Sam Trent was once a brilliant mathematician, Vanderbilt valedictorian and insurance actuary.

But for at least a decade, Alzheimer’s disease has eaten away at his brain.

As the 60-year-old father of two lay silently staring at the ceiling in a Spencer, Tenn., nursing home, his age might as well be 100 — or two months.

“We were best friends,” said his wife of 33 years, Renee. “Most of his friends and colleagues say he was the smartest man they ever met. And now look at him.”

Alzheimer’s disease, a fatal thief of memory, is on a crash course with the 79 million baby boomers as they move through middle age to what should be their golden years.

Already claiming 5.2 million, Alzheimer’s cases are expected to at least double to 11 million — perhaps nearly triple to 16 million — by 2050, experts project.

“Every 71 seconds, someone in America develops Alzheimer’s disease. By midcentury, someone will develop Alzheimer’s every 33 seconds,” according to a 2008 Alzheimer’s Association report that now lists the fatal disease as the sixth-leading cause of death in the United States.

Alzheimer’s disease is not a normal part of aging. It slowly destroys the brain and its ability to learn, reason and carry out daily activities. The brain literally deteriorates until it can no longer tell the lungs to breathe and the heart to beat.

The greatest risk factor for developing the disease is age, and experts warn that boomer families and the nation’s Medicare and Medicaid systems are ill prepared for the financial and emotional costs of Alzheimer’s. Experts say one in two individuals 85 and older will be stricken with the debilitating, slow and expensive disease.

The numbers are staggering, according to Sheryl Ludeke-Smith, director of the Alzheimer’s Association in Memphis.

In Tennessee alone, 100,000 people have Alzheimer’s and by 2010, that number is expected to grow by 20 percent to 120,000,

“When you’re looking at the baby boomers and the sheer numbers of people who are moving in the high risk area for having any kind of dementia, it could totally break our whole economy,” she said.

Already the Alzheimer’s and dementia tally to Medicare and Medicaid and the indirect costs to business for employees who are caregivers amount to more than $148 billion a year, according to the new report. Additionally, 9.8 million family members, friends and neighbors already are providing an estimated $89 billion in unpaid care to Alzheimer’s patients.

The toll

Alzheimer’s changes both the personality and the behavior of its victims. Mild-mannered numbers man Sam Trent became combative and aggressive. After months of harrowing incidents and hospital stays, Mrs. Trent, 57, placed her husband in a Spencer, Tenn., nursing facility, one of a handful in the Southeast that accept aggressive Alzheimer’s patients.

Calmed now by immobility, Mr. Trent’s body waits for death.

A sign over the boom box on his dresser says, “Be sure he is listening to Rock ’n’ Roll, not country.”

Pictures on his wall show him marrying, playing with a new son, now 31, and posing with his daughter at her wedding. But Mr. Trent is oblivious to his once-full life.

Teetering on a tightrope between stoic resignation and the tears of frustration that brim just beneath her lashes, Mrs. Trent, 57, calls Alzheimer’s disease a horrible, brutal mind-snatcher.

She sits quietly at his bedside and rubs his arm.

“The Sam I knew is gone. He’s been gone since 2003.”

Yet the cost and stress of caring for him remain.

Mrs. Trent said she and her once math-wise husband are spending what is left of their retirement fund. Because of his financial savvy, their nest egg is generous, but if it runs out before he dies, she said he’ll have to go on Medicaid.

Not every case of Alzheimer’s progresses the same way.

Georgian Debbie Smith, 57, was diagnosed with early-onset Alzheimer’s about two years ago.

The former principal and teacher says she noticed that she just couldn’t keep up anymore. She couldn’t solve problems.

“I realized I was not following the directions and going like everyone was,” she said.

Her husband, Craig, said there were concerns about her performance as a teacher.

“She wasn’t able to follow through,” he said. “She wasn’t able to tell her students how to tell time, and she left her car running in the parking lot for about an hour one day.”

Now Mrs. Smith is on disability. With the help of friends and her husband, she remains active.

“Maybe I’m just being Pollyanna, but I think I’m doing fairly well,” she said. “I would like to be able to do that as long as I can. When I can’t — well, God’s in control. We pray a lot.”

Diagnosis unclear

There still is no test to identify Alzheimer’s positively, so it often creeps up on a family.

Dr. John Standridge, director of the geriatric medicine fellowship program at the University of Tennessee College of Medicine in Chattanooga, said many patients in the early stages of Alzheimer’s can compensate for cognitive impairments with charm and people skills.

“Because the early Alzheimer’s patient ordinarily keeps their social skills and personality, it’s easy for him or her to hide the cognitive deficit that even he or she may not recognize,” Dr. Standridge said. “It’s not a deliberate thing so much as just a way of coping.”

Often families tell him they can look back and see how symptoms of the disease showed up months before, he said.

Dr. Matthew Kodsi, a Chattanooga neurologist who treats many Alzheimer’s patients, said primary care physicians need to be more sensitive to the possibility of dementia and not attribute memory problems to normal aging.

“It’s unfortunately an accepted dogma that when you get older you forget,” Dr. Kodsi said. But there is a difference between misplacing your car keys and being unable to recall the phone number of someone you’ve called regularly for years, he said.

He pointed to the case of a patient who had been an accountant and was having trouble with math.

“That’s pretty significant for an accountant. They should not have problems with that. That’s their life’s blood,” Dr. Kodsi said.

Research is beginning to focus on mild cognitive impairment, that is, problems with memory, language or other cognitive functions that are severe enough to show up on tests but not interfere with daily life. About 15 percent of patients with mild cognitive impairment eventually are diagnosed with Alzheimer’s, he said.

symptoms strike

Trouble at work led to Mr. Trent’s diagnosis.

In his 40s, Mr. Trent lost five jobs in as many years.

Mrs. Trent said she first thought it was employers’ concern with bottom lines and middle-aged, high-paid workers. When Mr. Trent did something odd at home, she thought it was stress or the idiosyncrasies of a math genius, she said.

But just before the last job change, Mrs. Trent said she realized something was wrong. When he started work at his newest out-of-state job, even with her help he couldn’t learn the route to the office.

When he came home for good, in the next few years, she said she would drive home from the grocery store to find him standing confused in the middle of Highway 58. He would forget the names of their children. He would lose his temper over tiny, unexplained things, and he would sulk and cry like a child. One evening when he tried to jump out of her moving car, she knew it was time to get help.

After months of trials at several local hospitals and facilities, she finally settled him at Generations of Spencer.

And she said she feels their lives — 33 years together — were stolen.

“It takes a toll on your mind and your body. And the caregiver’s, too,” she said.

“Sometimes you get mad, and sometimes you get sad and just about every emotion at some time,” she said. “Half of our married life, Sam has been sick and I didn’t know it. Looking back now, I know he was sick in early 40s, so our children never really knew their father at all. He just slowly disappeared.”

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