When the University of Tennessee Lady Vols take to the basketball court this season, their legendary coach will face scrutiny unlike any other in sports.
Earlier this week, Pat Summitt, 59, announced that she has early-onset Alzheimer's disease. But she's not quitting her job. So when she makes good decisions, will it mean she is overcoming the disease? Will poor calls mean she should retire?
Or will she be expected to make the same mix of winning and losing moves as she ever did in her 37-year career?
With Summitt, Alzheimer's disease will be put on public display as never before, in front of thousands of screaming fans, national TV audiences and the media.
Summitt's resolve to keep coaching "is courageous," said Dr. Amanda Smith, medical director of the Byrd Alzheimer's Institute at the University of South Florida. "And it's incredibly important, because people tend to discriminate against those with dementia or assume they can't do anything."
Feared diseases have gained more public acceptance thanks to celebrities — think of Magic Johnson revealing he had AIDS — and some think Summitt could do the same for Alzheimer's.
It's possible that every bad decision Summitt makes could be chalked up to Alzheimer's, but "a lot of people make bad decisions each day, and they're not demented," Smith pointed out.
Despite Alzheimer's fearsome image as a disease that rapidly drains the memory, doctors say Summitt could perform well this season. She has a job that relies heavily on long-term memory and expertise, and these processes tend to be the last to go in Alzheimer's. And she has a strong support system.
What won't be known until the basketball season starts is whether her performance will be affected — and how the public will accept any changes.
And at some point in the not-so-distant future, Summitt — like the rest of the 5.3 million Americans with Alzheimer's disease — will descend deeper into a disease for which there is no cure.
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Glenda Clare of Tampa was the busy owner of a landscaping business when she realized that familiar tasks like organization were becoming tough. She learned two days after her 63rd birthday that she had early-onset Alzheimer's.
Eighteen months later, Clare says medications, exercise and a healthy diet have helped her stay active. She no longer works, but volunteers with support groups at the Byrd center.
She's happy Summitt chose to come forward with her diagnosis and is optimistic for her.
"She seems to know what her strengths and weaknesses are. She's surrounded by people that can give her support. She will probably do quite well,'' Clare said.
Medical experts agree.
"Coaching is like playing the piano, or riding a bike — something you don't need immediate recollection to perform or function well," said David Morgan, CEO of the Byrd Center.
But Summitt "will require some individuals to act as a surrogate for her short-term memory," he said. She might need, for instance, to rely more heavily on written notes and plays.
Summitt said in her public statement that her assistant coaches will play larger roles this season, but it's not known exactly how issues such as team management, calling game plays and recruiting players will change.
Her medical treatments will likely involve medications such as Aricept, which counter symptoms of the disease. They do not slow its progression, but neither do they impede functioning.
There are experimental drugs that target the plaques that cause damage to the brain, Smith said, though Summitt would have to enroll in a clinical trial to get those. A healthy diet and supplements such as fish oil appear to be beneficial, along with exercise.
"This is an illness that slowly progresses over time," Smith said. "It doesn't mean she has to stop doing what she's doing" right away.
The rate at which cognitive skills and memory will decline can't be predicted, though Alzheimer's tends to progress more rapidly when it is diagnosed before age 65, Smith said.
So coaching will likely be a "season-by-season decision" for Summitt, Smith said.
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The disease will be an issue for Summitt's players and staff, as well as the public.
"People will be looking to see the signs — if she makes mistakes, forgets a name," said Eileen Poiley, who trains caregivers and leads Alzheimer's support groups at the Byrd Center.
Poiley said it will be important for people around Summitt "to be understanding, and to be patient." For example, it might be difficult for Summitt to answer a barrage of questions at a news conference.
How will her condition affect how the media covers her?
"That's an interesting question," said Jack McElroy, editor of the Knoxville News Sentinel, one of two newspapers granted an interview with Summitt when she revealed her diagnosis. He said Summitt's illness will add a new dimension to the coverage. "It's a sports and medical story from now on," he said.
Summitt, he said, is held in very high regard in Knoxville and in the world of college sports. Not only has she led the Lady Vols to eight national championships, she also is beloved for her community involvement and insistence that all her players earn their degrees.
Plus, McElroy noted, hers is not the highest-pressure arena in college sports.
"It's not football,'' he said, "or men's basketball.''
Glenda Clare, the Tampa Alzheimer's patient, pointed out that how Summitt will perform is an unfolding story.
"People need to realize that every person with Alzheimer's is different,'' she said.
"It affects each person differently. You can't anticipate how it's going to affect Pat.''
Richard Martin can be reached at [email protected].