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The Nun Study of Aging and Alzheimer's Disease is a continuing longitudinal study, begun in 1986, to examine the onset of Alzheimer's disease. David Snowdon, the founding Nun Study investigator, began the research at the University of Minnesota, later transferring the study to the University of Kentucky in 1986. In 2008, with Snowdon's retirement, the study returned to the University of Minnesota. Jim Morteimer and Bill Marksberry, a neurologist specializing in Alzheimer's disease, helped with the Nun Study. Similar environmental influences and general lifestyles among the participants make the nuns an ideal population to study, and although it is ongoing it has yielded several findings. At the University of Minnesota, Kelvin Lim and Laura Hemmy are developing a new Alzheimer's Disease study working with the School Sisters of Notre Dame.
A few of the major findings from the nun study derived from archived manuscripts assessed by Snowdon. Among these archives were several of the sister's autobiographies written just before they took their vows. After coding these archives, several themes arose. Positivity was closely related to longevity, as well as idea density. Idea density is an analysis which measures ideas in speech and writing. This research found that higher idea density scores correlated with a higher chance of having sufficient mental capacity in late-life, despite neurological evidence that showed the onset of Alzheimer's disease.
In 1992, researchers at Rush University Medical Center Rush Alzheimer's Disease Center (RADC), building on the success of the Nun Study, proposed the Rush Religious Orders Study. The Religious Orders Study was funded by the National Institute on Aging in 1993, and was ongoing, as of 2012.
Origin and procedure
The Nun Study, begun in 1986 with funding by the National Institute on Aging, focused on a group of 678 American Roman Catholic sisters who were members of the School Sisters of Notre Dame. The purpose of the study was to conclude if activities, academics, past experiences, and disposition correlated to continued cognitive, neurological, and physical ability as patients got older, as well as overall longevity. The participants were gathered on a volunteer basis following a presentation on the importance of donating one's brain for research purposes after death. Prior to the study's beginning, researchers required the participants to be at least 75 years of age and for them to participate in the study until their deaths. Participation in the study included the following; all participants gave permission for researchers to have access to their autobiographies and personal documented information and to participate in regular physical and mental examinations. These examinations were designed to test the subject’s proficiency with object identification, memory, orientation, and language. These categories were tested through a series of mental state examinations with the data being recorded with each passing test. After their deaths, participants were asked to give permission for their brains to be harvested postmortem and studied for signs of Alzheimer’s disease through a process called neuropathological evaluation.
All participants willingly signed a form agreeing to the terms of the study. After a period of just over a year most of the original nuns in the study had died of natural causes. As of 2017, there were three participants still living. Studying a relatively homogeneous group (no drug use, little or no alcohol, similar housing and reproductive histories) minimized the extraneous variables that may confound other similar research.
During the examination process Snowdon was able to compare the collected cognitive test scores with the data received from examining the brains of the subject. These results assisted in giving new layers of understanding to the nature of Alzheimer’s disease. He concluded that Alzheimer's disease is likely caused by early childhood experiences and/or trauma instead of something from adulthood.
Researchers accessed the convent archive to review documents amassed throughout the lives of the nuns in the study. They also collected data via annual cognitive and physical function examinations conducted throughout the remainder of the participants' lives. After the death of a participant, the researchers would evaluate the brains of the deceased to assess any brain pathology.
Writing, emotions, lifestyle and cognition
One of the major findings from the nun study was how the participants' lifestyle and education may deter Alzheimer's symptoms. Participants who had an education level of a bachelor's degree or higher were less likely to develop Alzheimer's later in life. They also lived longer than their colleagues who did not have higher education. Furthermore, the participants' word choice and vocabulary were also correlated to the development of Alzheimer's. Among the documents reviewed were autobiographical essays that were written by the nuns upon joining the sisterhood. Upon review, it was found that an essay's lack of linguistic density (e.g., complexity, vivacity, fluency) functioned as a significant predictor of its author's risk for developing Alzheimer's disease in old age. However, the study also found that the nuns who wrote positively in their personal journals were more likely to live longer than their counterparts.
Snowdon and associates found three indicators of longer life when coding the sister's autobiographies: the amount of positive sentences, positive words, and the variety of positive emotions used. The less positivity in writing correlated with greater mortality. There were many variables this study was unable to glean from the autobiographies of the sisters, such as long term hopefulness or bleakness in one's personality, optimism, pessimism, ambition, and others.
The average age of nuns who began an autobiography was 22 years. Some participants who used more advanced words in their autobiography had less symptoms of Alzheimer’s in older years. Roughly 80% of nuns whose writing was measured as lacking in linguistic density went on to develop Alzheimer's disease in old age; meanwhile, of those whose writing was not lacking, only 10% later developed the disease. This was found when researchers examined neuropathology after nuns died, confirming that most of those who had a low idea density had Alzheimer’s disease, and most of those with high idea density did not.
Snowdon found that exercise was inversely correlated with development of Alzheimer’s disease, showing that participants who engaged in some sort of daily exercise were more likely to retain cognitive abilities during aging. Participants who started exercising later in life were more likely to retain cognitive abilities, even if not having exercised before.
In 1992, a gene called apolipoprotein E was established as a possible factor in Alzheimer's disease, but its presence did not predict disease with certainty. Existence of amyloid plaques and tangles in the brain is a common finding in Alzheimer's pathology. Results from the nuns indicated that neurofibrillary tangles located in regions of the brain outside the neocortex and hippocampus may have less of an effect than plaques located within those areas. Another potential factor was brain weight, as subjects with brains weighing under 1000 grams were seen as higher risk than those in a higher weight class.
Conclusions and further research
Overall, findings of the Nun Study indicated multiple factors concerning expression of Alzheimer's traits. The data primarily stated that age and disease do not always guarantee impaired cognitive ability and "that traits in early, mid, and late life have strong relationships with the risk of Alzheimer's disease, as well as the mental and cognitive disabilities of old age."
The findings influenced other scientific studies and discoveries, one of which indicated that if a person has a stroke, there is a smaller requirement of Alzheimer’s brain lesions necessary to diagnose a person with dementia. Another is that postmortem MRI scans of the hippocampus can help distinguish that some nondemented individuals fit the criteria for Alzheimer’s disease. Researchers have also used the autopsy data to determine that there is a relationship between the number of teeth an individual has at death with how likely they were to have had dementia. Those with less teeth were more likely to have dementia while living. Another study reaffirmed the findings of The Nun Study that higher idea density is correlated with better cognition during aging, even if the individual had brain lesions resembling those of Alzheimer’s disease. A 2019 study combined The Nun Study and Max Weber's vocational lectures, indicating that the vocation and lifestyle of nuns correlated with higher potential for developing dementia. Using research from the original study, Weinstein et al. found a correlation between longevity, and autonomy. Subjects were shown to have a longer lifespan based on the amount of purposeful and reflective behavior shown in their writing.
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- Sauer, Alissa (9 January 2017). "What Nuns Are Teaching Us About Alzheimer's". Alzheimers.net.
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- Riley, Kathryn P.; Snowdon, David A.; Desrosiers, Mark F.; Markesbery, William R. (March 2005). "Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study". Neurobiology of Aging. 26 (3): 341–347. doi:10.1016/j.neurobiolaging.2004.06.019. PMID 15639312. S2CID 41770951.
- "Physical exercise and dementia". UK Alzheimer's Society. 2021. Retrieved 21 January 2021.
- Snowdon, David. Aging with Grace.
- Snowdon, David. Aging with Grace. pp. 121–123.
- Snowdon, David. Aging with Grace. p. 124.
- Snowdon, David. Aging with Grace. pp. 85–89.
- "Inside the brain: Alzheimer's effect". Alzheimer's Association. 2021. Retrieved 21 January 2021.
- Snowdon, David (1997). "Aging and Alzheimer's Disease: Lessons from the Nun Study" (PDF). The Gerontologist. 37 (2): 150–6. doi:10.1093/geront/37.2.150. PMID 9127971.
- "FAQ". The Nun Study. The University of Minnesota. 15 December 208. Archived from the original on 12 May 2010.
- Gosche, K. M.; Mortimer, J. A.; Smith, C. D.; Markesbery, W. R.; Snowdon, D. A. (28 May 2002). "Hippocampal volume as an index of Alzheimer neuropathology: Findings from the Nun Study". Neurology. 58 (10): 1476–1482. CiteSeerX 10.1.1.631.4067. doi:10.1212/WNL.58.10.1476. PMID 12034782. S2CID 24979186.
- Stein, Pamela Sparks; Desrosiers, Mark; Donegan, Sara Jean; Yepes, Juan F.; Kryscio, Richard J. (1 October 2007). "Tooth loss, dementia and neuropathology in the Nun Study". The Journal of the American Dental Association. 138 (10): 1314–1322. doi:10.14219/jada.archive.2007.0046. PMID 17908844.
- Keohane, Kieran; Balfe, Myles (July 2019). "The Nun Study and Alzheimer's disease: Quality of vocation as a potential protective factor?". Dementia. 18 (5): 1651–1662. doi:10.1177/1471301217725186. ISSN 1471-3012. PMID 28840756.
- Weinstein, Netta; Legate, Nicole; Ryan, William S.; Hemmy, Laura (2019). "Autonomous orientation predicts longevity: New findings from the Nun Study". Journal of Personality. 87 (2): 181–193. doi:10.1111/jopy.12379. ISSN 1467-6494. PMC 6446812. PMID 29524338.
- Official Nun Study homepage – as of 2018: Official Nun Study homepage
- Nun study video: video 1
- "Nuns Offer Clues to Alzheimer's and Aging" by Pam Belluck for New York Times, 2001: Article contains, among other things, quotes from the nuns' autobiographical essays which may help to elucidate what is meant above by a "lack of linguistic density."
- Study Links Cognitive Ability of Youth With Alzheimer's Disease Risk Later in Life National Institute on Aging, entry on Nun Study, 1996
- Agatha Christie And Nuns Tell A Tale Of Alzheimer's, on NPR
- Religious Orders Study, Rush University