Fanny wandered the halls of Hearthstone Alzheimer Care nursing home in New York, wearing pajama bottoms and a sweatshirt with a crocheted heart on the front. She clutched in her arms an infant-size doll in a pink jumpsuit.
At first Fanny, in her 80s, smiled broadly, her large blue eyes gazing intently at her surroundings as though she were seeing everything for the first time. Then she walked up to the Hearthstone director, Cindy Suna, tickled her chin and giggled, "Uga, guga, guga, gu." A bit later in the afternoon, Fanny switched from giddy to confused.
"I don't know where to go," she said over and over. "I don't know where I am."
Fanny is one of about four million Americans who suffer from Alzheimer's disease. As many as 50 percent of people 85 and older have the disease, which causes memory loss and impairment of logical thought processes.
It can be particularly painful for the adult children and spouses of Alzheimer's sufferers, who watch as their loved ones fail to recognize them and lose the ability to speak. The only treatment is using drugs like Aricept, which may delay mental deterioration by no more than a year. Since there is no chance of improvement, many caregivers focus on making Alzheimer's patients as comfortable as possible, using children's toys, games and picture books to provide solace.
At Hearthstone, like many nursing homes, caregivers hand out plastic baby dolls to women with late-stage Alzheimer's.
"It brings comfort, although at some level it may be disturbing for a family to see Mom holding a doll," Suna said.
Miriam Josef, a social worker with Cabrini Hospice in New York, agreed that dolls can calm patients and reduce agitation. In a late-stage Alzheimer's patient, most of the brain has deteriorated except the area that controls the senses and motor function. Many such people have lost their short-term memory. Dolls remind them of childrearing, Josef said, and allow patients to communicate affection.
"As people move toward the end of life and start to regress, they go back to childhood," she said. "Toys soothe children. Why wouldn't they soothe those with dementia?"
Susan Glaser, a gerontologist at the Garden of Palms nursing home in Los Angeles, also uses dolls and stuffed animals for patients with Alzheimer's.
"They see the dolls as live babies and will want to rock them and nurture them," Glaser said.
Businesses have noticed the trend. The Web site Practical Senior Gifts sells a bright yellow gift basket for nursing home residents. Contents include a cuddly hippopotamus and a smiling plastic sun.
Not everyone approves of the toys. Some family members believe these methods demean adults who have lived full and accomplished lives.
Nancy Meek, a social worker for Silverado Senior Living in Houston, is among those who discourage the practice. She felt that dancing and listening to music were more age-appropriate and effective for her father, who recently died of Alzheimer's. Although her father was often confused, mistook Meek for his wife and eventually stopped talking entirely, he still responded to music.
"He would come alive again, tapping his feet and shaking his hips," she said.
Besides, her father, like many Alzheimer's patients, occasionally grew aware of his declining condition.
She didn't want him holding a Barbie doll during a lucid moment.
"Where would this leave his dignity?" she asked. "He'd be sitting there wondering, `What are these toys doing here?'"
An aversion to the use of toys sometimes stems from the denial that a loved one has become like a child, said Gary Small, a psychiatrist at University of California at Los Angeles.
"A PET scan of a person with advanced Alzheimer's and a young child's brain looks very much the same," he said. "People need to put it in perspective. If a patient is childlike, that's what's upsetting, but not the toys. If anything comforts the patient, that's good."
Dolls and stuffed animals are only a few of the many playthings used to console those with Alzheimer's. Hearthstone residents play trivia games that stimulate vocabulary and reasoning skills. For instance, a caregiver might say, "A very young deer is a ..." and the residents yell out answers.
Hearthstone also has less challenging games. One recent afternoon, a caregiver sat down to play Treasure Hunt with a retired professor, Willard.
On the table were several toys including a tube filled with colored beads, a butterfly puzzle and a clear plastic container filled with sand, shells, starfish and twine. The caregiver gently placed Willard's hand into the sand, helping him feel the bumpy exterior of the starfish, the smooth inside of the shells and the coarse twine.
Because the senses are largely intact in a person with advanced Alzheimer's, touching anything with texture can be comforting, Mills said.
For people who have become largely unresponsive, like Willard, being read to is an activity that can still elicit emotion.
Lydia Burdick watched as her formerly sociable mother withdrew from the world. In an effort to connect with her, Burdick wrote the picture book "Sunshine on My Face" for people with Alzheimer's. Her mother's favorite page read, "I love to take a warm bath and get squeaky clean," accompanied by an illustration of an elderly woman playing in suds.
Burdick would ask, "Who likes to take a warm bath?" and her mother would giggle and say, "I do." For many months, sharing books was the only way Burdick could communicate with her mother, who died in 2003.
"My goal was to turn the world into as happy a place as I could for her, because there wasn't much I could do about this disease," Burdick said.
Many people have found Burdick's book helpful, including Sarah Bodner of Miami, a geriatric psychiatrist whose 84-year-old mother has suffered from Alzheimer's for eight years.
Bodner's mother calls her "Mom" and crawls into bed with her almost every night. She asks her to read the book over and over, possibly because she forgets she just read it, Bodner said.
"This is like a second childhood in many respects, and that's why Lydia Burdick's book is spot on," she said.
Bodner's mother also displays the less endearing side of childhood. She doesn't like to take her medication and throws tantrums every other day. Bodner has difficulty persuading her to brush her teeth or put on pajamas before bed.
But Bodner said caring for her mother is worth it.
"I love my mother," she said. "I never had children or a husband, and in many ways it shows you that this type of relationship can be gratifying."