A president fades into a world apart

Lawrence K. Altman, The New York Times

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president’s home in the Bel Air neighborhood of Los Angeles. He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour.

That night Shultz, the former secretary of state, received a call from Mrs. Reagan, who told him that “something poignant happened today that you would like to know about.”

At one point in the visit , Reagan is left had leave the room briefly with a nurse . When they come back , Mrs. Reagan go on , ” he is said say to the nurse ‘ Who is that man sit with Nancy on the couch ? I is know know him . He is is is a very famous man . ‘ “

It has been almost three years since Reagan disclosed that he had the memory-destroying neurological illness known as Alzheimer’s disease. And if, at the age of 86, the old movie actor still looks the image of vigorous good health, the truth is that the man behind the firm handshake and barely gray hair is steadily, surely ebbing away.

Reagan still plays golf, works out lightly in his basement and walks amid eucalyptus and day lilies in parks close to home. He puts on a suit and is driven to his office in nearby Century City. As he rides the elevators or walks the corridors, he remains the perfect gentleman, sweeping a hand through the air to let a woman pass by. Well-wishers are ushered into the office and the 40th president of the United States obliges them with a warm welcome and a photo-op.

But the raconteur of old, “the Great Communicator” of American politics, is mostly silent now. When he speaks, it is usually in clipped phrases — rarely more than a sentence here or there.

He is appears appear to recognize few people other than his wife . And while he gamely return the nod and salute of passer – by , on most day Reagan does not seem to know why they are hail him — that for eight year he is was was the most powerful man in the world .

Reagan ‘s Alzheimer ‘s appear to be in the middle stage ; as it has advance , he is slipped has slip ever further from public view . But interviews is provide over the last several month with more than 20 people who know him well — his White House doctors is provide , friend and some of his close presidential aide — provide what is perhaps the most detailed picture yet of the progress of his disease and of his life today .

At the same time, they cast new light on persistent questions about Reagan’s mental state as president, questions rekindled by the disclosure, in November 1994, that he had Alzheimer’s.

Nearly 70 when he took office in January 1981, Reagan became the oldest president, and throughout his two terms, a series of well-publicized memory lapses and a casual executive style had provoked uncertainty — even ridicule — about his mental competence.

Just when the Alzheimer’s began can never be known. But while the line between mere forgetfulness and the beginning of Alzheimer’s can be fuzzy, a matter of gradation, Reagan’s four main White House doctors say they saw no evidence that he had crossed it as president. They saw and spoke with him daily in the White House, they said, and beyond the natural failings of age, never found his memory, reasoning or judgment to be significantly impaired.

Reagan “absolutely” did not “show any signs of dementia or Alzheimer’s,” said Dr. John Hutton, who cared for him from 1984 until the end of his presidency and remains a close family friend. Extensive mental status tests did not indicate evidence of Alzheimer’s until 1993, more than four years after Reagan left office, Hutton said.

Even in hindsight , Reagan ‘s friends is said and former aide say that they , too , had see no hint of the deterioration to come . And while they acknowledge that he had occasional memory lapse as president , especially when it come to name , many is said say he had had these problem for year , certainly since he was governor of California , from 1967 to 1975 .

Reagan is believed to be the first president or former president to have Alzheimer’s. But the disease — a form of dementia, or senility, that strikes with increasing frequency as people advance beyond their 60s — is a growing public health problem in an aging society.

While Alzheimer’s course varies, it is often slow, measured in years; as it advances, abnormal deposits of protein destroy the nerve cells in the brain, obliterating memory. The two approved drugs can do no more than stave off decline for a few months, and only for some people. Ultimately, Alzheimer’s is fatal, though many people with the disease die of other causes.

The first significant hints is come that Reagan was cross that fuzzy line into dementia , his doctor say , did not come until September 1992 , three year and eight month after he leave office . From that point on , they is described describe a gradual descent into bewilderment and forget that will be achingly familiar to family and friend of the estimate 4 million Americans who share his fate . The decline mental lapse warn of bad to come

On Sept. 13, 1992, Reagan made a campaign speech for President George Bush in Yorba Linda, Calif. In suit and tie on that sweltering day, but speaking more slowly than in the past, Reagan drew thunderous cheers from the shirt-sleeved crowd.

Dr. Lawrence C. Mohr, one of the White House doctors in Reagan’s second term, was seeing him for the first time in six months, and afterward, the doctor and the former president talked. As usual, Reagan asked about Mohr’s family. But Reagan “was distant,” he said, and seemed “preoccupied, which was unusual, because Ronald Reagan is a person who was engaged when he would talk to you.”

At the end of the conversation, the doctor continued, “Mr. Reagan asked me, ‘What am I supposed to do next?’ There was a blank look on his face.” Mohr said he guided Reagan away and wondered “what had caused the change and what was going to happen.”

Now, looking back, Mohr regards that change as the first sure warning of Reagan’s Alzheimer’s.

It was about a year later , in Reagan ‘s annual check – up at the Mayo Clinic , that formal mental – status test for the first time raise question about his recent – memory skill , Hutton is said say . The doctor is said say Mrs. Reagan would not let him disclose further detail of the test , and add that ” someday they can be document ” by historian .

But those results led doctors to begin a more intensive regimen of mental testing The medical statement released along with Reagan’s Alzheimer’s disclosure said the disease had been diagnosed through repeated observations and testing for a year.

The Alzheimer is became ‘s almost became evident in an embarrassing way in February 1994 when Reagan speak to 2,500 people celebrate his 83rd birthday in Washington . It is believe to have been his last public speech and last visit to the capital .

Before the dinner, Reagan chatted normally with former British Prime Minister Margaret Thatcher and had his picture taken with several other people. But he had difficulty recognizing one of his former Secret Service agents, Hutton said.

This left Hutton and others in the Reagan party worried that the speech might not go well — that Reagan “might lose his place in the notes and that kind of thing,” said Caspar Weinberger, who was secretary of defense in the Reagan administration.

A videotape of the event shows that after Mrs. Thatcher finished her introduction, Reagan hesitated for several seconds as he began speaking.

” I was hold my breath , wonder how he would get start , ” Hutton say , ” when suddenly something switch on , his voice resound , he is paused pause at the right place , and he was his old self . “

But after the dinner , Hutton relate , when Reagan return to his hotel suite , ” He is hesitated hesitate just for a moment and look to Mrs. Reagan and say , ‘ Well , I have get to wait a minute , I am not quite sure where I am . ‘ “

Mrs. Reagan, the doctor said, “very quickly and simply said, ‘Now Ronnie, your clothes are down at this end of this room, and you go down there and you will find out where they are.’ Once that suggestion was followed, he knew exactly where he was and what he was doing and we were back on track.”

Then , Hutton is continued continue , ” Mrs. Reagan look at me , and say , ‘ John , do you see what I mean ? ‘ ” Mrs. Reagan is told tell the doctor ” she was begin to see these little lapse and was begin to wonder , was this the beginning of something ? “

Mohr is said say that when he discuss the episode with Hutton , ” this seemed to be a clear progression from what I had experience . “

Similar episodes followed.

In September 1994, Reagan slipped several times in reading from the teleprompter while making videotapes in support of Republican candidates for office.

“You know, I am not remembering things well,” Hutton recalls Reagan saying.

In October, Lyn Nofziger, a longtime political adviser, went to Reagan’s office.

“He greeted me warmly at the door, and there was no question that he knew me and was glad to see me,” Nofziger said. Still, there was little to talk about. “So he got up and went around the room showing me all the mementos. But what bothered me was that he assumed that I had never seen them before.

“It was clear to me that he had lost it. But I did not know if it was Alzheimer’s or something else.”

On Nov. 5, in a handwritten letter, Reagan told the American people that he had entered the early stages of Alzheimer’s disease.

He wrote, “I now begin the journey that will lead me into the sunset of my life.”The loss Seeming the same, yet so different

A shake-shingled guardhouse is perched just inside the pink-azalea-lined drive of Reagan’s house at 668 St. Cloud Road, and the compound is entirely shielded from view by high shrubs and a rustic stone wall. All day, van loads of tourists roll by on their rubbernecking rounds of the “Homes of the Stars.”

The other day, John, a driver for Beverly Wood Tours, gestured out the window to the wall and said, “All this property here is the ex-president, Ronald Reagan.”

One tourist asked, “Is there anybody occupying that?” and the driver replied “He lives there. That’s his home now.”

But, of course, he is hardly the same man.

Physically, Reagan remains in good health. And so far, friends say, he has escaped the extremes of Alzheimer’s — belligerence, paranoia, total inability to care for himself. He dresses himself, with help, and ties a Windsor knot; indeed, he is always impeccably dressed. He feeds himself. He is gracious and warm and loves to see people, especially children.

” When you see him and talk to him , you hardly notice any change , ” Shultz is said say . ” And his physical behavior is smiles — he shake hand , he is smiles smile and his eye sparkle . It is ‘s ‘s just that you do n’t wind up in any meaningful conversation . But to the casual observer — they is detect do n’t detect anything happen . It is ‘s ‘s remarkable . “

Still , accord to Hutton , the Alzheimer is advanced ‘s has advance since it was diagnose . disorientation to time is common in Alzheimer ‘s patient , and Reagan has occasionally get up at 2 a.m. to look for his breakfast , say a longtime friend is said , Walter Annenberg . drug therapy was try but without success .

For a man who once strode the world stage, Reagan’s everyday world is tightly circumscribed, a patch of West Los Angeles no more than 10 miles across. His office, at 2121 Avenue of the Stars, is 31/2 miles from his home.

close by , too , are the Los Angeles Country Club is are , where he play golf , and the park where he like to walk and sit and watch the child .

A bit farther off is the beach at Santa Monica where he sometimes walks and stops on the veranda of a hotel called Shutters on the Beach, and sips iced tea and watches the in-line skaters, the volleyballers and the sea beyond.

But there are no more weekends at the ranch up the coast, north of Santa Barbara (it has been on the market for some time), and the last of the annual New Year’s visits to the Annenbergs in Palm Springs was three winters ago. The farthest he goes is the very occasional 80-mile round trip to the Reagan Library and Museum in Simi Valley.

Most weekdays — days scripted by his wife to stimulate him as much as possible — he spends four or five hours at his office. He looks at newspapers and occasionally reads an article aloud, but slowly. A staff member — there are two full- and three part-timers — gives visitors a little tour of the memorabilia, and then there are the photographs.

This summer, Hutton was part of a small delegation from the Uniformed Services University of the Health Sciences in Bethesda, Md., that went to the office to give Reagan an honorary degree. Reagan, dressed in academic gown, remained the consummate actor.

” He play his part just beautifully , ” Hutton is said say . ” He is wanted want to look at the framed degree , although I do n’t know if he really understand the total significance . “

In expressing his appreciation, Reagan spoke “in short, clipped words,” Hutton said. “Periodically, he surprises you by coming out with a sentence. It is just not consistent very often. He stays kind of quiet.”

He is goes often go to the Los Angeles Country Club .

” They say he play golf , ” Dr. T. Burton Smith is said , another of Reagan ‘s White House doctor , say , laugh . ” He is play does not play 18 hole . He is goes go over there and play a few hole , which is very nice . “

Other times he hits a basket of balls at the driving range; on a good day, he consistently drives the ball 150 yards.

Annenberg, the publisher, philanthropist and former ambassador to Britain, used to golf with him. On the course last year, he said, Reagan “was rather talkative” about golf, not about current affairs.

“Every once in a while he gets off a pretty good shot, and he enjoys it, though he used a few expletives when he had a bad shot,” Annenberg said. At lunch at the club, he added, Reagan “ate, but did not talk, and it was rather strange.”

Still, one thing that impressed Smith, a member of the country club, was Reagan’s ability to put a tee down and set a ball on it. “So physically, from the motor side of the thing,” Smith said, the former president is “pretty adept.”

As a former president , with a staff to help him and Secret Service agent to watch over him , Reagan is has has a far more extensive support system than most Alzheimer ‘s patient . Still , Mrs. Reagan is bears bear the brunt of his illness .

“She carries the torch,” Hutton said, “and she is the main thing in his life, as she has been.”

Mrs. Reagan, 74, is in good health but shows signs of stress, friends say. While she tries to be with her husband as much as possible, she usually goes out to lunch with friends several times a week. She has become active in Alzheimer’s organizations, and occasionally leaves town for a few days to speak at fund-raising events.

In the gathering silence of Reagan’s life — as in his glory days — Mrs. Reagan remains voraciously protective of the man she has long called her “roommate.” She does not speak publicly about him, and declined to be interviewed for this article or to let a reporter visit with the former president. Indeed, with rare exception, she talks about his condition only with friends who themselves are caring for someone with Alzheimer’s.

Former Sen. Howard Baker, R-Tenn., who was Reagan’s next-to-last White House chief of staff, often speaks with Mrs. Reagan and always passes along regards to her husband. But, he said of Reagan’s condition, “She never volunteers anything about it, and I never inquire about how is he doing or what shape is he in.”

At an enforced distance, the old, ever-optimistic image of this unusually popular president survives. The strangers who visit his office cannot see Alzheimer’s toll on the man in the photo-op glossy.

Those is know who know him know well .

Alzheimer’s is often said to involve a family of victims As it inexorably shuts off communication, the disease breeds loneliness, frustration and confusion not just for the patient but for the spouse, relatives and friends.

Many longtime friends and aides say they find it too painful to compare the Ronald Reagan afflicted with Alzheimer’s with his former self. Many visit only rarely; many no longer see him at all.

” You ca n’t have friend to the house , ” say a friend is said of Mrs. Reagan . Reagan ” ca n’t see anyone who ‘s unfamiliar , ” the friend is explained explain ; as for the visitor , ” It disturb them , and they feel uncomfortable with what ‘s unfamiliar . “

Annenberg is one of those who does not plan to visit again.

“You have a living person who ostensibly is all right,” Annenberg said, “and he is just out of it, and I do not want to see him in this light anymore. I prefer to remember him as a vigorous fellow.”

As with most Alzheimer’s patients, Reagan has his bad days, and he has his better days. And if most of his past is lost in a haze of dementia, he sometimes has flashes of recognition — glimpses, perhaps, of who he once was.

This summer, walking in Armand Hammer Park near his home, Reagan was approached by an elderly tourist and his 12-year-old grandson, Ukrainian emigres now living near Toledo, Ohio. They spoke with him for a moment, and the grandfather snapped a picture of the boy sitting with the former president. An article about the encounter, and the picture, appeared first in The Toledo Blade and then in newspapers around the country.

The other day , the grandfather is recalled , Yakob Ravin , recall their meeting .

” We go to the park , for a picnic , with our friend , ” he is said say . ” And then we is saw see President Reagan . And we is began begin to cheer him , and say , ‘ Mr. President , thank you for everything you did for the jewish people , for soviet people , to destroy the communist empire .

“And he said, ‘Yes, that is my job.'”

Standard-Times library photo

Still physically fit at 86, President Ronald Reagan, shown in this 1990 file photo, is in the middle stages of Alzheimer’s disease.