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."
Collins, 87, a tiny woman who struggles with Alzheimer's disease, appears transfixed. She smiles uncertainly.
"Who is this?" prompts Wise. "Do you know this lady? That's Catherine!"
As Collins's daughter Catherine narrates, images begin to unfold -- beloved faces and scenes, a bouquet of the memories that have been slipping out of Christine Collins's 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 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 Collins views the tape, 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 the 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?" 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.!" 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 Collins holding three of her five daughters, the smallest still an infant. "Who are those girls?" teases Wise. "That's Catherine. That's Millie. That's Dot."
"I know 'em all. That's my babies!" 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!"
Mining Pockets of Memory
This videotape is a first draft, part of an effort by Cohen, medical student Somya Verma and Collins's daughters to create a work that the family will be able to show repeatedly, mining what Cohen calls "pockets of memory" in the elderly woman's ailing brain. Already, her delighted response has exceeded their hopes.
Cohen, director of GW'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. Cohen found a way to reach his father by making a videotape, focusing especially on scenes from Ben Cohen's Navy career, that always seemed to bring a smile.
When his father saw the tape for the first time, Gene 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 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 different long-term care facilities in Washington. The other participating facilities are the Lisner Louise Dickson Hurt Home and Thomas House.
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, Cohen will first 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 patient's and family member's responses and interactions 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," Cohen said.
Anguish for Patients and Families
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, Cohen said, Alzheimer's sufferers like Christine Collins 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 affected person. Quizzing such patients about family members or past events is apt to heighten their anxiety. "It's not better for them to be challenged, because they can't do it," Cohen said. "What's going to keep them is, you give them their memory on the video."
In a small pilot study, 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 Wise did frequently with her mother.
While the videotape may trigger memories each time it's used, 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," 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."
Transforming Old Snapshots
Before watching the videotape with her mother, Wise makes her own debut as a television anchor in a conference room downstairs. Cohen tapes her commenting on a new batch of family photographs that he plans to add to a revised version of the tape.
Wise, a teacher at J.O. Wilson Elementary School in Northeast Washington, spreads the photos on a table and arranges them chronologically with Cohen and Verma, a second-year medical student at George Washington University. There are family reunions and weddings, shots of Collins relaxing on a Florida vacation and sitting on a sofa with a gaggle of great-grandchildren.
They select each photograph and slide it into a clear plastic easel. Then, using an 8mm video camera, Cohen zooms in on the photo, training the camera on various faces in the picture as Wise provides a running commentary.
One snapshot shows Collins feasting at a family reunion. "Uh-oh, we caught you doing your favorite thing: eating crabs," says Wise. "We got crabs and we cooked them and we ate for days."
Another pictures Collins, then 75 years old, at a granddaughter's wedding. "All right, girl," quips Wise, "you remember this part of the wedding when the bride threw the bouquet? And guess who's up there catching it? . . . There you are, trying to catch it--with your great-granddaughters."
Cohen said the video camera transforms old snapshots, blowing up faces to almost life-size and making the images accessible to an elderly person with poor vision. He said an 8mm video camera can be purchased for as little as $200, and making a biographical videotape is simple and fun.
The idea of making video biographies of elderly people particularly appeals to high school and college students, Cohen added. If the results with Alzheimer's patients live up to his expectations, he says nursing homes and health agencies could adopt the idea, using student volunteers to help families create such videos inexpensively.
The process of making the video brings families together, Cohen added, and the result is a lasting memorial to the person with Alzheimer's disease. "In the end, basically, this tragic illness . . . has left the family with this wonderful exit gift."
Providing a Good Day
In Christine Collins's room, the hour-long videotape is coming to an end. Collins's attention has not faltered for a moment. She has seen old friends and great-grandchildren. Now she throws her arms up and claps her hands joyfully.
"I am seeing something!" she cries. "Just let me live on. I may not walk or nothing, but just let me look and see! Who would have thought I would have seen this today? Nothing better could have happened to me."
Verma's eyes are wet, and Cohen's face is pink with satisfaction. Nurses and staff members crowd around, smiling.
"It does fill you," says Wise. "I had to hold back tears. . . . When they have Alzheimer's, they have different days. This was a good day. This has made me feel so good!"
Just then, Wise remembers that her mother's birthday is coming up in a couple of weeks. "What do you want for your birthday?" she asks.
Christine Collins points to the television. "All over again!"
* The Alzheimer's Disease Education and Referral Center (ADEAR), part of the National Institute on Aging, provides information on study findings and on how to participate in tests of new treatments, as well as referrals to government-funded Alzheimer's disease centers specializing in patient diagnosis and research. Call 1-800-438-4380 or consult the center's Web site at www.alzheimers.org/adear.
* The Alzheimer's Association, a private, nonprofit organization, has 200 chapters throughout the country that offer support groups, educational programs, referrals to local services such as respite care, and basic information about how to deal with the disease. Call 1-800-272-3900 to find the chapter nearest you, or check the organization's Web site at www.alz.org.
* The National Council on the Aging, a private, nonprofit agency, offers a booklet, "Managing Alzheimer's Disease," that describes resources such as adult day care and home health care as well as financial and legal issues involved in caring for someone with the disorder. Call 1-877-390-7828 or consult the agency's Web site at www.ncoa.org.
* The American Health Care Association is a federation of more than 12,000 long-term care providers, such as nursing homes and assisted-living residences. (Between 1993 and 1998, U.S. nursing homes nearly doubled the number of "special care beds" dedicated to Alzheimer's patients.) For consumer information on how to choose such a facility and how to pay for it, call 1-800-555-9414 or consult the Web sites at www.ahca.org or www.ncal.org.
* For people in the advanced stages of Alzheimer's disease, hospice programs may be appropriate. The National Hospice Organization can help family members locate such programs, which may offer either in-hospital care or home health care. Some hospices have special divisions for Alzheimer's patients. Call 1-800-658-8898.
* 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. NW, 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.
CAPTION: Left: Sitting close to a television, Christine Collins views family photos of her life. Below: Joyce Wise, one of Collins's daughters, speaks with her mother as she watches the video biography for the first time.
CAPTION: Collins gets a hug from daughter Joyce after watching the video, which was created through a research project aimed at improving the lives of Alzheimer's disease patients.
CAPTION: "I am seeing something!" exclaims Christine Collins, sitting between daughter Joyce Wise and Janice Waters, a volunteer at the Washington Home. "Nothing better could have happened to me."