Nun study update

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For the last dozen years, it's been known that young people who follow the stylistic advice of Strunk & White are more likely to get Alzheimer's disease when they get old. Well, at least, in a cohort of nuns,

Low idea density and low grammatical complexity in autobiographies written in early life were associated with low cognitive test scores in late life. Low idea density in early life had stronger and more consistent associations with poor cognitive function than did low grammatical complexity. Among the 14 sisters who died, neuropathologically confirmed Alzheimer's disease was present in all of those with low idea density in early life and in none of those with high idea density.

And if you look into what "idea density" means, you'll see that many aspects of Strunkish writing style, especially avoidance of adjectives and adverbs, are precisely designed to lower it. (For details and links, see "Writing style and dementia", 12/3/2004; and "Miers dementia unlikely", 10/21/2005.)

Now there's a new chapter in the story, based on looking for physical symptoms of Alzheimer's in living nuns using positron emission tomography (PET) brain imaging, rather than relying on post-mortem examination of the brains of dead ones ("Can Language Skills Ward Off Alzheimer's? A Nuns' Study", Time, 7/9/2009).

The recent journal article under discussion is D. Iacono et al., "The Nun Study. Clinically silent AD, neuronal hypertrophy, and linguistic skills in early life", Neurology, published online 7/8./2009.

Background: It is common to find substantial Alzheimer disease (AD) lesions, i.e., neuritic β-amyloid plaques and neurofibrillary tangles, in the autopsied brains of elderly subjects with normal cognition assessed shortly before death. We have termed this status asymptomatic AD (ASYMAD). We assessed the morphologic substrate of ASYMAD compared to mild cognitive impairment (MCI) in subjects from the Nun Study. In addition, possible correlations between linguistic abilities in early life and the presence of AD pathology with and without clinical manifestations in late life were considered.

Methods: Design-based stereology was used to measure the volumes of neuronal cell bodies, nuclei, and nucleoli in the CA1 region of hippocampus (CA1). Four groups of subjects were compared: ASYMAD (n = 10), MCI (n = 5), AD (n = 10), and age-matched controls (n = 13). Linguistic ability assessed in early life was compared among all groups.

Results: A significant hypertrophy of the cell bodies (+44.9%), nuclei (+59.7%), and nucleoli (+80.2%) in the CA1 neurons was found in ASYMAD compared with MCI. Similar differences were observed with controls. Furthermore, significant higher idea density scores in early life were observed in controls and ASYMAD group compared to MCI and AD groups.

Conclusions: 1) Neuronal hypertrophy may constitute an early cellular response to Alzheimer disease (AD) pathology or reflect compensatory mechanisms that prevent cognitive impairment despite substantial AD lesions; 2) higher idea density scores in early life are associated with intact cognition in late life despite the presence of AD lesions.

See also William E. Klunk et al., "Amyloid Imaging with PET in Alzheimer’s Disease, Mild Cognitive Impairment, and Clinically Unimpaired Subjects", chapter 6  in Dan Silverman (Ed.) PET in the Evaluation of Alzheimer's Disease and Related Disorders, 2009.


  1. Vincent said,

    August 27, 2009 @ 5:23 am

    When I read the kind of prose described in your quotes, I feel assailed by a kind of instant cognitive impairment, as if my cell bodies have spontaneously hypertrophied. Never mind, I won't sue for damages.

  2. Mark P said,

    August 27, 2009 @ 8:21 am

    Idea-dense people are not rule followers, and, as a rule, non-rule followers don't show symptoms of AD. So, it's a good idea to break rules early and often so that if you live to tell about it, you'll be able to tell about it.

    Or is it simply that following S&W causes AD in later life?

  3. Morten Jonsson said,

    August 27, 2009 @ 10:26 am

    Presumably the nun's autobiographies were relatively unfiltered–that is, the assignment was simply to write down something about oneself, not worrying about the style. But an essay written to follow a set of rules, like Strunk and White's, is highly filtered. The nuns wrote much the way they thought; otherwise their writing would have no value as a diagnostic. The Strunk and White fans write the way they think they ought to think, which is quite a different matter.

    But of course you know that, and this is just a tasteless dig at Strunk and White.

  4. Jerry Friedman said,

    August 27, 2009 @ 10:46 am

    "And if you look into what 'idea density' means, you'll see that many aspects of Strunkish writing style, especially avoidance of adjectives and adverbs, are precisely designed to lower it."

    Another possibility was, "'Idea density'? Strunkishness like adjective and adverb avoidance aims to lower it." That has more than twice the idea density. Thank you, Mark Liberman, for considering our understanding and taste, even at the risk of eventual cognitive impairment.

  5. Chris said,

    August 27, 2009 @ 10:53 am

    If your brain naturally generates baroque E. M. Forster sentences, and you whack them with the Strunk & White stick until they look like Hemingway, seems to me that you've done more mental exercise than either the naturally simple or naturally complex writer has done, and you'll be doing the Times Sunday crossword well in to your 90's.

  6. John Cowan said,

    August 27, 2009 @ 12:00 pm

    Strunk & White notoriously doesn't follow the prescriptions of Strunk and White. Its younger sibling Strunk & Cowan actually contains an apologia for its parallel instances of this disgusting behavior.

  7. Philip said,

    August 27, 2009 @ 12:42 pm

    Is the inability to recognize irony also linked with Alzheimer's?

  8. Picky said,

    August 27, 2009 @ 12:01 pm

    Oh dear, here we go again … the fact is S&W doesn't advocate avoidance of adjectives and adverbs. Mr White's advice, typically useless though it be, is rather more idea-dense than that.

    {(myl) "Write with nouns and verbs, not with adjectives and adverbs." How can we construe that as anything other than "[advocating] avoidance of adjectives and adverbs"?]

  9. fred lapides said,

    August 27, 2009 @ 4:54 pm

    14 nuns studied and that gives us our science?

  10. Alvin Blanco said,

    August 27, 2009 @ 5:32 pm

    White's advice about modifiers isn't all that surprising, and it's not unique to him. Put your energy into finding and employing precise nouns rather than propping up vague ones with extraneous adverbs and adjectives. Modifiers are used all the time, and to good effect–as White pointed out. But look to your nouns first; if they're good ones, maybe you don't need the modifiers. How did this come to be considered controversial advice?

  11. sleepnothavingness said,

    August 27, 2009 @ 7:09 pm

    Mark P:

    Are we to infer the presence of rebel nuns in this study, then?

  12. Picky said,

    August 28, 2009 @ 4:24 am

    @Alvin Blanco: Because he didn't put it as well as you have, and the lack of clarity left him exposed to those (including the landlords at Language Log) who like to paint him as worse than he was.

  13. Graeme said,

    August 28, 2009 @ 6:17 am

    Wow. Where do they get their supply of nun's brains from?

  14. Sili said,

    August 28, 2009 @ 4:19 pm


    When someone prides themselves on clarity, they're fair game for mockery when they fall so far far far short of their goal.

    I'm mildly surprised that it's so easy to get nuns to help out with studies like this. I'd honestly thought that Catholics would be more afraid of anything that could break down the mind/body fallacy.

  15. Picky said,

    August 28, 2009 @ 4:38 pm


    If you're talking about White, I quite agree with you – mock away. A style advice guide that lacks clarity deserves mockery at the very least. But let's not continue repeating the untrue allegation that he advocated avoidance of adjectives and adverbs.

  16. Maureen said,

    August 30, 2009 @ 11:34 pm

    Re: mind/body fallacy and Catholicism

    Catholic theology is very clear that the body and the soul are intimately affected by each other, and that the mind and body are not in fact particularly separate. Of course, it's also very clear that the mind is also affected by the state of the soul, which is a bit harder to prove in laboratory tests. :)

    But beyond all that, the point is that if you truly believe that Jesus Christ is the Truth, then all truths point to Him; and therefore, any honest experiment or study can do nothing but honor God and hunt out more cool features of Creation. To turn your back on scientific truth is to turn your back on a form of divine revelation. Why wouldn't nuns want to participate in a work further revealing God's logos?

  17. Zach Elwood said,

    September 3, 2009 @ 3:35 am

    Weird. I just found out all these people hate Strunk and White. I don't get it. I just finished reading the 1979 edition for the second time in 10 years. While I sometimes find thinking about good grammar and phrasing a pain, it is a small price to pay if the end result is better communication. I thought it was fairly clear when the authors were espousing personal preference and when they were talking about prevailing trends. The edition I read also pointed out several times that there is no final authority on language, and that, in the end, a writer should write for themselves (though that was White's section, not Strunk's). And if it's the occasional meandering people find fault with; it does give the book personality and entertainment value. This is my first time reading this blog, though; perhaps there are Strunk/White offensives of which I'm not aware.

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