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and the U.S. Marines about using the device to help decide which injured warriors can head back out and engage the enemy. Fadem is also in discussions with several pharmaceutical companies interested in using the Cognision system to test whether drugs that target the brain are making a diference. "We started looking at diferent cognitive disorders this technology could be useful for, and Alzheimer's disease sort of jumped of the page," Fadem says. Earlier diagnosis of Alzheimer's could mean earlier treatment. Te device is being tested in 1,000 people with mild to moderate Alzheimer's at seven sites across the country, including the Sanders-Brown center. Greg Jicha (pronounced JI-kah), a physician and associate professor of neurology at the Sanders-Brown center, is in charge of that trial and several others at Sanders-Brown. You can always distinguish the researchers who also see patients from the pure researchers by their outfts — the men, anyway. Tey wear ties. Jicha's tie has tiny portraits of Mickey, Goofy, Pluto and Donald. Te other dead giveaway is the stethoscope draped around his neck. "When people get Alzheimer's, perhaps even years before plaques and tangles start to form, their nerve cells are sick and not working properly," he says. Cognision appears capable of picking up even the early degradation. "Tis is potentially an easy way to detect what we think may be the earliest stage of disease," he says. By 2025 an estimated seven million Americans age 65 and older will have Alzheimer's, a 40 percent increase from the fve million with the disease today, according to a study in the journal Neurology. In Kentucky, Alzheimer's is expected to grow by 21 percent between 2010 and 2025 and infict 97,000 people. In Indiana, Alzheimer's is projected to rise by 8 percent to 130,000 by 2025. Behind the higher numbers for Kentucky may be the state's overall burden of poor health and a slightly higher increase in the number of people 65 and older. Research suggests that Alzheimer's corresponds with higher rates of type 2 diabetes, high blood pressure, heart disease and stroke — all of which are afected by lifestyle factors such as tobacco use and diet. "Managing blood pressure, diet and smoking — all contributors to vascular disease and heart disease," says Robert Friedland, a University of Louisville neurology professor who specializes in Alzheimer's, helps prevent the disease. He also advises regular exercise and fossing. "Infammation in the mouth," Friedland says, "is not good for the brain and the heart." Te role of infammation in Alzheimer's is a growing research area. Nationwide, we spend $203 billion caring for people with cognitive degeneration, a price that could rocket to $1.2 trillion by 2050 if projections of disease growth hold up. Te needs of Alzheimer's patients are complex and allencompassing. Tese aren't people who can be fxed by surgery. Tey don't just need a nurse. Tese are folks who need everything. Someone has to feed them. Someone has to bathe them. Someone has to keep them from wandering away in the night. he sound of a doorbell startles Gloria Bray from sleep. It's around 5 a.m. She rushes downstairs, with Angel, a Yorkshire terrier no bigger than a shoebox, racing ahead. As Gloria fips on the living room light, Angel goes into full pit-bull mode, snarling and baring her tiny needle teeth at a young man standing on the porch. "Mrs. Bray, Mr. Bray is outside walking around with hardly no clothes on," the man says. Ten Gloria sees her husband Oscar, once a proud man with impeccable grooming. A woman leads him by the hand. Te woman was on her way to work when she saw Oscar and pulled over to help. Oscar is wearing Depends. Tis is not an unusual story. Any family dealing with Alzheimer's has its tales: Te battle over car keys. Te refusal to bathe. Te changed personalities. Sweet, calm people who grow angry and sometimes violent. Sharp-tongued people who mellow. Mothers who cannot remember their way home from the store. Fathers who cannot recall their children. Leave a note on the table that says, "Call me," and you will be called every 10 minutes by someone who cannot remember she already did. A psychiatrist tells me his mother, now in her 90s, nurses fond memories of travels all over the world. In truth, she has hardly traveled at all. Gloria Bray has trouble sleeping now, ear ever cocked for the sound of her husband's cane on the foor. "You don't know how his mind is working, what he might attempt. He may climb the fence," she says. She's been married 57 years to this sweet, gentle man who is now so changed, he has occasionally threatened her with his cane. On advice, she hid the knives in an upstairs bedroom. "I miss the companionship," Gloria Bray says. "Just someone to talk to. We used to travel a lot. It was nothing for us to run down to Florida. I miss that. I'm just homebound now, really. I'm just homebound." Oscar is no longer himself. "He curses now," Gloria says. "He never did that. 'Shut your damn mouth. Get the hell out of my face. Get out of my room.'" It hurts. Sure, he doesn't know any better. Sure, it's not the same Oscar she's always known. But how do you not take these things personally? It's one thing to know that your spouse is altered. It's something else again to walk away from nearly six decades of feelings. "I miss the companionship," Gloria says. "Just someone to talk to. We used to travel a lot. It was nothing for us to run down to Florida. I miss that. I'm just homebound now, really. I'm just homebound." It's a story that will only grow more common, says Teri Shirk, executive director of the Greater Kentucky/Southern Indiana Chapter of the Alzheimer's Association. "Right now, we're not prepared in Louisville, and we're not prepared as a country. We do not have the in-home care support. We do not have the nursing-home beds. We don't have the professional caregivers. We have to get prepared, or we better fnd a cure." It used to be cancer that scared the bejesus out of everyone. Te Lord Voldemort of disease, people avoided the name: Te C Word. It's not that we've grown cozy with cancer, but it's one of several killers that is just not as lethal as it was. In fact, among the 10 leading causes of death, Alzheimer's, suicide and accident are the only ones with a higher rate of death in 2010 than in 2000. Since 2000, heart disease has fallen more than 30 percent, cancer mortality 31 percent, stroke 35 percent; and even diabetes has dropped a little, by 4 percent, according to the National Vital Statistics System. In that same time frame, Alzheimer's deaths rose nearly 39 percent. It is now the No. 6 leading cause of mortality, and No. 5 among people older than 65. In the list of killers, Alzheimer's is also the only disease with no treatment capable of changing its course. "You know if you're diagnosed with diabetes, the doctor has things you can do," Shirk says. "Tere's absolutely nothing we know of that is going to prevent you from getting Alzheimer's if you're going to get it." But, Shirk says, "we know if we fnd a medication that can stave of the disease for just fve years, it completely changes the cost trajectory." To date, there are only a handful of medications available to treat 11.13 LOUISVILLE MAGAZINE 41