Her blank stare. Even when he isn't with her, he still sees it in his mind's eye. It haunts him, that emptiness in his wife's face.
How can their friends or their grandchildren, or a beautiful sunset or a funny movie or a delicious meal -- all of which used to elicit smiles and laughter from his wife -- now be met with a stare that seems devoid of life?
"I don't know what's going on inside her, and that is so hard," 69-year-old Jerome Snyder said as he and his wife, Diane, met recently with her physician, Dr. Charles Bernick, at the new Cleveland Clinic Lou Ruvo Center for Brain Health.
"It's horrible for her and horrible for me. Here's your partner, the woman you love, and there's nothing you can do."
The two have been married nearly 30 years. Though they did not have children together, they have five children between them and 10 grandchildren.
Eight years ago, at the age of 59, Diane was diagnosed with Alzheimer's, a still incurable disease of the brain that causes the progressive degeneration of brain cells.
Memory is lost. Behavioral changes occur. Staring into space is common.
After his wife was diagnosed, Snyder started reading everything about Alzheimer's that he could get his hands on. He can tell you that in 1906, German neuropathologist Alois Alzheimer first described the abnormal clumps and tangled bundles of fibers that he found in the brain of a deceased dementia patient.
Snyder even thought he might have found a new drug in Europe to arrest the disease.
Snyder, a multimillionaire whose business ventures include several financial institutions and the Bingo Palace, which later became Palace Station, had hoped that the same vigor he brought to his business interests would help to quickly find a cure for the disease.
He was an early and key supporter of businessman and philanthropist Larry Ruvo, the brain health center founder who named the facility at Grand Central Parkway and Bonneville Avenue after his father, whose last years were spent suffering from Alzheimer's.
"I try to be a problem solver," Snyder said. "But so far, there has been nothing I can do about the problem my wife has.
"She was a very independent woman. She used to run shopping centers for me and go to Europe by herself. We skied together, traveled the world together. I hate to have seen this happen to her, what it did to us."
Though he said it is probably too late for the Ruvo Center to help his wife, Snyder said he wanted to talk about her plight and the center that opened on July 13.
"If we don't do something about this disease, it's going to take a toll on this nation emotionally and financially that we have yet to really comprehend," he said.
'WE HAVE TO HOPE'
"We have to hope this place helps find a cure for Alzheimer's," Snyder said of the Ruvo Center. "It's going to be horrific for the nation if we don't."
Bernick, a longtime Las Vegas neurologist who also serves as the Ruvo Center's associate medical director, said about 5 million Americans, and as many as 40,000 Nevadans, have the disease.
About 15 patients are seen daily at the new center, Bernick said. That is expected to increase to about 8,000 patient visits a year once the entire staff is in place.
Given the fact that 77 million baby boomers are heading into retirement -- age is unquestionably a risk factor for Alzheimer's -- researchers predict close to 16 million people will be affected in the United States by 2050.
Most people with Alzheimer's begin to show symptoms after 70, Bernick said, although the average age at diagnosis is 80.
But signs of Alzheimer's can begin in the late 40s. Such symptoms include forgetting recently learned information, having difficulty concentrating, losing track of time (even the day of the week or the season), social withdrawal and depression.
Bernick said Nevada will see a 100 percent increase in this kind of dementia during the next 20 years.
Fortunately, he said, new imaging techniques available at the Ruvo Center can provide an earlier diagnosis of Alzheimer's, which is thought to happen when abnormal proteins trigger brain cell death.
With earlier diagnosis of the disease, which Bernick said can also have a genetic factor, some new drugs on the market can delay progression of symptoms.
Doctors who treat patients early also have found evidence that stepped up exercise and mental activity, coupled with a diet rich in antioxidants, can help slow down the onset of severe symptoms.
The cost of placing someone in a care facility runs around $4,000 a month. Few Americans have insurance to cover that expense, Bernick said.
"They end up having to become impoverished enough to go on Medicaid," he said, referring to the government health program supported by taxpayers.
Snyder admits his financial situation allows him to care for his wife much differently than most Americans could for a loved one with the disease.
He has a live-in caregiver working five days a week; Diane's sister helps out on weekends.
Still, he said, the emotional toll is nearly overwhelming. Diane used to love having friends over for dinner. Or they'd go out with friends, he said. But that had to stop.
"She can't make it through dinner now without some kind of accident," he said.
Diane can't remember thoughts long enough to express them. They'll watch television or he'll take her to a movie, but it's obvious by her answers to his questions later that what she has seen didn't register, he said.
"Her sister can take her to the same movie, and she doesn't remember it," he said.
Often, Snyder must feed his wife because she doesn't know how to use utensils.
She sleeps in the same room as the caregiver.
He said his wife often gets up at night and can get lost in the house, which makes it hard for him to get enough sleep himself.
She sometimes forgets to use the bathroom.
A subtle beginning
The onset of the disease was subtle. So much so that Snyder isn't sure just why he suggested to his wife that she be tested for Alzheimer's eight years ago.
She never before had gotten lost walking around the block or forgot the route home while driving.
"It was nothing dramatic," he said.
Just the way she failed to engage in everyday life, he said, probably led to his suggestion of a doctor's visit.
Generally, he said, Diane still knows who he is. But her condition seems to be worsening.
Long ago, he said, their dreams of living in different places around the world during their retirement years ended.
'Now I work more than I ever did, to try to keep my mind off what's happening," he said. "One day I'll probably have to put her in a facility, and I don't know whether I'll be able to live with myself."
Caregivers will also get help at the Ruvo Center, according to Maureen Peckman, the center's CEO.
Peckman said that far too often caregivers get sick themselves trying to care for patients.
"We will make up a strategic plan with the entire family that will have to be changed as the disease progresses," she said.
The current 40-person staff of physicians, social workers, nurses, therapists and administrators will grow to about 65, Peckman said.
"We will have people reading (brain) scans of our patients at the Cleveland Clinic as well."
Every bit of information about financial and caregiver assistance and possible new therapies will be made known to a patient's loved ones.
She noted that the center also will serve people who suffer from Parkinson's, Huntington's and Lou Gehrig's diseases.
"If you have a memory disorder, we can be of assistance," Peckman said.
That includes Iraqi war veterans who suffered brain trauma during the conflict and cancer chemotherapy patients who have found that the curing drug regimen robbed them of memory.
"We want to be a one-stop shop for patients and their loved ones," she said.
As her husband talked recently at the Ruvo Center about the challenges his wife faces, Diane broke out of her stare briefly to say that she could still walk and talk.
"I won't give up," she said. "I'll never give up."
Jerome Snyder closed his eyes as she talked.
When he opened them, the stare was back.
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.