"Every day when I take that little pill, I think of how lucky I am to be here," said Sando, who lives in Newport Beach, Calif. "I'm enjoying every day."

Sando's neurologist, William Rodman Shankle, who is both respected and discounted by his peers, cautions that Sando isn't cured.

But as his patient travels with his wife, drives to Mass and plays with his grandchildren, Shankle believes he represents the future of Alzheimer's disease.

"You can't get any more dramatic than completely reverting to normal," Shankle said.

Sando's journey into Alzheimer's disease began with a book.

He retired from his Riverside obstetrics-gynecology practice in 1999 after a 37-year career that included delivering four of his own grandchildren. He and his wife, Pauline, moved to Newport Beach eager for family time, long walks and reading.

But a few years into retirement, Pauline noticed some strange changes in her husband. Sando, who once added rows of numbers in his head, struggled with calculations. He suggested they buy an adding machine.

"So we did and he was still having trouble with numbers," Pauline said.

One fall night, Sando and Pauline attended a social function in Riverside where a woman gave Sando a big hug. They chatted. She walked away.

Sando turned to his wife. "She was so friendly and so nice. Who was that?"

She was a former colleague from the medical association, whom Sando had worked closely with for years.

"That really bothered me," Sando said. "Then I started thinking back. I'd be on the phone with one of my kids. They'd say, can we get together for whatever reason. I would say let me check my daily planner. I'd hang up the phone, get distracted and never even remember the conversation."

Within a week, the Sandos were sitting in Dr. Shankle's office after receiving a referral from a physician friend.

Neurologist Shankle, a 52-year-old statistician and researcher, keeps a model of the brain on his desk and iconic black-and-white photos of Marilyn Monroe on the wall. The pictures were taken by a deceased Alzheimer's patient who once worked for the New York Times.

There was never any question Shankle would study the brain.

"I never found any other organ to be of interest," he said. "The brain just captured me, even before I entered medical school. I've always enjoyed the challenge of trying to understand behavior and then trying to identify how to treat it."

First discovered in 1906, Alzheimer's disease is the sixth-leading cause of death for Americans over 65.

But in the new millennium, a handful of expensive medications have become commonly used for slowing the progression of the disease. But studies have indicated small improvements in patients, which may delay their entry into a nursing home, but will not restore intellectual losses.

Shankle said that's because most patients aren't diagnosed early enough to fully benefit.

He started Sando on Exelon, a drug approved by the Food and Drug Administration in 2000 that stops the breakdown of a chemical transmitter in the brain. Shankle also directed Sando to make lifestyle changes - mandatory daily walks, a glass of wine only on rare occasions, and Sudoku instead of crossword puzzles to give his mind a new challenge.

Within a few months, Sando's memory test score improved to 100 percent. A PET scan at five months revealed much more activity in the memory storage parts of his brain.

Pauline didn't need to see test results to be convinced.

"He was back to reading his five books again and adding up everything," she said.

But Shankle knew there would be skeptics who would doubt the diagnosis. So he came up with an experiment.

He asked Sando if he would consider going off Exelon for three weeks so they could see what would happen.

Because of his medical background, Sando agreed without reservation.

Sando's word score dropped to six out of 10 and he struggled to track his books again.

"That was the proof in the pudding," Shankle said.

Once Sando went back on the medication, his function returned.

But Dr. Wesson Ashford, senior research scientist at the Stanford VA Alzheimer's Research Center, said the brain becomes dependent on medication, so function plunges if the drug is stopped. He also cautioned that the medications have side effects and risks.

As for the Sando case, Ashford said he respects Shankle's work in early detection, but noted that extensive studies must be done before drawing any conclusions.

"Some people may get more benefit than others do," said Ashford, a geriatric psychiatrist. "You can't make claims until you do large double-blind studies. You can't base your treatment recommendations on one patient."

Shankle said he has replicated Sando's results with a handful of other Alzheimer's patients who have also been diagnosed in the earliest stages before their brains underwent irreversible tissue loss.

"Unfortunately very few physicians have seen cases like that," Shankle said. "There are not enough people that come in that early."

That strikes some as arrogant and anecdotal.

"That's testimonial," said Dr. Lou Schneider, a USC professor of neurology, who declined to discuss Shankle's treatment of Sando. "This kind of stuff cannot be argued in a newspaper like columnists debating the war in Iraq."

Stages of Alzheimer's disease

Gradual onset:

Impaired memory

Language difficulty

Impaired judgment

Lack of spontaneity

Social difficulties

Depression, terror

Steady progress:

Wandering

Repetitive behavior

Disorientation

Twitching, seizures

Difficulty thinking

Agitation

Terminal stage:

Complete dependence

Inability to recognize people

Severe speech impairment

Emaciation

Total loss of body control

Course of disease varies greatly, averaging eight to 10 years

Some resources

The Institute for Brain Aging and Dementia at UC Irvine offers memory testing, clinical trials and research. 949-824-2382; www.alz.uci.edu

Dr. William Rodman Shankle; 949-833-2383; www.shankleclinic.com