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Steamboat Springs — An empty chair sits by a row of windows in Bill Bowes home, where red geraniums in rectangular boxes strain toward the light outside.

On a good day, Bowes wife, 81-year-old Marie Bowes, would be sitting in the chair, watching the birds and listening to the swish of cars passing by on a nearby county road.

She might walk around her cozy log home and later go for a drive with her husband.

But on this afternoon, Marie Bowes, who has Alzheimer's disease, lies fully clothed and in a deep slumber in her bed upstairs, giving no sign of waking, even at the gentle nudging of her husband.

"You don't know if you're facing a tough day or an easy day," their daughter Heidi Nunnikhoven said about the daily challenges of caring for her mother.

The Bowes family is among an increasing number of families adapting to the painful changes that Alzheimer's causes in patients' minds and in family relationships.

Hand in hand, Alzheimer's patients and their caregivers embark on unpredictable and often frightening journeys that, while sometimes painful, can reveal unexpected gifts, caregivers say.

Paramount to this process is the comfort, education and advice offered by a growing network of support groups for Alzheimer's caregivers, said Barbara Bronner, a clinical social worker in Steamboat Springs.

"Families have done a great job of taking care of family members, but in isolation," said Bronner, who is facilitating The Savvy Caregiver, a series of upcoming training sessions in Steamboat Springs.

The sessions, sponsored by the Colorado Alzheimer's Association, are relatively new to the area and are part of the Alzheimer's Association's efforts to reach out to caregivers and patients in rural areas, Bronner said.

Accompanied by Memory Cafe, a social occasion for patients and caregivers, she said the training sessions and regular support group meetings send an important message: You're not alone.

"Friends are helpful and can be empathetic, but no one understands what it's like unless they've been there," she said. "That's the beauty of these groups."

An aging disease

An estimated 4.5 million Americans have Alzheimer's disease, according the Alzheimer's Association, which predicts that number will triple within the next 50 years.

The increase in Alzheimer's patients is driven by higher life expectancy, neurologist Dr. Pamela Kinder said.

"Alzheimer's is becoming more common because people are aging," she said. "There are some types that run in families, but the majority of cases are spontaneous. We don't know why, but we think it has something to do with aging."

Kinder estimated that a 65-year-old person has about a 12 percent chance of developing the disease. The risk increases to 50 percent when a person reaches 85, she said.

Heredity doesn't seem to play a major role; 10 percent or less of total cases appear in sucessive generations of the same family, Kinder said.

The cause of Alzheimer's is unknown, however doctors and researchers suspect it involves the degeneration of neurons that produce chemicals affecting memory and other brain functions, Kinder said.

Part of the process of diagnosing Alzheimer's, the most common type of dementia, is eliminating other possible causes of dementia, such as stroke, chemical imbalance or brain tumor, Kinder said.

Progression of the disease tends to be slow, though it varies from case to case. Typically it will be three to 10 years from the time of diagnosis before Alzheimer's will have a major impact on the patient and his or her day-to-day activities, Kinder said.

Coping and learning

Marie Bowes has never been diagnosed officially with Alzheimer's, but "everybody knows that's what it is," Bill Bowes said.

The family became concerned about three years ago when Marie Bowes began having problems with her memory, he said.

Although people with Alzheimer's can tell stories about events that happened decades earlier, they often have problems with short-term memory -- repeating things and forgetting events that just happened, Kinder said.

As the disease progresses, patients may become disoriented or have problems in social situations, she said.

In Marie Bowes's case, the disease has affected her ability to carry on continuous conversations.

"She remembers a lot of things, but she can't discuss them," Bill Bowes said.

One of his biggest challenges has been maintaining continuity and inspiring his wife's interest in her family and what's happening around her, he said.

For Nunnikhoven, the difficulty has been seeing her mother fade from the outgoing, vivacious woman she once was.

"My mom was a very strong woman, a very vocal woman and very entertaining. ... She wasn't the type to accept help," she said.

For families, one of the toughest aspects of Alzheimer's is its effect on the rules families have and the way they operate, which suddenly don't work anymore, Bronner said.

Abandoning the usual techniques of reasoning and argument was hard for Barbara Ross, whose father was diagnosed with Alzheimer's about two years ago.

"Part of it is that we're so used to relating to people close to our lives on a logical, rational basis and having their response be in that same reality," she said. "When they no longer are, you have to shift within yourself to connect in a different way."

Ross attended the first Savvy Caregiver training in Steamboat last year to get a broader perspective of the disease and to help her mother, who is her father's primary caregiver.

One of the most valuable lessons in the course emphasized entering her father's world and focusing less on what he said and more on the feelings behind his words, Ross said.

"Trying to imagine how confusing and scary it would be on the inside of my dad really helped me," she said.

For patients, Alzheimer's can be like looking through a fog, where suddenly life is no longer clear or sharp -- a frightening situation that can make some individuals nervous or aggressive, Bronner said.

"The strategy is to have someone feel less anxious and more calm in a reassured state," she said.

For example, an Alzheimer's patient may talk about someone who is deceased as if they are alive. Instead of responding that that person is dead, caregivers can help keep the patient comfortable by joining them in a pleasant recall of the person and then changing the subject, Bronner said.

Finding the gifts

When dealing with a progressive disease such as Alzheimer's, caregivers must redefine their concept of hope, Bronner said, adding that living with the disease is about living in the moment.

Ross has learned to slow down and enjoy life more as a result of her father's acute presence in the now, one of the gifts the disease has brought to her family, she said.

"When he's walking. he's so aware of the birds flying in front of him or the grass," she said. "He notices those things in the moment."

In some ways, the process of watching himself "disappear" has made her father more open and more compassionate about other peoples' situations, Ross said.

"That's what we have to look for is, 'What are those gifts,'" she said.

Recognizing Alzheimer's patients' strengths and "what is still there" is another important aspect of coping with the disease, Bronner said.

Humor is important in the Bowes household, where the sound of Marie Bowes' laugh -- she finds humor in bizarre things, such as two-vowel words -- brings the family a sense of comfort and familiarity, Heidi and her husband, Tony Nunnikhoven, said.

"Mom's smile has never gone away," she said. "Even though she can't communicate very well, she still lights up, and thank God for that."

Every now and then, someone elicits pieces of Marie Bowes that seemingly had disappeared. Her son Mike, for example, can engage her in a half-hour conversation on the phone, her family said.

Her feistiness also makes the occasional appearance, especially when staff with the Visiting Nurse Association come by to give her a bath, one of her least favorite activities, Heidi Nunnikhoven said.

"She still has that strong will. ... That doesn't go away," she said.

Support

Bill Bowes considers himself fortunate not only because he is retired and can spend a lot of time with his wife, but because his children are nearby to help. The Nunnikhovens live in the house with their children, and two other daughters live in the area and frequently come by to see their mother, he said.

Family support for the caregiver is important, too, Kinder said, explaining that sometimes people who don't live day to day in the situation don't understand the true effects of Alzheimer's.

In many cases, patients who had a strong social life can maintain a superficial normality during short visits with family members, which can result in disagreements, she said.

"There can be a denial, especially if they only see them for a short time," Kinder said.

Even with family help, outside support group meetings, such as those Bill Bowes attends in Steamboat, can help caregivers adapt to the often unpredictable course the disease takes, Bronner said.

"It gives you a sense of not being so alone," she said. "It really helps you to understand and develop strategies for your own particular situation."

Along with education about the disease, the Savvy Caregiver training provides caregivers the opportunity to share experiences that might help others understand what to expect as the disease progresses, Ross said.

In addition to understanding the importance of taking care of themselves, caregivers attending the trainings and support groups also learn how to approach difficult decisions involving power of attorney and other complicated legal and medical issues that surface in families dealing with the disease, Bronner said.

"The more people learn, the more people take advantage of what's out there and the more they can do the job they are committed to do," Bronner said.

-- To reach Tamera Manzanares call 871-4204 or e-mail tmanzanares@steamboatpilot.com