Alzheimer’s Precursors Founds at Earlier Age

Scientists studying Alzheimer’s disease are increasingly finding clues that the brain begins to deteriorate years before a person shows symptoms of dementia.

Now, research on a large extended family of 5,000 people in Colombia with a genetically driven form of Alzheimer’s has found evidence that the precursors of the disease begin even earlier than previously thought, and that this early brain deterioration occurs in more ways than has been documented before.

The studies, published this month in the journal Lancet Neurology, found that the brains of people destined to develop Alzheimer’s clearly show changes at least 20 years before they have any cognitive impairment. In the Colombian family, researchers saw these changes in people ages 18 to 26; on average, members of this family develop symptoms of mild cognitive impairment at 45 and of dementia at 53.

These brain changes occur earlier than the first signs of plaques made from a protein called beta amyloid or a-beta, a hallmark of Alzheimer’s. Researchers detected higher-than-normal levels of amyloid in the spinal fluid of these young adults. They found suggestions that memory-encoding parts of the brain were already working harder than in normal brains. And they identified indications that brain areas known to be affected by Alzheimer’s may be smaller than in those who do not have the Alzheimer’s gene.

“This is one of the most important pieces of direct evidence that individual persons have the disease and all the pathology many years before,” said Dr. Kaj Blennow, a professor in clinical neurochemistry at the University of Gothenburg in Sweden, who was not involved in the research.

Dr. Nick Fox, a neurologist at University College London, who was also not part of the research, said the findings suggested that “some of the things that we thought were more downstream may not be quite so downstream; they may be happening earlier.”

That, in turn, said Dr. Fox, who wrote a commentary about the findings in Lancet Neurology, could have implications for when and how to treat people, because “there may be targets to attack, whether it’s high levels of a-beta or whatever, when people are still functioning very well.”

The Colombian family suffers from a rare form of Alzheimer’s that is caused by a genetic mutation; it strikes about a third of its members in midlife. Because the family is so large and researchers can identify who will get the disease, studying the family provides an unusual opportunity to learn about Alzheimer’s causes and pathology.

Researchers, led by Dr. Eric Reiman of the Banner Alzheimer’s Institute in Phoenix, and in Colombia by Dr. Francisco Lopera, a neurologist at the University of Antioquia, recently received a grant from the National Institutes of Health to conduct a clinical trial to test a drug on family members before they develop symptoms, to see if early brain changes can be halted or slowed.

The studies in Lancet Neurology used several tests, including spinal taps, brain imaging and functional M.R.I.

“The prevailing theory has been that development of Alzheimer’s disease begins with the progressive accumulation of amyloid in the brain,” Dr. Reiman said. “This study suggests there are changes that are occurring before amyloid deposition.”

One possibility is that brain areas are already impaired. Another possibility, experts said, is that these brain differences may go back to the young developing brain.

“It is a genetic disease, and it’s not hard to imagine that your gene results in some differences in the way your brain is formed,” said Dr. Adam Fleisher, director of brain imaging at the Banner Institute and an author of the studies.

In one of the Lancet Neurology studies, researchers examined 44 relatives between ages 18 to 26. Twenty had the mutation that causes Alzheimer’s. The cerebrospinal fluid of those with the mutation contained more amyloid than that of relatives without it. This was striking because researchers know that when people develop amyloid plaques — whether they have early-onset or late-onset Alzheimer’s — amyloid levels in their spinal fluid are lower than normal. That is believed to be because the fluid form of amyloid gets absorbed into the plaque form, Dr. Reiman said.

So, the high level of amyloid fluid in the Colombian family supports a hypothesis about a difference between the beginning phases of genetic early-onset Alzheimer’s and the more common late-onset Alzheimer’s. The difference may be that early-onset Alzheimer’s involves an overproduction of amyloid, while late onset involves a problem clearing amyloid from the brain.

In another result, when the subjects performed a task matching names with faces, those with the mutation had greater activity in the hippocampus and parahippocampus, areas involved in memory. Dr. Reiman suggested this could mean that the pre-Alzheimer’s brain has to expend more effort to encode memories than a normal brain.

Researchers also found that the mutation carriers had less gray matter in areas that tend to shrink when people develop dementia. Dr. Fox emphasized that seeing less gray matter so early was so novel that it should be treated cautiously unless other studies find a similar result.

In the second study, brain imaging was used to look for amyloid plaques in 50 people ages 20 to 56: 11 with dementia, 19 mutation carriers without symptoms and 20 normal family members. Plaques occurred at an average age of 28, more than 15 years before cognitive impairment would be expected and two decades before dementia.

The study also found that amyloid plaques increased steadily until about age 37, after which the brain did not seem to gain many more plaques. Dr. Blennow said that while researchers know that amyloid plaques plateau when people already have dementia, they did not know that the plateau appears to occur years before.

The researchers are currently analyzing data from family members ages 7 to 17 to see if some of the brain changes occur at an even younger age.

“Some people think that that may be scary, that you can see it so many years before,” Dr. Reiman said. “But it seems to me that that provides potential opportunities for the development of future therapies.”

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Bruce Bent Sr. and Son Cleared of Fraud Charges

Regulators failed Monday to win a clear victory over the father-and-son team whose mutual fund failed in one of the signal events of the 2008 financial crisis. It was the latest setback in efforts by regulators to hold individuals responsible for the risk-taking that nearly brought down the American economy.

Louis Lanzano/Associated Press

Bruce Bent, right, and his son, Bruce Bent II, in October. The two were accused of defrauding investors when their flagship money market fund collapsed in September 2008.

Andrew Kelly/Reuters

Bruce Bent is credited with inventing a popular type of mutual fund.

A Manhattan federal jury rejected claims by the Securities and Exchange Commission that Bruce Bent, the inventor of a popular investment vehicle called a money market fund, defrauded investors when his flagship fund collapsed in September 2008, sowing panic among ordinary investors.

The collapse was a turning point because the fund, the Reserve Primary Fund, run by Mr. Bent and his son, Bruce Bent II, was pitched to investors as a nearly risk-free alternative to a bank account. The fund ended up foundering under the weight of hundreds of millions of dollars of bonds issued by Lehman Brothers that became worthless with Lehman’s bankruptcy on Sept. 15, 2008.

The S.E.C.’s lawyers accused the men of misleading investors and the company’s trustees as the fund’s investments fell below a net asset value of $1 per share, an event known as “breaking the buck.” That guaranteed value had been the symbol to investors that they could recover every dollar they invested in such a fund.

The agency accused the pair in a 2009 civil suit of falsely providing assurances that they would plow money into the faltering fund. In fact, the agency contended, both men “secretly harbored” concerns that they could not shore up the fund and keep it from insolvency.

The jury’s decision to clear Mr. Bent and his son on civil fraud charges underscores the difficulty that prosecutors and regulators have had in going after the big bets taken by various individuals and major financial institutions in the years leading up to the financial crisis.

The gulf in prosecutions against individuals is a stark departure from the prosecutions secured after the failure of savings and loan institutions in the late 1980s, after which more than 800 bank officials went to jail. In the wake of the latest crisis, law enforcement officials have failed to secure any high-profile courtroom victories.

“The agency has lost again because they haven’t been able to secure an individual conviction, even in this banner case,” said William K. Black, a professor of law at University of Missouri, Kansas City, and the federal government’s director of litigation during the savings and loan crisis.

The jurors did find the younger Mr. Bent negligent, and two entities associated with the fund were found liable on some counts of fraud.

Robert Khuzami, the S.E.C.’s director of enforcement, emphasized the points on which the commission’s case was affirmed.

“Today’s verdict of liability sends the message that fund executives cannot withhold from investors and trustees key information about their fund’s vulnerability,” he said. “This case, along with our actions against more than 100 other entities and individuals, demonstrates our continuing commitment to pursuing cases arising out of the financial crisis.”

But critics of the agency said Monday’s decision was still a defeat.

Thomas Gorman,  a partner at Dorsey & Whitney and formerly the senior counsel for the S.E.C.’s Division of Enforcement, noted that even with the negligence finding, “the complaint charged them with intentional fraud and went to great length to detail that, and the jury rejected those charges in each instance.”

Monday’s verdict came as regulators are still battling over rules to govern the money market fund industry.

In testimony at the trial, the elder Mr. Bent struck an unapologetic tone. “I thought Lehman was a good, worthwhile investment,” he said, adding in his testimony that the S.E.C. had made the same determination.

Mr. Bent’s fund had plowed roughly $785 million into the Lehman Brothers’ debt. That decision proved fatal when Lehman filed for bankruptcy and the debt, which made up about 1 percent of the fund’s assets, was suddenly worthless.

In the S.E.C.’s case, the agency accused the Bents of deceiving investors. Despite telling investors that they would avert the collapse of the fund by putting more money in, the agency alleged, the Bents never really had any intention of doing that.

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Changing of the Guard: Chinese Communist Party Faces Calls for Democracy

BEIJING — As the Communist Party’s 18th Congress approached, Li Weidong, a scholar of politics, made plans to observe a historic leadership battle in one of the world’s great nations.

Instead of staying in Beijing to monitor China’s once-a-decade transfer of power, Mr. Li boarded a plane.

“I’m going to the United States to study the elections,” Mr. Li said in a telephone interview during a stopover in Paris. After witnessing the American presidential election on Tuesday, Mr. Li went on the radio for another interview. “I still think China’s politics remain prehistoric,” he said. “I often joke that the Chinese civilization is the last prehistoric civilization left in the world.”

With China at a critical juncture, there is a rising chorus within the elite expressing doubt that the 91-year-old Communist Party’s authoritarian system can deal with the stresses bearing down on the nation and its 1.3 billion people. Policies introduced after 1978 by Deng Xiaoping lifted hundreds of millions out of poverty and transformed the country into the world’s second-largest economy. But the way party leaders have managed decades of growth has created towering problems that critics say can no longer be avoided.

Many of those critics have benefited from China’s stunning economic gains, and their ranks include billionaires, intellectuals and children of the party’s revolutionary founders. But they say the party’s agenda, as it stands today, is not visionary enough to set China on the path to stability. What is needed, they say, is a comprehensive strategy to gradually extricate the Communist Party, which has more than 80 million members, from its heavy-handed control of the economy, the courts, the news media, the military, educational institutions, civic life and just the plain day-to-day affairs of citizens.

Only then, the critics argue, can the government start to address the array of issues facing China, including rampant corruption, environmental degradation, and an aging population whose demographics have been skewed because of the one-child policy.

“In order to build a real market economy, we have to have real political reform,” said Yang Jisheng, a veteran journalist and a leading historian of the Mao era. “In the next years, we should have a constitutional democracy plus a market economy.”

For now, however, party leaders have given no indication that they intend to curb their role in government in a meaningful way.

“We will never copy a Western political system,” Hu Jintao, the departing party chief, said in a speech on Thursday opening the weeklong congress.

The party’s public agenda, which Mr. Hu described in detail in his 100-minute address, was laid out in a 64-page report that is in part intended to highlight priorities for the new leaders, who will be announced later this month. Much of the document had retrograde language that emphasized ideology stretching back to Mao and had little in the way of bold or creative thinking, said Qian Gang, the director of the China Media Project at the University of Hong Kong.

Most telling, there was no language signaling that the incoming Politburo Standing Committee, the group that rules China by consensus, would support major changes in the political system, whose perversions many now say are driving the nation toward crisis.

While Chinese who are critical of the current system generally do not expect a wholesale adoption of a Western model, they do favor at least an openness to bolder experimentation.

“To break one-party rule right now is probably not realistic, but we can have factions within the party made public and legalized, so they can campaign against each other,” said Mr. Yang, who added that there was no other way at the moment to ensure political accountability.

Only in the last few years has the idea of liberalizing the political system gained currency, and urgency, among a broad cross-section of elites. Before that, as the West foundered at the onset of the global financial crisis, many here pointed to the triumph of a “China model” or “Beijing consensus” — a mix of authoritarian politics, a command economy and quasi-market policies.

But the way in which China weathered the crisis — with the injection of $588 billion of stimulus money into the economy and an explosion of lending from state banks — led to a spate of large infrastructure projects that may never justify their cost. As a result, many economists now say that China’s investment-driven, export-oriented economic model is unsustainable and needs to shift toward greater reliance on Chinese consumers.

Constant lip-service is paid to that goal, and on Saturday, Zhang Ping, a senior official, reiterated that stance. But it will not be easy for the new leaders to carry it out. At the root of the current economic model is the political system, in which party officials and state-owned enterprises work closely together, reaping enormous profits from the party’s control of the economy. Under Mr. Hu’s decade-long tenure, these relationships and the dominance of state enterprises have only strengthened.

“What happens in this kind of economy is that wealth concentrates where power is,” said Mr. Yang, the journalist.

The 400 or so incoming members of the party’s Central Committee, Politburo and Politburo Standing Committee, as well as their friends and families, have close ties to the most powerful of China’s 145,000 state-owned enterprises. The growing presence of princelings — the children of notable Communist officials — in the party, the government and corporations could mean an even more closely meshed web of nepotism. It is a system that Xi Jinping, anointed to be the next party chief and president and himself a member of the “red nobility,” would find hard to unravel, even if he wanted to.

Mia Li contributed research.

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Malaysian charged with Facebook insult of sultan; sister says he’ll file police complaint

KUALA LUMPUR, Malaysia – The sister of a Malaysian man who has been charged with insulting a state sultan on Facebook says he is innocent and plans to lodge a complaint over his detention.

Anisa Abdul Jalil, sister of Ahmad Abdul Jalil, says her brother was charged Thursday with making offensive postings on Facebook last month.

She says the charges are ridiculous because there is no evidence linking Ahmad to the posts in question, which were made by someone using the name “Zul Yahaya.”

Ahmad was freed on bail Thursday after six days of detention. Anisa says he will file a complaint with police for unlawful detention and intimidation.

Nine Malaysian states have sultans and other royal figures. Though their roles are largely ceremonial, acts provoking hatred against them are considered seditious.

Social Media News Headlines – Yahoo! News

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Oregon is No. 1 in AP Top 25; K-St 2, Notre Dame 3

NEW YORK (AP) — Oregon is No. 1 in The Associated Press college football poll after Alabama gave up the top spot following a loss to Texas A&M.

The Ducks have 45 of 60 first-place votes. Kansas State is No. 2 with 14 first-place votes. Notre Dame is third and received one first-place vote.

The Crimson Tide, which had been No. 1 for 10 straight weeks, dropped to fourth after a 29-24 loss to the Aggies in Tuscaloosa, Ala., on Saturday.

Texas A&M moved up six spots to No. 9.

The Ducks were last No. 1 in 2010. That was the first season in the history of the program that Oregon reached No. 1, and the Ducks spent seven weeks there and reached the BCS championship game, which they lost to Auburn.

No. 25 Kent State is ranked for first time since Nov. 5, 1973.

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Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

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Hurricane Sandy and the Disaster-Preparedness Economy

Jeffrey Phelps for The New York Times

An assembly line at a Generac Power Systems plant. Generac makes residential generators, coveted items in the wake of Hurricane Sandy.

FOLKS here don’t wish disaster on their fellow Americans. They didn’t pray for Hurricane Sandy to come grinding up the East Coast, tearing lives apart and plunging millions into darkness.

But the fact is, disasters are good business in Waukesha. And, lately, there have been a lot of disasters.

This Milwaukee suburb, once known for its curative spring waters and, more recently, for being a Republican stronghold in a state that President Obama won on Election Day, happens to be the home of one of the largest makers of residential generators in the country. So when the lights go out in New York — or on the storm-savaged Jersey Shore or in tornado-hit Missouri or wherever — the orders come pouring in like a tidal surge.

It’s all part of what you might call the Mad Max Economy, a multibillion-dollar-a-year collection of industries that thrive when things get really, really bad. Weather radios, kerosene heaters, D batteries, candles, industrial fans for drying soggy homes — all are scarce and coveted in the gloomy aftermath of Hurricane Sandy and her ilk.

It didn’t start with the last few hurricanes, either. Modern Mad Max capitalism has been around a while, decades even, growing out of something like old-fashioned self-reliance, political beliefs and post-Apocalyptic visions. The cold war may have been the start, when schoolchildren dove under desks and ordinary citizens dug bomb shelters out back. But economic fears, as well as worries about climate change and an unreliable electronic grid have all fed it.

 Driven of late by freakish storms, this industry is growing fast, well beyond the fringe groups that first embraced it. And by some measures, it’s bigger than ever.

Businesses like Generac Power Systems, one of three companies in Wisconsin turning out generators, are just the start.

The market for gasoline cans, for example, was flat for years. No longer. “Demand for gas cans is phenomenal, to the point where we can’t keep up with demand,” says Phil Monckton, vice president for sales and marketing at Scepter, a manufacturer based in Scarborough, Ontario. “There was inventory built up, but it is long gone.”

Even now, nearly two weeks after the superstorm made landfall in New Jersey, batteries are a hot commodity in the New York area. Win Sakdinan, a spokesman for Duracell, says that when the company gave away D batteries in the Rockaways, a particularly hard-hit area, people “held them in their hands like they were gold.”

Sales of Eton emergency radios and flashlights rose 15 percent in the week before Hurricane Sandy — and 220 percent the week of the storm, says Kiersten Moffatt, a company spokeswoman. “It’s important to note that we not only see lifts in the specific regions affected, we see a lift nationwide,” she wrote in an e-mail. “We’ve seen that mindfulness motivates consumers all over the country to be prepared in the case of a similar event.”

Garo Arabian, director of operations at B-Air, a manufacturer based in Azusa, Calif., says he has sold thousands of industrial fans since the storm. “Our marketing and graphic designer is from Syria, and he says: ‘I don’t understand. In Syria, we open the windows.’ ”

But Mr. Arabian says contractors and many insurers know that mold spores won’t grow if carpeting or drywall can be dried out within 72 hours. “The industry has grown,” he says, “because there is more awareness about this kind of thing.”

Retailers that managed to stay open benefited, too. Steve Rinker, who oversees 11 Lowe’s home improvement stores in New York and New Jersey, says his stores were sometimes among the few open in a sea of retail businesses.

Predictably, emergency supplies like flashlights, lanterns, batteries and sump pumps sold out quickly, even when they were replenished. The one sought-after item that surprised him the most? Holiday candles. “If anyone is looking for holiday candles, they are sold out,” he says. “People bought every holiday candle we have during the storm.”

If the hurricane was a windfall for Lowe’s, its customers didn’t seem to mind. Rather, most appeared exceedingly grateful when Mr. Rinker, working at a store in Paterson, N.J., pointed them toward a space heater, or a gasoline can, that could lessen the misery of another day without power.

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David Petraeus, Seen as an Invincible C.I.A. Director, Self-Destructs

Alex Wong/Getty Images

David H. Petraeus, with his wife, Holly, in 2011 during his confirmation hearing in the Senate before becoming director of the Central Intelligence Agency.

WASHINGTON — David H. Petraeus’s “Rules for Living” appeared on The Daily Beast Web site on Monday, posted by his biographer, a fellow West Point graduate 20 years his junior named Paula Broadwell. The fifth rule, beneath his familiar portrait in full military regalia, began: “We all make mistakes. The key is to recognize them and admit them.”

Mr. Petraeus took his own advice on Friday and resigned as director of the Central Intelligence Agency after admitting to an extramarital affair; officials identified the woman in question as Ms. Broadwell. The full back story is not yet clear, though his affair came to light after F.B.I. agents conducting a criminal investigation into possible security breaches examined his computer e-mails. The decision to step down was his.

Few imagined that such a dazzling career would have so tawdry and so sudden a collapse. Mr. Petraeus, a slender fitness fanatic, is known as a brainy ascetic. He and his wife, Holly, whose father was the superintendent at West Point when Mr. Petraeus graduated in 1974, and their two grown children had long been viewed by military families as an inspiration, a model for making a marriage work despite the separation and hardship of long deployments overseas.

After he began the C.I.A. job in September 2011, the couple settled into a house in the Virginia suburbs and began the closest thing to a normal life together that they had had in years, even if the basement he had designated for a home gym was commandeered for secure C.I.A. communications gear.

After years in war zones, Mr. Petraeus told friends, he was amazed to eat dinner most nights with his wife and to discover weekends again. He told friends that on the day his daughter was married last month, he went for a 34-mile bike ride.

“It’s a personal tragedy, of course, but it’s also a tragedy for the country,” said Bruce Riedel, a C.I.A. veteran and a presidential adviser.

Like many others in jaundiced Washington, Mr. Riedel wondered whether the affair really required Mr. Petraeus, who turned 60 on Wednesday, to step down and leave the agency leaderless. But under the military law that governed his 37-year Army career, adultery is a crime when it may “bring discredit upon the armed forces.” And a secret affair can make an intelligence officer vulnerable to blackmail.

The C.I.A. director, Mr. Riedel said, probably felt he had no choice.

“I think Dave Petraeus grew up with a code that’s very demanding about duty and honor,” he said. “He violated the code.”

Ambition and Ability

He was the pre-eminent military officer of his generation, a soldier-scholar blazing with ambition and intellect, completing his meteoric rise as a commander in the Iraq and Afghanistan wars. Worshipful Congressional committees lauded him as a miracle worker for helping turn the war in Iraq around, applying a counterinsurgency strategy he had helped devise and that was widely viewed for a time as the future of warfare. Then, dispatched to Afghanistan to replace Gen. Stanley McChrystal, who had been fired by President Obama, he quietly shifted away from the doctrine he had championed and adopted an aggressive counterterrorism strategy.

He was fiercely competitive and carefully protective of his reputation. Asked to throw out the first pitch at the 2008 World Series, he brought his security detail to Washington’s stadium to practice getting the ball over the plate.

Mr. Petraeus had seemed all but indestructible. He had been shot in a training accident, broken his pelvis in a sky diving mishap and survived prostate cancer. Criticized by the antiwar group MoveOn.org in 2007 as “General Betray Us,” he shrugged off the attack and rallied his indignant supporters. Until Friday, fans speculated that post-C.I.A. he might become president of Princeton University, where he had earned his Ph.D. in international relations in 1987, or conceivably even president of the United States. (He has told friends he will never run for president; to show his impartiality, while in the military, he did not vote.)

Reporting was contributed by Thom Shanker, Michael R. Gordon and David E. Sanger from Washington, and Viv Bernstein from Charlotte, N.C.

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Out of hospital, Beljan keeps lead at Disney

LAKE BUENA VISTA, Fla. (AP) — Charlie Beljan was in a hospital bed in the middle of the night, still wearing his golf shoes, thinking his season was over.

He was about six hours from his tee time Saturday at Disney. Just 12 hours earlier, he was having a panic attack on the golf course so severe that he could barely breathe, his blood pressure spiked and his arms felt numb. After signing his card, he was strapped into a stretcher, loaded into an ambulance and taken to a hospital.

"I thought I literally had a chance to die," Beljan said.

In a turnaround that even by Disney's standards seems like a fairy tale, the 28-year-old rookie now has a chance to win his first PGA Tour title.

Beljan was released from the hospital, overcame two early bogeys and was solid over the final hour in the Children's Miracle Network Hospitals Classic for a 1-under 71 that gave him a two-shot lead going into the final round.

"I honestly didn't know if I was going to play one hole, any holes or was I going to get through the day," Beljan said. "I felt good, better as the day went on, and I just hung tough, hung in there. I knew what the rewards were at the end of the week if I could pull something off, and that's kind of what kept me going."

The rewards were ample.

This is the final PGA Tour event of the year, and Beljan is No. 139 on the money list. Only the top 125 get full cards for next year. Doctors told him he was in good enough health to be released, but perhaps not to play golf. He ignored their recommendations.

"The position I'm in, it's kind of hard not to show up," he said before teeing off.

Beljan had a pair of three-putt bogeys that cost him his three-shot lead after three holes, and felt some tightening in his chest as he approached the turn, the same symptoms that caused much fear Friday. But he steadied himself, began the back nine with back-to-back birdies, and kept in front.

He was at 13-under 203, two shots ahead of Brian Gay (67), Josh Teater (67) and Charlie Wi, who was tied for the lead until closing with two bogeys for a 70.

"It's nice to be able to walk around and smile," Beljan said. "Yesterday, I was hanging on for my life."

When last seen at Disney, Beljan was gasping to draw a big breath and sitting in the fairway to wait his turn to hit. Paramedics followed him around the back nine after taking his blood pressure on the 10th tee. After signing for a 64, Beljan emerged from the scoring room strapped into a stretcher and was loaded into an ambulance.

For most of the night, he felt 99 percent sure he wouldn't be playing. But with the comfort of knowing that he was physically fine, he went back to his hotel for a shower, breakfast and headed to the golf course. Despite being nervous that another episode could strike again, he was steady for so much of the day.

Now comes the hard work.

Beljan's wife, 7-week-old son and mother-in-law were flying in from Phoenix for the final round. He has long dreamed of how cool it would be to have his family come onto the green to celebrate his first PGA Tour win.

But there's a long way to go.

Beljan's three-shot lead was gone before he stepped onto the fourth tee in the third round. He will start Sunday with 11 players separated by three shots. That includes Sea Island winner Tommy Gainey and Camilo Villegas, winless in four years, along with Robert Garrigus, who won at Disney two years ago. The group at 205 included Vaughn Taylor, who like Beljan is making a last-ditch effort to keep his card.

Beljan was simply thrilled to be playing.

"I think the big advantage for me is I'm not thinking about the golf or the putts or the chips or the shots or the swings," said Beljan, who didn't even realize he was in the lead until about 10:30 p.m. Friday at the hospital. "I'm just thinking about my health, one shot at a time, one hole at a time. And shoot, the last 36 holes it's worked out pretty well."

Beljan showed off his power on the opening hole when he was behind a tree 183 yards from the hole. He hit a pitching wedge straight up and over the tree, with enough on it to reach the green. He three-putted from 50 feet, however, and then dropped another shot on the par-3 third with a three-putt from about 25 feet on the fringe.

His only other bogey came from a bunker on the 12th.

Several players made a run at him — Wi, Gainey among them — and Charles Howell III was right in the mix. Howell was one shot out of the lead until driving into the water on the 17th to make triple bogey, and then making bogey on the last hole to finish five shots behind.

Beljan said a variety of tests showed nothing was wrong with him.

"Physically, everything is wonderful," he said. "It's that little space between those ears that I've got to work on."

This all started about three months ago when he fainted on a flight home from the Reno-Tahoe Open as he was going to the bathroom. Since then, Beljan said he has had a half-dozen panic attacks, usually in controlled environments when he can settle himself down. This one came on a golf course, and it spiraled out of control on Friday.

When he showed up at the course, he felt nervous and a little embarrassed about Friday's afternoon's episodes. But he doesn't mind the travails if it means a chance to win a tournament, or even keep his job for next year. Even if he doesn't win, Beljan would need to finish around 10th to move into the top 125.

Besides, it would be a fitting way for a wild year to end.

After getting his card at Q-school last year, he had hand surgery before starting the season. He found out at the Sony Open that he was going to be a father. He was married in March. He played poorly all year except for one week at the Greenbrier. His baby was born at the end of the FedEx Cup season. He fainted on the plane. He at least secured a spot inside the top 150, only to realize that won't mean as much next year because of a shorter season.

"It's been a long, exciting, hectic, crazy, stressful year," he said. "But hopefully, we're going to end it with a bang."

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The New Old Age Blog: The Emotional Aftermath of Hurricane Sandy

Let’s talk about the emotional aftermath of the storm that left tens of thousands of older people on the East Coast without power, bunkered down in their homes, chilled to the bone and out of touch with the outside world.

Let’s name the feelings they may have experienced. Fear. Despair. Hopelessness. Anxiety. Panic.

Linda Leest and her staff at Services Now for Adult Persons in Queens heard this in the voices of the older people they had been calling every day, people who were homebound and at risk because of medical conditions that compromise their physical functioning.

“They’re afraid of being alone,” she said in a telephone interview a few days after the storm. “They’re worried that if anything happens to them, no one is going to know. They feel that they’ve lost their connection with the world.”

What do we know about how older adults fare, emotionally, in a disaster like that devastating storm, which destroyed homes and businesses and isolated older adults in darkened apartment buildings, walk-ups and houses?

Most do well — emotional resilience is an underappreciated characteristic of older age — but those who are dependent on others, with pre-existing physical and mental disabilities, are especially vulnerable.

Most will recover from the disorienting sense that their world has been turned upside down within a few weeks or months. But some will be thrown into a tailspin and will require professional help. The sooner that help is received, the more likely it is to prevent a significant deterioration in their health.

The best overview comes from a November 2008 position paper from the American Association for Geriatric Psychiatry that reviewed the effects of Hurricane Katrina and other disasters. After Katrina, “the elderly had the highest mortality rates, health decline and suicide rates of any subgroup,” that document notes. “High rates of psychosomatic problems were seen, with worsening health problems and increased mortality and disability.”

This is an important point: Emotional trauma in older adults often is hard to detect, and looks different from what occurs in younger people. Instead of acknowledging anxiety or depression, for instance, older people may complain of having a headache, a bad stomachache or some other physical ailment.

“This age group doesn’t generally feel comfortable talking about their feelings; likely, they’ll mask those emotions or minimize what they’re experiencing,” said Dr. Mark Nathanson, a geriatric psychiatrist at Columbia University Medical Center.

Signs that caregivers should watch out for include greater-than-usual confusion in an older relative, a decline in overall functioning and a disregard for “self care such as bathing, eating, dressing properly and taking medication,” Dr. Nathanson said.

As an example, he mentioned an older man who had “been sitting in a cold house for days and decided to stop taking his water pill because he felt it was just too much trouble.” Being distraught or distracted and forgetting or neglecting to take pills for chronic conditions like diabetes or heart disease can have immediate harmful effects.

Especially at risk of emotional disturbances are older adults who are frail and advanced in age, those who have cognitive impairments like Alzheimer’s disease, those with serious mental illnesses like schizophrenia or major depression, and those with chronic medical conditions or otherwise in poor physical health, according to the geriatric psychiatry association’s position paper.

A common thread in all of the above is the depletion of physical and emotional reserves, which impairs an older person’s ability to adapt to adverse circumstances.

“In geriatrics, we have this idea of the ‘geriatric cascade’ that refers to how a seemingly minor thing can set in motion a functional, cognitive and psychological downward spiral” in vulnerable older adults, said Dr. Mark Lachs, chief of the division of geriatrics at Weill Cornell Medical College. “Well, the storm was a major thing — a very large disequilibrating event — and its impact is an enormous concern.”

Of special concern are older people who may be in the early stages of Alzheimer’s disease or other types of dementia who are living alone. For this group, the maintenance of ordinary routines and the sense of a dependable structure in their lives is particularly important, and “a situation like Sandy, which causes so much disruption, can be a tipping point,” Dr. Lachs said.

Also of concern are older people who may have experienced trauma in the past, and who may suffer a reignition of post-traumatic stress symptoms because of the disaster.

Most painful of all, for many older adults, is the sense of profound isolation that can descend on those without working phones, electricity or relatives who can come by to help.

“That isolation, I can’t tell you how disorienting that can be,” said Bobbie Sackman, director of public policy for the Council of Senior Centers and Services of New York City. “They’re scared, but they won’t tell you because they’re too proud and ashamed to ask for help.”

The best remedy, in the short run, is the human touch.

“Now is the time for people to reach out to their neighbors in high-rises or in areas where seniors are clustered, to knock on doors and ask people how they are doing,” said Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in the Bronx.

Don’t make it a one-time thing; let the older person know you’ll call or come by again, and set up a specific time so “there’s something for them to look forward to,” Dr. Kennedy said. So-called naturally occurring retirement communities with large concentrations of older people should be organizing from within to contact residents who may not be connected with social services and find out how they’re doing, he recommended.

In conversations with older adults, offer reassurance and ask open-ended questions like “Are you low on pills?” or “Can I run out and get you something?” rather than trying to get them to open up, experts recommended. Focusing on problem-solving can make people feel that their lives are being put back in order and provide comfort.

Although short-term psychotherapy has positive outcomes for older adults who’ve undergone a disaster, it’s often hard to convince a senior to seek out mental health services because of the perceived stigma associated with psychological conditions. Don’t let that deter you: Keep trying to connect them with services that can be of help.

Be mindful of worrisome signs like unusual listlessness, apathy, unresponsiveness, agitation or confusion. These may signal that an older adult has developed delirium, which can be extremely dangerous if not addressed quickly, Dr. Nathanson said. If you suspect that’s the case, call 911 or make sure you take the person to the nearest hospital emergency room.

This is a safe place to talk about all kinds of issues affecting older adults. Would you be willing to share what kinds of mental health issues you or family members are dealing with since the storm so readers can learn from one another?

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