Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier and More Meaningful Lives. David Snowdon. New York: Bantam Press, 2001, pp. 256, $24.95 (HB) ISBN: 0-553-80163-5.

Carol Brayne, Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier and More Meaningful Lives. David Snowdon. New York: Bantam Press, 2001, pp. 256, $24.95 (HB) ISBN: 0-553-80163-5., International Journal of Epidemiology, Volume 31, Issue 4, August 2002, Page 879, https://doi.org/10.1093/ije/31.4.879

This book seeks to tell us what a study based on a religious order of nuns in the US can tell us ‘about leading longer, healthier and more meaningful lives’. It is the story of a research project now known internationally as the Nun Study (searchable on the web). The scientific findings from this study have been powerful and widely publicized for some years. This book sets these scientific findings into the context of setting up and carrying out the study. It is a description of the education of the scientist conducting the study by those he was seeking to study, and how the study evolved over time with the active involvement of the nuns themselves. The style and presentation of the text, with illustrations, provide a marked contrast to the dry and impersonal style of scientific papers that should make it accessible and interesting to a wide audience.

The content of the book maps the Nun Study from its first, rather limited, ideas to the much more detailed study with which we are familiar. It reads somewhat as a breathless diary, attempting to inject the pace and urgency of cutting edge laboratory medicine, rather than the slower, more laborious, pace of much epidemiology. This does work, as the book is short and easy to read, although it results in a more superficial account than can satisfy the truly curious. There are several important issues raised in the book beyond the possible recommendations for healthy ageing. Longitudinal studies in closed communities have to be based on a relationship between the researched and the researcher, and this leads to loss of objectivity. In this study it would have been impossible to conduct the study in any other way, but this may have had some impact on findings. The value of carefully stored records is again emphasized by the serendipitous finding of written records by new novices, which were then linked to later patterns of cognitive ageing. The descriptions of development and progression of dementia, both gentle and aggressive, show that the process does not have to be stigmatizing, nor always distressing in the context of a caring, supported and loving community. The description of the brain donation programme within the study from first cautious steps to enthusiastic acceptance and participation (in principle before death and with actual donation after death) by the majority of the community is welcome. In the UK in the aftermath of events at Alder Hey this is an encouraging endorsement of the contribution of post-mortem studies to the greater understanding of ageing and dementia.

The titles of the chapters (as well as the book itself) are all carefully chosen, giving a flavour of the relentlessly positive style of writing (‘the road to good counsel’, ‘the last nun standing’, ‘grey matters’, ‘amazing brains’, ‘the heart of the matter’, ‘our daily bread’). At a time when the study is still in progress the relationship of the author to the community is complex, and a book of this kind can only present an upbeat message. Nothing could or should jeopardize the ongoing work, and the value of the study. Perhaps it really is all this positive, but it does leave this reader with the feeling that not all the story has been told.

Who should read this book? Non-clinical colleagues involved in the conduct of dementia studies enjoyed it immensely and recommended it to researchers and clinical students for its insight into the need for communication skills. Most people interested in dementia and the ageing process would enjoy reading it, without necessarily learning much new, since the findings from the study are already well known. Nor is it a book which provides detailed design, set-up and conduct of this study, but this is not its intention. Those wishing to conduct any kind of longitudinal study with biological tissue retrieval would be well advised to read the book for insight into how to go about the process with a population sample.