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As a combat infantryman in Vietnam, Leon Douglas Bryant lost his right arm and part of his left hand. The injuries didn't stop him from raising a family and enjoying a long career as a benefits counselor for VA.
Decades later, he would lose another part of himself. This time, the impact on his life was far more devastating.
Bryant first received a diagnosis of dementia in 2006. It was confirmed as Alzheimer's disease in 2010. Today, his home is a VA community living center in Baltimore, where his wife and two sons visit him several times a week.
"Most days, he doesn't recognize me," shares his 35-year-old son, also named Leon, an auditor for the Department of Defense. He and older brother, Quinton, 40, an accountant for a utility company, each come twice a week and on weekends, partly to help ease the burden on their mother.
Bryant's wife of 41 years, Linda, a retired elementary school teacher, says she copes with the help of family and friends, an Alzheimer's Association support group, prayer, and a resilient sense of humor. A survivor of breast cancer, she tries to find the lighter moments in the family's daily struggle.
"Every day he asks me if I'll marry him," she says with a smile. "Sometimes I say yes, sometimes I say I'll think about it. I know that five minutes later he'll ask me again."
Some days, though, she cries.
"I see him and remember how he was. Sometimes I'll bring out pictures."
Bryant, who earned a Purple Heart and Bronze Star in Vietnam, cut a dashing figure in his Army uniform. He went on to serve 33 years with VA, helping fellow Veterans. Outside work, he loved sports, the company of good friends, and especially family. He would talk proudly of his two sons, both of whom finished college and went on to get good jobs.
He was relatively young—in his late 50s—when his memory lapses became frequent and severe.
"He started forgetting how to go places where he had been many times, like church," says son Leon. "He wouldn't remember how to get home."
One time, Linda sent her husband to Popeyes to pick up chicken. He came back empty-handed and confused, claiming the restaurant had no chicken.
At first, says Quinton, his father seemed aware of how his memory was slipping. "It was frustrating to him. He would apologize to us when he repeated himself." Gradually, the self-awareness ebbed.
As his thinking and memory further declined, Bryant was evaluated for Alzheimer's. He underwent a battery of neuropsychological tests, some including questions as basic as what day of the week it was, or what year. These were followed by brain scans to rule out other causes.
Today, there's little hope on the horizon for Bryant's condition. Some symptoms, such as agitation, can be managed fairly well with medication and adjunct treatment. Drugs that slow the disease's progress, however, work only short-term.
Would earlier warning of Bryant's impending decline been a blessing for him and his loved ones? Or would it have needlessly raised anxiety years ahead of the Alzheimer's diagnosis?
This question will increasingly face families in the future as researchers refine tests such as PET scans and lumbar punctures to detect the first signs of amyloid build-up in the brain—perhaps 15 years or more before any symptoms appear.
Linda Bryant, the former teacher, is clear on her view: "Knowledge is power. The more you know, and the earlier you know, the more prepared you can be. The more resources you can have on hand."
Researchers point out that as new treatments emerge—several potential ones are in clinical trials now—early detection may do more than help families line up resources or prepare emotionally. It may trigger early treatment. This, experts say, may be critical in thwarting Alzheimer's, based on study results so far.
For the Bryants, the question seems moot. For now, Linda and her two sons offer whatever comfort they can as they watch the man they love fade slowly into the clutches of dementia.
Visits often involve helping with personal care. Quinton remembers his mother filling that role for her mother, who was also in a nursing home. "Fast-forward 20 years," he says, "and now it's my Dad." He says the family has gotten used to tasks that at first were unpleasant or uncomfortable. With certain jobs, "it's come full-circle," he says. "My Dad taught me to shave. Now I'm shaving him."
The grandkids seem to elicit a special response from the elder Bryant. "He cries whenever he sees my daughters," says Quinton, "even though he can't call them by name."
Leon likes to bring his own three-year-old boy—also named Leon—to visit. "They seem to click," he says. "My son has the same name as me, and my father thinks my son is me. But they have a good relationship. They're protective of each other. If we're walking and my son sees my father going the wrong way, he'll grab him and guide him back the right way.
He adds: "One thing I know I'm accomplishing by visiting is that he still recognizes me, at least some of the time. I feel if I stay away too many days, when I come back, he'll have no memory of me at all. I don't want that to happen."
Quinton reflects: "For me it's a question of embracing the inevitable. It's going to get worse. I know that within a few months, or however long it takes, even the little recognition he has now will be gone. So I'm grateful for what it is right now, and I try to appreciate every day."