Sunday, February 21, 2010

Memories Slip, but Golf is Forever

by Matthew Futterman

Millions of golf enthusiasts have waxed endlessly about the game's mystical power and its hold on the human mind. A handful of people with Alzheimer's disease, no longer able to dress or nourish themselves without assistance, are proving them right.

A little after 9 a.m. last week, Wardell Johnston declared he wanted to be left alone. Confused and annoyed by the activities and tasks confronting him, the 87-year-old Alzheimer's sufferer shut his door at the Silverado Senior Living home in Belmont, Calif.
Just hours later, Mr. Johnston was measuring the uphill, right-to-left break on a 12-foot putt and knocking his ball into the hole. Then the former civil engineer, who played the game regularly as a younger man, ambled over to the driving range. He grabbed a six iron and practiced chipping with the sort of easy, stress-free swing duffers half his age could learn something from.
"I quit," he said with a cocky grin after each successful shot. Then he deftly cradled another ball with his club, moving it into position for the next stroke. "I haven't played a lot lately," he added. "I should, though. I've still got all the strokes."

Anyone who has dealt with people suffering from mid- to late-stage Alzheimer's knows how difficult it can be to transport someone from fear and confusion to contentment and lucidity. But at Silverado, caregivers have stumbled onto a technique that works nearly every time -- a golf outing. They run through a series of putting drills, knocking the ball around with the wonder of small children playing the game for the first time, which is how many of them experience it each week. For those who played the game when they were younger, swinging a club often sparks a startling transformation, however fleeting, that can make them seem like regular old folks again.

Experts in Alzheimer's say these weekly golf outings illustrate an individualized method of an increasingly popular treatment known as behavioural therapy. Behavioural therapy has been around for more than a decade, but personalizing the treatment to a patient's interests is less common. Rather than providing the same series of experiences to every patient, caregivers have begun to search for activities patients enjoyed when they were younger, and to allow the patients to experience them again.

"This is motor memory for these people, and usually you don't lose that," said Carl Cotman, a professor of neurology at the University of California at Irvine. Dr. Cotman, who has done research on treatment programs at assisted-living facilities throughout the country, said structured, individually focused experiences, especially ones that include off-site exercise like the golf outing, are rare. "It needs to be more common," he said.

Silverado and other assisted-living facilities often use activities like dancing or playing music to stimulate their residents. Like golf, such activities have proved helpful in both making people with dementia feel competent and generating periods of lucidity.

The problem is that personalizing activities for each Alzheimer's patient can be expensive. And playing sports has usually been deemed too difficult, since it often requires a level of balance and coordination -- think of riding a bicycle or hitting a tennis ball -- that people in the later stages of dementia no longer possess.

The golf swing, however, shows staying power in the human mind. "Golf is all about memory, and not just the motion of the swing, but your score and the club you hit and from how many yards you were from the hole," said Bert Hayslip Jr., a psychology professor at the University of North Texas who has studied Alzheimer's sufferers. "There is something about that game that imprints itself on people's minds."

The rule for memory among brain specialists is "first in, last out." The things we learn first -- our names, for instance -- are the memories we hold on to the longest. John Daly, director for the geriatric medicine fellowship training program at the University of California at San Diego, said explicit memories -- what you had for breakfast or even the current appearance of a spouse or a child -- are stored in the cerebral cortex. Alzheimer's usually affects this part of the brain first. Skills like swinging a golf club or playing a musical instrument are part of what is referred to as implicit or procedural memory, which is centered in the cerebellum and other areas of the brain. These are often some of the last memories Alzheimer's patients lose.

Push Alzheimer's sufferers to remember or recognize things they no longer do, and they will often become agitated, as most people do when they are being forced to understand something that is confusing. But give them an activity that once brought about true pleasure, and the agitation can dissipate, their minds can clear, and memories related to that activity can return.
"It's very innovative," Dr. Daly said of Silverado's golf outings, "and it's the sort of thing we're going to need to see a lot more of."

Currently, as many as 5.3 million Americans suffer from Alzheimer's, a number that is expected to rise to about 15 million by 2050, according to the national Alzheimer's Association. The most well-off can afford to live their final years in a place like Silverado, a $6,000-a-month facility with lush gardens, carpeted bedrooms resembling those in small hotels, pets, and an array of activities and entertainment to keep residents stimulated.

No one had thought to take the residents on an outing to a real golf course until Maryam Mahbod, an administrator, met a golf professional named Gerry Benton at a Bay Area concert last year. Ms. Mahbod told Mr. Benton she wanted to take a group of them to the golf course where Mr. Benton teaches in Cupertino, about 20 miles south of Belmont. Mr. Benton, an easygoing Californian with a yin-yang stud in his left ear, thought even a bad day on the golf course would beat another afternoon in an assisted-living facility.

Before they arrived at Deep Cliff Golf Course for the first time, Mr. Benton set up a series of drills on the practice green that he uses to teach young children, such as a tic-tac-toe grid and a croquet-like series of arches. He said he wasn't surprised by the physical abilities of the Alzheimer's sufferers. "You've got a stick, a ball and a hole, and there is something primal about that," Mr. Benton said. "That's how this game started, with a bunch of bored shepherds sitting around in Scotland knocking rocks."