people with Alzheimer's disease often become unable to recognize their own spouses and children.
In the middle stages of the disease, Dr. Cohen said, Alzheimer's sufferers typically become confused even about the identities of people whom they know well, and they have difficulty communicating with others. "They may seem to have it together, yet they can't explain the photos in their rooms," he said. They may react to a simple question "with extreme frustration, analogous to a 2-year-old throwing a temper tantrum."
Such behavior often makes it hard for relatives and caregivers to converse with the person. Quizzing such patients about family members or past events often heightens their anxiety. "It's not better for them to be challenged, because they can't do it," Dr. Cohen said. "What's going to keep them is, you give them their memory on the video."
In a small pilot study, Dr. Cohen found that biographical videotapes seem to provide a structure that helps keep Alzheimer's patients focused and makes visits with family members easier for everyone. Watching the videotape together isn't a purely passive process because a family member or visitor can freeze images at any point and reminisce with the patient, as Ms. Wise did frequently with her mother.
While the videotape may trigger memories each time it's used, Dr. Cohen said, watching it probably won't improve the patient's memory or prevent further deterioration, although some family members may hope for such an outcome.
On the other hand, Alzheimer's patients seem to enjoy watching the personalized videotapes over and over.
"The tragedy of the illness creates an irony," Dr. Cohen said. "Sometimes half a day later or an hour later, the person has no recollection at all that they saw the film. But if the film works, it's fresh every time."
Video biography information
Anyone wishing to obtain a manual on how to make a videotaped biography may write to Gene D. Cohen at the George Washington University Center on Aging, Health and Humanities, 2175 K St. N.W., Suite 810, Washington, DC 20037. Please send a self-addressed, stamped envelope. The manual will be published at the conclusion of the research project, in about a year.
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