James Jacobs tickled the foot of his 85-year-old mother, who was tethered to a bed in a second-floor room. But Irene Jacobs' pale blue eyes remained focused out an open window.
"She doesn't recognize him," said Jacobs' wife, Marie, as she spread a disposable diaper under her mother-in-law. "It hurts, real bad. But you have to remember, she doesn't know what she's doing."
The first inkling that something was wrong came about seven years ago, when Irene Jacobs began to have trouble telling time. Later, she forgot about food cooking on the stove, got lost in her back yard and stripped in front of visitors.
Doctors diagnosed her illness as Alzheimer's disease.
"There are very few days when Mom really knows what's going on, and that's really sad," said Marie Jacobs, 48. "She was really outgoing and loving before this started.
"Now, you could set food down in front of her and she'd starve to death because she doesn't know what to do with it," she said.
Alzheimer's affects up to 4 million Americans, most of them over 65. It results from the degeneration and death of nerve cells in areas of the brain that control thought, memory and speech. There is no cure and no prevention.
Women appeared to be more likely than men to get Alzheimer's in several studies that allowed for the fact that women generally live longer.
Alzheimer's is the fourth-leading cause of death for adults in the United States, and researchers say it could afflict as many as 14 million Americans by 2050.
Knowledge about patients in rural areas is virtually nonexistent, according to Dr. Robert Keefover, a neuropsychiatrist at West Virginia University Health Sciences Center.
"We don't know how many people out there have it or how their families deal with it," said Keefover, who is overseeing a $3.6-million project to find out just that information.
With financing from the National Institute on Aging, researchers from West Virginia University and Marshall University will try to screen every person over 65 for Alzheimer's in three isolated West Virginia counties over the next three years.
Keefover said the project will test the effectiveness of several screening methods used to diagnose Alzheimer's.
"Ultimately, we'll know how to better find folks with Alzheimer's," Keefover said. "We'll also come up with better ways to help them, including the kinds of things that can be done without highly trained, expensive medical personnel."
West Virginia was chosen because of its mostly rural population, Keefover said. Lincoln, Morgan and Tucker counties were picked because they have no urban areas, he said.
Elderly residents of the three counties will have access to free examinations to detect Alzheimer's. The study is expected to provide data about the prevalence and risk factors associated with Alzheimer's among the rural elderly.
Besides Alzheimer's, researchers will be looking for evidence of other diseases marked by dementia, a deterioration of mental processes, including memory disorders, personality change, impaired reasoning and disorientation.
The study grew out of recommendations made by a statewide task force composed of physicians at West Virginia University, Marshall and other medical and social service groups around the state.
Dr. Joye Martin, an associate professor of family medicine and community health at Marshall, said the Jacobs family and others who care for rural Alzheimer's patients face special challenges.
"They don't have access to adult day care or other resources available in urban areas," Martin said. "They burn out. They get physically ill themselves. It's not unheard of for a care-giver to die before the Alzheimer's patient himself because it's so hard on them."
James Jacobs, 56, like many others in rural areas, takes pride in the fact that his mother is not in a nursing home.
"My brother wanted to put her in one, but no way would I do that," Jacobs said. "It's caused a family feud. My brother never calls and has never come out to visit her, even though he's just 30 miles away."