Aging With Grace: What The Nun Study Teaches Us About Leading Longer, Healthier, And More Meaningful Lives

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In 1986 epidemiologist Dr. David Snowdon embarked on a revolutionary scientific study that would forever change the way we view aging and old age. Dubbed the "Nun Study" because it involves a unique population of 678 Catholic sisters, this remarkable long-term research project remains today at the forefront of some of the world's most significant research on aging.

This remarkable book by one of the world's leading experts on Alzheimer's ...

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In 1986 epidemiologist Dr. David Snowdon embarked on a revolutionary scientific study that would forever change the way we view aging and old age. Dubbed the "Nun Study" because it involves a unique population of 678 Catholic sisters, this remarkable long-term research project remains today at the forefront of some of the world's most significant research on aging.

This remarkable book by one of the world's leading experts on Alzheimer's disease combines fascinating high-tech research on the brain with the heartfelt story of the aging nuns who are teaching scientists how we grow old — and how we can do so with grace. The Nun Study's findings are already helping scientists unlock the secrets to living a longer, healthier life.

Yet Aging With Grace is more than a groundbreaking health and hard-science book. It is the story of an altar boy who grew up to be a scientist studying the effects of aging on nuns. It is the poignant and inspiring stories of the nuns themselves. Ranging in age from 75 to 104, these remarkable women have allowed Dr. Snowdon access to their medical and personal records — and they have agreed to donate their brains upon death.

In Aging With Grace, we accompany Dr. Snowdon on his loving visits to nuns like Sister Clarissa, who at the age of 90 drives around the convent in a motorized cart she calls her "Chevy" and knows as much about baseball as any die-hard fan a third her age.

Then there is 104-year-old Sister Matthia, who until her death in 1998 knitted two pairs of mittens a day and prayed every evening for each of the four thousand students she taught over the years. These bright,articulate, and altruistic women have much to teach us about how faith, wisdom, and spirituality can influence the length and quality of our lives.

We also follow Dr. Snowdon into the lab as he and his colleagues race to decode one of the most devastating diseases known to humanity. We discover:

* Why high linguistic ability in early life seems to protect against Alzheimer's
* Which ordinary foods in the diet defend the brain against aging
* Why preventing strokes and depression is key to avoiding dementia
* Why it's never too late to start an exercise program
* What role heredity plays, and how lifestyle can increase our chances for a mentally vital old age
* How intangibles like community and faith help us age with grace

Both cutting-edge science and a personal prescription for hope, Aging With Grace shows how old age doesn't have to mean an inevitable slide into illness and disability; rather, it can be a time of promise and productivity, intellectual and spiritual vigor, and continuing freedom from disease.

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Editorial Reviews

From Barnes & Noble
Begun in 1986, Dr. David Snowdon's Nun Study tracked hundreds of elderly, yet vital Catholic sisters. Each of the nuns participating granted Snowdon extraordinary access, allowing him complete review of their medical and personal records and even agreeing to donate their brains for research after their demise. His study reveals the surprising relationships among heredity, training, diet, community, and faith in healthy longevity. Some of his conclusions are startling: He notes, for example, that high linguistic ability in early life seems to protect against Alzheimer's. A good-hearted book for anyone who fears getting old.
Publishers Weekly - Publisher's Weekly
Since 1986, the author, an epidemiologist, has directed a research project dubbed the Nun Study. According to Snowdon, who previously studied Seventh-Day Adventists, religious group members make ideal subjects because of their similar and somewhat insular lives. Specifically, he has been tracking the lives of 678 elderly nuns who are members of the School Sisters of Notre Dame, to assess the effects of aging. Snowdon describes in detail a pilot study he conducted with the sisters in Mankato, Wis., on the link between level of education and disabilities related to aging. This initial research convinced him to expand his base to other convents and to focus primarily on Alzheimer's disease. The participants, ranging in age from 75 to 104, agreed to provide access to their medical and personal histories and, after death, to donate their brain tissue to the project. What distinguishes this study is Snowdon's decision not to maintain the usual "objective" distance from his subjects but rather to become emotionally involved with them. His commitment to treat them with "care and respect" is readily apparent in the many warm and sympathetic anecdotes and his expression of deeply felt grief when any of the sisters becomes incapacitated by Alzheimer's or dies. Among the project's findings is a clear correlation between a low rate of Alzheimer's and high linguistic ability. Snowdon has also found a positive relationship between the consumption of certain antioxidants (e.g., lycopene, found in pink grapefruit, tomatoes and watermelon), an exercise program and an optimistic outlook and aging successfully. Although the study is still under way, readers will certainly appreciate the early insights to be gleaned from Snowdon's human- (rather than statistic-) centered and compassionate story. (May 8) Copyright 2001 Cahners Business Information.
Library Journal
Since 1986, the School Sisters of Notre Dame in Mankato, MN, have opened their lives, personal histories, and medical records in an extraordinary way, thereby offering researchers a unique view of Alzheimer's and aging. Snowdon, a professor of neurology and director of the Nun Study at the Sanders-Brown Center on Aging at the University of Kentucky Medical Center, have studied this population of 678 Catholic sisters, some of whom have remained active and lucid all their lives while others have become demented. This is an ideal population to study, for it is carefully controlled: income is not a factor, all the subjects are nonsmokers, and all have similar access to diet, healthcare, and housing. Snowdon writes with empathy and affection of these sisters, who also generously agreed to donate their brains for postmortem pathological studies. From this research, Snowdon explains, it emerged that pathological changes did not always correlate with observable changes, that linguistic ability seems to protect against Alzheimer's, that prevention of stroke and heart diseases can help avoid dementia, and that heredity, diet, and exercise also play a part. Blending personal histories with scientific fact, this inspirational and fascinating look at growing older is highly recommended. [Snowden's research was recently profiled in a cover story in Time magazine. Ed.] Jodith Janes, Cleveland Clinic Fdn. Copyright 2001 Cahners Business Information.
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Product Details

  • ISBN-13: 9780553801637
  • Publisher: Bantam Books
  • Publication date: 5/8/2001
  • Pages: 256
  • Product dimensions: 6.46 (w) x 9.56 (h) x 0.94 (d)

Meet the Author

Dr. David Snowdon received his Ph.D. in epidemiology from the University of Minnesota and began the Nun Study there in 1986. In 1990 he moved the Nun Study to the Sanders-Brown Center on Aging at the University of Kentucky Medical Center, where he is also Professor of Neurology. One of the world's leading experts on Alzheimer's disease, he has presented his findings at scientific conferences throughout North America and Europe and has been published in such major medical journals as The Journal of the American Medical Association and The Journal of Gerontology.

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Read an Excerpt

The Road to Good Counsel Hill
They will open up to you, but only if you give of yourself first.

-- Sister Carmen Burg

On a spring morning in 1986, when the midwestern snowpack finally had begun to melt and the change of seasons encouraged new ideas to sprout, I sat nervously in the reception room of a convent in St. Paul, Minnesota, with a new idea of my own. I had come here to meet Sister Carmen Burg, who would either help my idea take root or wish me luck and send me on my way. I feared that she had bad news for me.

As an assistant professor of epidemiology at the University of Minnesota, I was struggling mightily to find my niche. In the competitive world of scientific research, especially at a large institution, I knew I had little time to establish my value to the department. All too frequently I remembered my chairman's words: "It's nice to be independent, but you must be funded."

Sister Carmen was an elected leader of one of Minnesota's largest groups of Catholic nuns, the School Sisters of Notre Dame. Nearly two hundred sisters lived at the Good Counsel Hill convent in Mankato, ninety miles southwest of St. Paul. I had contacted Sister Carmen to propose a research project involving the nuns. Now I worried that she had offered to meet me here -- before I ever got to Mankato -- so that it would be less awkward to turn me down. Underscoring my anxiety were images that had been seared into my memory at Sacred Heart elementary school. Most of the sisters had been serious, take-no-prisoners disciplinarians.

I had learned what I knew about the School Sisters of Notre Dame from Nora Keenan, a graduate student in our department. Nora had an unusual background for an epidemiologist: She had previously been one of the Notre Dames and had lived at the Mankato convent. She explained to me that her former congregation had originated in Bavaria in 1833, at a time of great political and social upheaval. The founder was a teacher at a parochial school, Caroline Gerhardinger, who later took the religious name Mary Teresa of Jesus. Mother Teresa, as she was known, believed that society could be transformed through the family, and that her call was to provide education and spiritual formation for girls - particularly poor girls in rural areas. Shortly after the congregation was established, millions of Germans -- driven by crop failure and revolution -- began to emigrate to the United States, and the American bishops asked Mother Teresa to consider a new frontier for her mission. Together with four other sisters, she arrived at a forest settlement in Pennsylvania in 1847. From there, the congregation had moved west and south with the immigrants, founding schools and convents throughout North America. By 1986, the congregation (now based in Rome) had more than seven thousand sisters in nearly thirty countries. The Mankato convent -- one of seven provincial motherhouses in this country -- had been established in 1912.

Nora's account immediately sparked my interest. As I told her one day over lunch, I had built my career so far around studying unique populations of religious groups. For my Ph.D. thesis at Minnesota, I had joined an ongoing study of the Lutheran Brotherhood and investigated whether cancer and heart disease had any links to alcohol use. I then worked at California's Loma Linda Medical College, investigating the impact of diet on the health of Seventh-day Adventists. Now that I was back at Minnesota, I wanted to study aging and health, and I suspected that nuns or priests -- I did not really have a preference -- would offer unique clues. It was then that Nora had offered an introduction to Sister Carmen.

My nervous wait ended when a short, smiling woman came into the reception room and held out her hand. Sister Carmen was dressed in a simple white blouse, camel-colored cardigan, and long plaid skirt. Only a small pin over her heart signaled her membership in the School Sisters of Notre Dame. I had forgotten that since my days at Sacred Heart school, the reforms of the Second Vatican Council (or Vatican II) had made the black-and-white habit an option. Now in her early sixties, Sister Carmen wore large glasses, and behind them I could see the intelligent, patient eyes of a woman who had taught thousands of children. After we had chatted for a few minutes, she got right to the point.

"You know, Dr. Snowdon," she said in her distinct midwestern accent, "I love being a nun. Sisters are as human as the next person. But my question is, why on earth do you want to study nuns?"

She listened attentively as I described my past work with Lutherans and Adventists. I explained to Sister Carmen that these religious groups kept extensive membership lists and historical records that made them ideal subjects for epidemiological studies. And the members often had similar lifestyles, which enabled researchers to make powerful comparisons of factors connected to illness or health. Nuns had even more similar histories. They do not smoke. They are celibate. They have similar jobs and income, and they receive similar health care for most of their lives. All of these factors reduce the confounding variables -- such as poverty and lack of health care -- that can cloud the meaning of data. Outside a laboratory, it would be hard to find as pure an environment for research.

In fact, I went on, nuns had already played a crucial role in expanding our understanding of two devastating diseases that afflict women: breast cancer and cervical cancer. In the 1950s scientists observed that nuns had an unusually high risk for breast cancer. This led researchers to examine overall breast cancer rates more closely, comparing single to married women. It emerged that single women, like nuns, also had a high risk of breast cancer. The variable turned out to be pregnancy and the hormonal changes it causes. Much of today's understanding of how hormones affect breast health had its origin in this research.

Several famous studies, on the other hand, have reported cervical cancer to be rare in nuns and common in prostitutes, I offered, immediately realizing how odd this must have sounded to Sister Carmen. In this case, it was a sexually transmitted virus that ultimately emerged as the link to cancer. "Again, it isn't difficult to make the connection," I added.

"No, it isn't," she agreed.

I gladly changed the subject to aging and the purpose of my visit. "I'm hoping the study of the School Sisters of Notre Dame will lead to some major clues about aging and disease," I said. "Ultimately, I want to increase our knowledge and help people live longer, better lives."

Sister Carmen brightened when she heard this. If she was bothered by the vagueness -- or vastness -- of what I was proposing, she didn't let on. She sat quietly for a minute.

"Let me tell you, Dr. Snowdon," she began. "We have always believed in the power of knowledge and ideas. A large part of our mission has always been teaching. Over ninety percent of our sisters have been teachers at one time. Some of our older sisters taught in towns that had no schools before they arrived.

"Our sisters have spent their entire adult lives trying to help other people in the community. Even in their retirement, they have a deep passion and drive to help others. I think they would see your study as a way to continue their lifelong mission of helping others, of educating others."

"Yes, I hope so," I said.

Sister Carmen paused again and then let out a big, contented sigh. "Okay," she said, as only a Minnesotan can.

"Okay?" I was confused. "You mean -- "

"Wait." She raised her open hand and stopped me in midsentence. "I'll move forward with your request, but you need to listen carefully to what I am about to say. No matter what you do, I want you to remember who these women are. They are real people. Very dear to us. They are holy people, too. I don't want you to treat them as research subjects. Get to know them. Understand that many of the older sisters were the teachers or mentors of the younger sisters, and we treat them with the care and respect they deserve. We will expect nothing less from you."

I was a little stunned by Sister Carmen's statement. My prior research projects had included tens of thousands of participants, and I knew them only through their medical records and the questionnaires they had filled out. All researchers are taught that scientific objectivity depends on keeping one's distance from the people one studies. I had no idea how I could fulfill her request, so I simply nodded and said, "I'll do my best."

Sister Carmen gave me this parting advice: "They will open up to you," she said, "but only if you give of yourself first."

Copyright ©(2001) by David Snowdon.

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Interviews & Essays

An Interview with Dr. David Snowdon

Q: What makes the Nun Study unique?

A: Before I started the Nun Study, I'd done research involving tens of thousands of participants with data drawn from questionnaires. When I first sought permission to work with the School Sisters of Notre Dame, a leader of the congregation, Sister Carmen Burg, said yes on one condition. She insisted that I treat the sisters as human beings, not as research subjects -- she told me to go to the convents and get to know them as individuals. This, of course, flies in the face of the way scientists are trained in the name of "objectivity." But what a gift! I now have honorary great-nephew status with a group of remarkable women.

Q: What makes them remarkable?

A: The School Sisters of Notre Dame were founded in Germany with a special mission to serve poor girls in rural areas. In this country, they followed the settlers west and played a great role in the expansion of educational opportunity. Almost all of the sisters were lifelong teachers. Some of the oldest nuns taught in communities that had no schools before they came. Of the sisters in our study, about 85 percent had bachelor's degrees, and 45 percent had master's degrees -- amazing figures for women of any generation.

Q: Is your book about the sisters or about the science?

A: Both. I try to take readers inside the process of how we've made our discoveries -- like all real science, it has many twists and turns and surprises. But as I've learned, you can't understand aging and Alzheimer's disease without seeing how they affect real human beings. One of my closest friends among the sisters -- I call her Sister Maria in the book -- died of Alzheimer's disease. You could see aspects of her beautiful personality right up until the end. And the well sisters give extraordinary support to those who are failing -- they don't lose sight of their humanity. That's an important message I'd like people to take from the book.

Q: You are an epidemiologist. What perspective does that give you on Alzheimer's disease?

A: Epidemiologists are trained to search out the causes of diseases in large groups, often over long periods of time. Nuns are an ideal group to study because they live such similar lives -- it is easier to home in on the differences that really count. Because of this, the Nun Study has been able to discover that the most common form of Alzheimer's is not a yes/no disease that suddenly occurs as we get older. It actually appears to have roots in early life, and there are many lifestyle factors, including education, nutrition, exercise, depression, and cardiovascular health, that seem to play a role in its development.

Q: Wasn't it difficult to ask the sisters to donate their brains?

A: It's probably the hardest thing I've ever done. The brain is not just another organ. Most of us feel that it contains our identity -- our mental, emotional and spiritual history. That makes the sisters' response all the more amazing -- 66 percent of those who were eligible joined the Nun Study. (Based on other studies, we thought we'd be lucky to get 20 percent.) I'll never forget what Sister Rita Schwalbe, one of the convent leaders, told me: "Our congregation was founded to work with the poor and powerless. Who's more powerless than someone with Alzheimer's disease?"

Q: What happens to the sisters' brains after they die?

A: They are brought to our lab at the Sanders-Brown Center on Aging at the University of Kentucky, where they are analyzed to determine the extent and location of the characteristic damage of Alzheimer's disease -- the so-called "plaques and tangles" that kill neurons and disrupt communication within the brain. This information is then matched with the mental and physical tests we have conducted on the sisters while they were alive. This has resulted in some real surprises.

Q: Such as?

A: We have discovered sisters with the most extensive form of Alzheimer's damage in their brains who performed brilliantly on our mental tests. We have discovered that a sister may be severely demented without having significant brain damage. In other words, the symptoms don't always match the pathology. This astounded Dr. William Markesbery, the neuropathologist for the Nun Study. We have also discovered that the cumulative brain damage done by small strokes may tip the balance toward dementia. Ultimately, this is good news, because we do know how to prevent strokes. Another piece of good news: some of the healthiest brains we have found are in centenarians. Even if we become extremely old, decline is not inevitable.

Q: Haven't you also shown that the sisters have remarkable longevity? How do you account for this?

A: The risk of death in any given year after age sixty-five is about 25 percent lower for the School Sisters of Notre Dame than it is for the general population of women in the United States. This means that the sisters live dramatically longer lives than their lay counterparts. At one point, in one convent alone, there were seven living centenarians -- the sisters called them The Magnificent Seven. Certainly education and a prudent, healthy lifestyle play an important role -- for example, none of the sisters smoke. But I believe that intangibles such as positive life purpose, spirituality, and a supportive community are also significant.

Q: Based on your findings, is there anything we can do to prevent Alzheimer's? For instance, some people say we should avoid aluminum in soda cans or cookware.

A: That aluminum story just won't die -- but it has never been proven, and most scientists today discount it. The Nun Study has also shown that another suspect -- the mercury in dental fillings -- is not a factor. In my public talks, I stress doing everything we can to prevent strokes -- and to treat them immediately if one occurs. We've all heard this message before: Keep your weight and blood pressure down. Exercise. Quit smoking. But if you know these steps can also help prevent the symptoms of Alzheimer's, you're more likely to pay attention.

Q: If a person has a family history of Alzheimer's, can they take a genetic test for the disease?

A: When I'm asked this, I often reply, "What difference would it make if you knew?" Many people overestimate the power of genes. The early-onset form of Alzheimer's, which emerges in people before age 65, does seem to be strongly genetically determined, but it accounts for only 5 to 10 percent of cases. There is also a gene associated with late-onset Alzheimer's, but many people who get Alzheimer's do not carry it. We will probably discover more genes in the future -- and also more ways that they interact with things we can control.

Q: Are there any foods or supplements that can help ward off Alzheimer's?

A: I did my Ph.D. research on nutrition, and I would love to be able to come up with a definitive answer -- but we don't have one yet. The best evidence right now points to the protective effect of antioxidants -- like vitamins C and E. High levels of folic acid are also emerging as an important factor in brain health throughout life. But it may be more important to eat many fruits and vegetables than to load up on supplements. I currently take about one and a half times the standard daily value for vitamins -- and most of my colleagues also avoid megadoses. Finally, I think that some so-called alternatives, such as gingko biloba, show promise. But we need much more research in this area.

Q: You've made some remarkable claims about the autobiographies the sisters wrote when they entered the convent. Why did you study these?

A: The autobiographies are one- or two-page documents written when the sisters were in their early 20s, before they took their religious vows. When we first discovered them in the convent archives, it was as if we had opened a fascinating time capsule. We have since discovered that they have amazing predictive power. For example, a linguistic measure called idea density predicted who would get Alzheimer's -- 60 or more years later -- with 80 percent accuracy. The sisters who packed the most ideas into their sentences at age 22 were somehow protected at age 85! We still don't know exactly what brain mechanism is involved, but other research has shown that Alzheimer's may be a lifelong process. Another Nun Study paper, which will be published this May, links longevity to emotional expression in the autobiographies. We discovered that the sisters who expressed the most positive emotions in their writing lived years longer on average than those who expressed the least. Maintaining a positive attitude appears to be very important to living a long and healthy life.

Q: What's next for the Nun Study?

A: Right now, we believe that we will be collecting data for another twenty years. As of the start of 2001, 295 of the original 678 participants were still alive. The youngest was 84 and the oldest was 106. And as we continue to develop new hypotheses, we go back to study the brains we have already collected, all of which are carefully preserved. We want to clarify the dividing line between Alzheimer's and what is called mild cognitive impairment. We are developing more sophisticated ways to evaluate the living brain, so we can improve early detection and diagnosis. We will do more gene screening, and also continue our research on emotion and personality.

Q: Has the Nun Study changed your own attitudes towards aging?

A: Well, I turn fifty next year, and I'm much more optimistic now than when I was younger. I've known a number of centenarian sisters who are still active and enjoying life. They've made a good old age seem like a real possibility.

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  • Anonymous

    Posted January 3, 2003

    An excellent book on the topic of Alzheimers and aging

    I purchased this book when my husband and I started to suspect my father in law had Alzheimers. It is highly informative - an excellent book for those who would like a greater understanding of Alzheimers and/or aging. The book delt with a scientific topic without seeming like a textbook: the personal stories and the author's obvious affection for the nuns made "Aging with Grace" read more like a biography than a book reporting the results of a scientific study. "Aging With Grace" does not go into detail on treatment options, medications, resources for patients who DO have Alzheimers (that's not the purpose of this book). However, it does provide insight on how to incorporate a wellness plan into your life to reduce your chances of becoming afflicted with Alzheimer's. I would recommend this book to anyone interested in Alzheimer's, aging, or wellness. I think it would also make a good choice for a book club that is interested in reading non-fiction.

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  • Anonymous

    Posted May 21, 2001

    A Warm, Interesting Report on Longevity and Quality of Life!

    Most books about science operate mostly from the head. This book also has a heart, and gives you a close human connection with the people being examined. 678 elderly nuns from the order, School Sisters of Notre Dame, are being studied to understand what factors helps explain their long life, and ability to remain mentally and physically active at advanced ages. The results of this work will undoubtedly focus future scientific research into the most productive areas for extending and improving the quality of human life. Professor Snowdon is an epidmiologist who has had great success with studying religious communities. Because of the similar environments and habits involved, these communities can more clearly demonstrate the factors that favor or disfavor disease. He has also done work with Seventh Day Adventists and diet, for example. The School Sisters of Notre Dame is a teaching order, and its members are highly educated. For example, of the elderly nuns studied 85 percent held bachelor's degrees and 45 percent master's degrees. This is in sharp contrast with the rarity of these degrees in the general population among women of similar ages. Obviously, they have also led a life of strenuous service to God and to teaching others. The study benefits from many other unique qualities. Each nun also wrote an autobiography when she was young, and just joining the order. As a result, it is possible to go back and study those writings. The sisters have also generously agreed to donate their brains for research when they die. This means that the physical brains can be compared to the results of cognitive and physical tests to see what the causes of mental and physical dysfunctions might be. Early in the study, Professor Snowdon also gained another advantage. He was encouraged to develop a relationship with the sisters, rather than just to study them. The book's many examples reflect his personal connection and observation of their aging experiences. Although the study is continuing, it has already yielded some remarkable insights. In the area of Alzheimer's disease, the research has shown that higher education and better vocabulary and reading comprehension skills when young help prevent or delay the disease. In brains equally ridden with distortions of the disease, functionality of the person varies a lot due to those factors. You are advised to read to your children as a way to help them avoid Alzheimer's disease when they are older. Brains of those with Alzheimer's disease show plaques and tangles. The study suggests that the tangles are important, and the plaques less so. Keeping blood pressure under control to avoid stroke also helps to stave off Alzheimer's disease. Interestingly, more education and greater mental capacity when young are also predictive of longevity. The book also looks at the genetic impacts on Alzheimer's and seems to suggest that these can be overcome to some extent by education and mental development. There are also diet suggestions, like getting plenty of folic acid (found particularly in cooked tomatoes). The stories of the individual nuns will stay with you for a long time. These are very admirable people, and I learned a lot from reading about their lives. If you are like me, you will be saddened to think about the sister who had Alzheimer's who feared that she would forget God. You will also be saddened by the sister who was incorrectly diagnosed as having Alzheimer's and lived four very unpleasant years with this misapprehension. There's good news here if you do live a long time. 'The older you get the healthier you've been.' So after around 85, many sources of health risk don't seem to get any worse. The stories of active minds and bodies over 100 will inspire you. After you finish reading this book, I suggest that you locate some elderly people (ideally over 90) and get them to tell you about their lives. In that connection, you will also receive much inspiration

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