Future of Fear : Alzheimer’s struck Mollie Kaplan when she was just 59 years old. It is a disease Mollie can’t fight, a disease that makes her husband as much of a victim as she is herself.

Don’t sugarcoat this. It ain’t easy for any of us. --Samuel Kaplan

Mollie Kaplan can remember half a century ago when she was 12 and met her husband, Samuel, at a Halloween party in the Bronx. She can remember elementary school penmanship classes, when she changed her name from the Molly on her birth certificate to Mollie because she had a bad habit of writing the “y” below the line.

What she can’t remember is whether she had breakfast, so sometimes she eats it twice. She doesn’t cook much anymore, because if the recipe calls for salt, she can’t remember whether she added it.

“It’s so frustrating,” she said. “I can’t read a book anymore, because if I stop and put a bookmark where I leave off, when I pick the book up again, I don’t know what I have read.”

Mollie Kaplan is a victim of Alzheimer’s disease. But whereas its sufferers overwhelmingly are age 65 or older, she was just 59 when she was informed she had it.

And as medical science searches for a cure--or even a method of diagnosis other than the exclusion of other possibilities--more and more attention is being paid to those instances where Alzheimer’s strikes before 65, especially since heredity is believed to play a significant role in such cases.

This disease, which somehow affects the brain cells and produces intellectual impairment, is, according to the Alzheimer’s Assn., the fourth leading cause of death among adults, behind heart disease, cancer and strokes. It takes more than 100,000 lives annually in America.

Consider the statistics:

* About 4 million Americans are afflicted with Alzheimer’s (actress Rita Hayworth was a prominent victim).

* More than 47% of seniors age 85 or older have the illness.

* More than 50% of all nursing home patients are victims of Alzheimer’s.

* The financing of care for Alzheimer’s patients--including cost of diagnosis, treatment, nursing home care, informal care and lost wages--is estimated to be more than $80 billion per year.

* Finally, from onset of symptoms, the life span of an Alzheimer’s victim can range from three to 20 or more years.

Peter Braun, executive director of the Los Angeles chapter of

the Alzheimer’s Assn., said there are an estimated 650,000 cases of Alzheimer’s disease in California, probably more than 150,000 of them in Los Angeles County.

Only 10% of Alzheimer’s patients, according to the national association, are classified as early onset (diagnosed before age 65)--small comfort to someone who finds herself in that percentage.

Mollie Kaplan was found to have the ailment three years ago. “I wish it were cancer, because cancer you can fight,” she said. “I can’t do anything about this.”

For about 30 years, Mollie Kaplan had been a bookkeeper, most recently for a certified public accounting firm in the San Fernando Valley.

Then about three years ago, strange things began to happen. “Sam and I had separate checking accounts. I had my own account so I could buy groceries and such. When my monthly statements arrived from the bank, I found I couldn’t reconcile them. Here I had spent my career keeping books for companies, and now I couldn’t figure out my own statement.”

She said that although her bosses exerted no pressure, she resigned. “I was in charge of books for clients, and I was afraid I would start making boo-boos. You can’t do that with clients.”

At the same time, her husband recalled, he began to notice small but unusual things. There was the afternoon Mollie took a short walk from their Agoura Hills home:

“She had taken the garage door opener with her, but didn’t remember it. When she got back, she thought she had locked herself out. She panicked and phoned me at work from a neighbor’s house, and I came right home.”

Mollie: “If there had been pain--any degree of it--it would be so easy to tell you. But I felt nothing.”

It was about that time that Mollie Kaplan went to a local hospital for treatment of an angina attack. While there, she mentioned her increasing forgetfulness to her family doctor. “He said that they would do a brain scan. It didn’t prove anything, except that there were no signs of clots or tumors.”

Since Alzheimer’s was suspected, there were other tests, although Mollie said she doesn’t remember them. Sam Kaplan--while emphasizing that such testing shouldn’t be done on a person’s own--said one test involved showing Mollie a chain, a light and a doorknob, and later asking her to recall what she had been shown.

The doctor’s conclusion was that she had signs of Alzheimer’s disease.

Sam took his wife to another hospital, where extensive psychiatric, neurological and radiological testing--a full medical workup--was done. The conclusion again: Alzheimer’s.

“I wanted another opinion, and it was suggested that we go to Century City Hospital,” Sam said. “Not only did they do the other tests, they did Magnetic Resonance Imaging. They reached the same conclusion.”

From here, the Kaplans don’t know where to turn.

“Nothing can be done for her,” Sam said, staring out the kitchen window. “We are learning to live with it.”

Mollie said she has no other medical problems, and there has been no recurrence of angina. She is on no drug regimen, although she previously participated in a pharmaceutical company’s experiment with a memory drug.

She is aware of her increasing mental impairment and can recall some instances: “I put water in a pot on the stove to boil so Sam would have hot water for breakfast. Then I went into the bedroom to make the bed. I got so busy with the bed, I completely forgot about the water boiling.”

Mollie had given up smoking, but has taken it up again. As she spoke, she went around searching for her cigarette lighter, but, unable to remember where it was, accepted a match from her husband.

“There is an old Yiddish saying,” she began. Then a pause. She had already forgotten what she had intended to say.

Alzheimer’s always claims two victims--the other one being the care-giver. “I never thought this would happen to me,” Sam said, not without emotion. He later admitted: “I find myself edgy all the time. I was in the express lane at the supermarket. A guy started writing a check, and I almost decked him.

“People say to me, ‘join a support group.’ I say fine. But what is Mollie supposed to do while I am at the group?”

He said he once drove with his wife to such a support group in Thousand Oaks, but was told that only he would be permitted in. She said she would drive around for an hour and a half, then pick him up. When that time came, she couldn’t remember the location and had to phone to get specific directions.

Sam said he checked out a day-care center in Thousand Oaks for Alzheimer’s victims. He found both the appearance and the cost to be satisfactory, and made arrangements at the paint store where he is a salesman to cut his workday to five hours so he could drop his wife off in the morning and pick her up after he finished work.

But so far the point is moot. He drove Mollie over to see the place, he said, but she said she didn’t like it.

If nothing else, Mollie retains a disarming sense of humor. When asked about anything in the recent past, she often replies, “Who remembers? You are talking with an Alzheimer’s.”

It isn’t much of a humorous matter to Sam, now 64, who still loves the woman he met half a century ago but wearily confesses: “You don’t know what this is like until you get there.”

Since he worries about her while he is at work (and phones whenever he can find the time), he has considered another approach--an adult live-in. “We went to the temples and passed the word around, but it is very difficult to find someone.”

The Kaplans have an extra bedroom, and they are seeking an older woman who would agree to be on the premises without charge in exchange for free housing.

Right now, all Mollie has for daytime companionship is Mandy, a frisky terrier the Kaplans rescued from an animal shelter, who likes to chase rubber balls. Mollie spends time staring at the photos of her grandchildren, held by magnets to the refrigerator.

And wondering how this happened. In her case, the illness isn’t hereditary; she said no one in her family has ever been diagnosed with Alzheimer’s.

“My fear for Babe (their pet name for each other) is depression,” her husband said. “I look for things for her to do. I got her a jigsaw puzzle. I hope she’ll do it.”

Although she didn’t in the past, Mollie now watches game shows on television. “I feel it is good for my concentration. It helps me psychologically. If I can get the answer before the contestant does, I feel I did something good.”

Both said the illness has been difficult on their grown daughter and son. On a visit to their daughter’s house, one of the grandchildren poignantly asked: “Grandma, do you still remember us?”

Sam said: “During a visit, it’s not the same family discussion it used to be.”

If having a sense of humor can cure, there is hope for Mollie. When her husband paused to remember their vacation plans, she quipped: “It’s catching!”

Since a 100% accurate diagnosis of Alzheimer’s is possible only by brain autopsy, Mollie carries an organ donor card in her purse, hoping that some worthwhile research could result from her death.

“Take my head, please,” she said with a laugh.

In an office at the UCLA Neuropsychiatric Institute, geropsychiatrist and assistant professor of psychiatry Dr. Gary Small was discussing the $1-million study he is overseeing, funded by the national Alzheimer’s Assn., the state of California and the federal government.

It will focus on people who have or had a parent or sibling diagnosed with Alzheimer’s and who have anxiety because they themselves are experiencing memory changes.

“One part of the puzzle we have an answer to,” Small said, “is that if you have a close relative with Alzheimer’s, your risk for developing the illness is at least twice that of the general population.”

The psychiatrist said he has some participants already but needs about 100--including those at risk and having memory changes, and some who aren’t--to use as a control group. Participants will get free medical evaluations, MRI scan, Positron Emission Tomography (PET) scan, neurological assessment and annual follow-ups to check their progress.

Small said the PET scan, fairly new, is being used in this Alzheimer’s research because “it has been found to show characteristic patterns of decreased metabolism in certain brain regions. . . . This may lead to a positive test for the disease.”

These characteristic defects, he said, are more striking in early-onset cases than in later ones. A PET scan, he continued, may pick up what an MRI scan or CT(computerized tomographic) scan shows otherwise to be a normal brain.

“Early-onset cases are more likely to be familial,” he explained, “and such cases may be more likely to have rapid progression. Research has identified a small number of families where there is a high density of Alzheimer’s.”

Also, he said, researchers are looking into the possibility that Alzheimer’s is caused by a virus.

Typical symptoms of Alzheimer’s disease (named after Dr. Alois Alzheimer, a German neurologist who described it in 1906) include gradual progression of memory loss or other cognitive losses (language problems, motor skills), personality change and eventually loss of function.

Personality changes may include hostility, withdrawal, inappropriate laughing, agitation and paranoia.

Functionally, Small said, one may forget how to eat, how to use the toilet, how to take care of personal hygiene.

But not all signs of forgetfulness mean Alzheimer’s.

Small: “As people reach, say, age 50, there may be age-associated memory impairment. They will misplace glasses or keys, or have trouble remembering names.

“But, generally, they will retrieve that information with effort and over time. An Alzheimer’s victim may have identical things happen, but as the disease progresses, such information can’t be retrieved.”

What aren’t signs? “If you notice mild changes that don’t worsen over time, then don’t worry,” Small said.

But when testing is indicated, the process of exclusion is what doctors have to work with. Alzheimer’s is usually ruled out if there are signs of blood clots on the brain; stroke; thyroid, liver or kidney disease; reaction from medication, or depression.

Brain autopsies after the death of Alzheimer’s victims, Small said, show that current clinical diagnosis has an accuracy rate of 90% at the best research centers. Such autopsies, he said, show a high concentration of plaques and tangles in the brain, instead of normal cells.

Helen Kent, 64, a retired attorney from Southern California, is one of the participants in the Small study. Her 71-year-old brother is in a nursing home with Alzheimer’s.

“Things are happening to me that do disturb me,” she admitted. “I was recently in a Los Angeles courthouse, and in the corridor I ran into a lawyer I have known for years. I couldn’t remember his name. I thought about it the rest of the day, and I still couldn’t remember his name. And I still can’t.

“I am hoping this has no relationship to Alzheimer’s.”

Kent said her recent memory changes are something like what her brother, a former chemical engineer, went through: “If somebody asks what I did yesterday, I have to look at my calendar.

“It weighs on my mind, because as an attorney (she retired four years ago), my memory was absolutely fabulous. My mind was like a steel trap.”

Kent said she doesn’t see her Alzheimer-stricken brother often because he no longer recognizes her. When she does visit him, it is because there is always a glimmer of hope--but she winds up seeing it dashed.

There is something else she finds disturbing: “Years ago, my brother would stumble over words. I find myself doing that--like when I might be trying to say ‘crumb,’ I might come up with something such as ‘brump.’ I mispronounce entire words.”

Various approaches are being used to deal with the baffling malady. Just two months ago, a new Dementia Evaluation Clinic was established here to enable geriatricians at two campuses of the Jewish Homes for the Aging of Greater Los Angeles to better diagnose the disorder.

Jewish Homes has 875 residents, including those in the 120-bed Amado Foundation Alzheimer’s Disease Special Care Unit.

“Age-associated memory impairment is neither progressive nor disabling, whereas some dementias are both,” says a publication of the Alzheimer’s Assn. “Dementia is not a normal part of aging.”

Another association publication advises: “Coping with AD means getting ready for a lot of changes. The person you have known as a breadwinner or homemaker, as parent or spouse, slowly will lose the ability to fill those roles. At times, you may find it hard to recognize that he or she is still the same person.”

Because of the length of the illness, the association points out, “the effects on family finances are likely to be felt for a long time.”

Another point: “Although it is difficult to think about, you may eventually have to place your loved one in a nursing home.”

Meanwhile, inside her home in Agoura Hills, Mollie Kaplan can remember way back when Sam had to go off and serve in the Navy during World War II, and how he gave her an engagement ring before shipping overseas--”he wanted to make sure I wouldn’t date other guys.”

But if she puts a grocery bag down after returning from the market, she can’t remember where it is.

“They better hurry up with a cure,” she mused. “The clock’s running out on me.”