A Book Review: Aging with Grace -1

Aging with Grace

What the Nun Study Teaches Us About Leading

Longer, Healthier, and More Meaningful Lives

David Snowdon, PhD

Bantom Books, 2001

Granted, like all of us, I am aging, but it puzzled me when I received this book as a gift. Not long after though I did realize that this would be a fascinating read considering my ongoing study of brain development. Further, I was surprised because neither my friend nor I are Catholic. Indeed, my friend knew that I would like this book because of my work. Thank you, dear friend!

David Snowdon, PhD the author and researcher – calls himself “a medical detective, an epidemiologist looking for clues to the mysteries of aging.” (p.2) His chosen population, nuns, provided an ideal environment for the study. He shares many precious stories of his encounter with nuns that I will not try to recount. I recommend the book for a very interesting read. However, I will list key points learned from this long-term study.

Key Points:

Study Parameters

  • All participants were part of one of the Schools of Notre Dame (p. 9): Baltimore, Chicago, Dallas, Mankato, Milwaukee, St. Louis, and Wilton, CT (p. 242) Ages range from 75-106 (“About the Nun Study” in back of book)

  • Nuns underwent an hour-long battery of tests annually as a part of the study – “Mini Mental State Exam.” (p. 6) 8 different but overlapping tests --- (p. 144) “All the abilities being tested relate to those needed for everyday tasks and are important for maintaining independence.” (p. 145)

1. State date and identify location.

2. Spell Words Backwards (p. 145)

3. Boston Naming – examiner presents 15-line drawings on large index cards (ranging “from common to less frequently encountered.” P. 145) or an alternative for the Boston Naming for individuals who have poor eyesight names objects instead.

4. Verbal Fluency – “measures language, memory, and processing speed. Participants are asked to name as many items in a given class, such as fruits and vegetables, as they can in one minute.” (p. 145)

5. Constructional Praxis “measures visual-spatial ability” by showing 4 line drawings and asking the participant “to draw [these] shapes of increasing complexity.” (p. 145)

“The final three memory tests build on each other.”

1. Word List Memory – learning phase of the following.

2. Delayed Word Recall Test (leg, cheese, tent, motor, flower, stamp, cup, king, forest, menu). The examiner showed index cards with these words on them to the examinee who said the words. After 3 times, other tests were done for 5 minutes to distract her, then she was asked to recall as many of the 10 as possible. (p. 4)

3. Word Recognition Test – The participant is asked to read 20 words on large index cards and identify the 10 words that were learned from the Word List Memory. The other 10 words are considered distracters.

  • The Physical Tests – also mimicked real life tasks:

1. Put on sweater

2. Cut a clay hot dog

3. Read instructions on a pill bottle / take out the correct dosage.

4. Hand coordination – participants were timed as they opened 3 small doors with different latches.

5. Grip Strength – participants grasped a dynomometer.

6. Walking 6 feet and if possible 50 feet – timed.

7. Up and Go – stand up and walk around a sign – timed.

8. Lower body strength – putting on and tying a pair of shoes (p. 146)

In addition to the Mental and Physical tests, nursing staff members were asked to give supplemental information on the participants’ function. (p. 146) When participants are unable to perform the standard tasks, the evaluators quickly move into a “special protocol.” (p. 147)

Questions in the author’s mind as he worked through this study:

1.“Did everyone with plaques and tangles develop the symptoms of Alzheimer’s?”

2.“What caused these plaques and tangle to appear?”

3.“Was it genes, or was it something in the person’s upbringing or environment?”

4.“Was aging the primary factor or did many factors work together to bring on Alzheimer’s?” (p. 47, 48”)

  • Willing participants signed agreements to have their brains autopsied after death. Dr. William Markesbury of the University of Kentucky Hospital did these autopsies. Beginning with an overall exam of the brain, he finishes by looking for microscopic evidences of Alzheimer’s (plaques and tangles); Microscopic examiners count these square millimeter by square millimeter.(p. 91) He does the autopsies “blind” -- not knowing anything about the individual’s function before death.

1. Plaques – tissue looks dirty – like dark, soiled spots on cloth; formed from a protein, beta-amyloid, usually soluable – when solid they are called plaques. (p. 90, 91)

2. Tangles – dark flames or tadpolelike shapes, protein, tau. Healthy nerve cells: ropelike structures, a sturdy skeleton that communicate with other cells; Alzheimer’s causes these to accumulate and tangle. (p. 91)


  • “Early-onset Alzheimer’s typically strikes before the age of sixty-five and spreads through families much more predictably than the late-onset variety. It accounts for something like 5 to 10 percent of all Alzheimer’s cases. It also afflicts people with Down syndrome; nearly everyone with that condition develops extensive plaques and tangles by the age of fifty. Since people with Down syndrome have an extra copy of chromosome 21, the researchers reasoned that they would be more susceptible to any gene it carried. This had let them to focus their search on chromosome 21.” (p. 129)

  • There are two camps within research of Alzheimer’s – those who believe that the tangles are more indicative of the disorder and those who believe the plaques are the prime indicators. The nun study data seems to favor the tangles opinion. (p. 130-131)

  • Three problems seemed to converge in the Nun Study that became the key focus: stroke, heart disease and dementia. “Strokes can bring on the sudden appearance of dementia symptoms that are caused by the rupture or blockage of a blood vessel. In contrast, the symptoms of Alzheimer’s disease usually progress slowly. However, with advancing age, these two diseases may become intertwined and confused. How stroke and Alzheimer’s knot together is far from an academic question. Effective prevention and treatment strategies might result from untying that know.” (p. 142)

Look for Part 2 for study findings and conclusions.