Source: Alan Schwarz, The New York Times [ Full Article ] The night that Sylvia Mackey and Eleanor Perfetto first met, back in October at a Baltimore Ravens reception for former National Football League players and their families, their connection was immediate. As she sat on a couch with her husband, Mrs. Mackey watched Dr. Perfetto cradle the hand of her husband as he blankly shuffled across the floor toward the Mackeys. "Your husband has dementia," Mrs. Mackey said. "Yours does, too," Dr. Perfetto replied. "We both just knew," Dr. Perfetto recalled on Friday, when the two visited the assisted-living facility where Dr. Perfettos husband, Ralph Wenzel, resides. Mrs. Mackey quickly added, "You can see it in the wives' faces just like the husbands'." On that evening last October, Mrs. Mackey added another N.F.L. wife to her growing network of women who seek her guidance and support as their husbands deteriorate mentally. Her husband, John, was a Hall of Fame tight end for the Baltimore Colts in the late 1960s and early '70s, and is probably the most notable victim of dementia among former football players. Mrs. Mackey said that she regularly communicates with about 10 women like Dr. Perfetto as they learn to handle their husbands' dementia, which often begins as early as their 50s. "I know about 20 in all," Mrs. Mackey said. "And if I know 20, there are probably 60 or 80 out there." Last May, Mrs. Mackey wrote a three-page letter to Paul Tagliabue, the N.F.L. commissioner at the time, detailing John Mackey's decline, the financial ruin it would soon cause her, and how the Mackeys were not the only couple facing such a crisis at a time when the league's coffers are bursting. She wrote that dementia "is a slow, deteriorating, ugly, caregiver-killing, degenerative, brain-destroying tragic horror," and appealed to Mr. Tagliabue to help. The result was the formation of the 88 Plan, a joint effort between the league and the N.F.L. Players Association named after John Mackey's jersey number. Under the plan, families of former players who have various forms of dementia can receive money for their care and treatment up to $88,000 a year if the player must live in an outside facility, and up to $50,000 a year if the player is cared for at home. The first applications were mailed in late February to families of 22 former players who are already known to have dementia, including Mr. Mackey, 65, and Mr. Wenzel, 64. No family has received any money yet. The N.F.L. spokesman Greg Aiello said the league would be aggressive in informing other families about the plan. Although both the league and the players union are quick to deny any connection between someones having played football and later cognitive failure in an e-mail message, Mr. Aiello described dementia as a condition that affects many elderly people the 88 Plan has been created at a time of heightened scrutiny of the effects of brain injuries among football players. In January, a neuropathologist who examined the brain of Andre Waters, the former Philadelphia Eagles player who committed suicide last fall at 44, said that repeated concussions had led to Mr. Waters's brain tissue resembling that of an 80-year-old with Alzheimer's disease. And last month, the doctors of the former New England Patriots linebacker Ted Johnson, 34, said he was exhibiting the depression and memory lapses associated with oncoming Alzheimer's. Coming Up With a Plan Former players who have dementia do not qualify for the N.F.L.s disability insurance program, because neither the league nor the union consider their conditions football-related, a stance that has been cast in doubt by several scientific studies. Dr. Perfetto said that Mr. Wenzels neurologist had determined that on-field brain trauma was the probable cause of his Alzheimer's-type dementia. In more lucid times Mr. Wenzel estimated his number of concussions as "more than I can count." Sylvia Mackey said that the cause of her husband's frontal temporal dementia was less clear, but that his football collisions including one headfirst impact with a goal post at full speed were the likely culprit. "I have been approached many times by lawyers who wanted to use me in a lawsuit I turned them all down, and Im glad I did," Sylvia Mackey said, turning back to the 88 Plan. "This is better, because everyone who is affected will benefit, whether they were stars or Hall of Famers or just regular players like Ralph." John Mackey and Ralph Wenzel will almost certainly qualify for aid, as they appear to be textbook cases of dementia among N.F.L. veterans. Mr. Mackey is a sturdy 6-foot-3 and 240 pounds underneath his trademark black cowboy hat. He's convivial with fans who remember him, but soon into any interaction quickly demonstrates his mental decline. During lunch on Friday, he used a spoon to drink his coffee, thinking it was soup, and uttered non sequiturs to almost any question, including several repetitions of "I want a cookie" and "I got in the end zone." His most prized possessions are two rings, which he repeatedly proffered on his fists. "I got this one for winning Super Bowl V, and this one when they put me in the Hall of Fame," he said several times. The rings are so precious to him that last year, when airport security screeners asked him to remove them, he grew enraged, ran toward the gate and had to be wrestled to the ground, screaming, by armed officials. "I was afraid they might shoot him dead," Sylvia Mackey said. She no longer lets him fly; when the two traveled from Baltimore to Miami for this year's Super Bowl, they rode Amtrak for 28 hours. When they are home in Baltimore, John regularly attends an adult day-care facility that costs $76 a day, with 24-hour care on the near horizon. Mr. Wenzels dementia is far more apparent than Mr. Mackey's. Mr. Wenzel walks gingerly, rarely mumbles more than a few nonsensical syllables before growing tired or tongue-tied, and cannot feed himself. He can offer no memories of his N.F.L. career, whether they are about the position he played (offensive line), his seasons (1966-73), his teams (the Pittsburgh Steelers and San Diego Chargers) or his teammates. "Do you remember playing with Lloyd Voss?" his wife asked, trying to give his memory some traction. "No," he said. "Your best friend?" "Nah," Mr. Wenzel said as his head drooped further. Dr. Perfetto, Mr. Wenzels second wife, found she could no longer care for her husband in their home in Stevensville, Md. In February she moved him to the Annapolitan Assisted Living Community at the cost of about $65,000 a year. His building's doors are locked and guarded so the residents do not wander away. Families Facing Bankruptcy A senior director in health policy for Pfizer, Dr. Perfetto, 48, said that caring for her husband would eventually bankrupt her retirement accounts. (Mr. Wenzel receives a monthly N.F.L. pension of $925.) Sylvia Mackey, 65, returned to work as a flight attendant for United Air Lines several years ago solely because her husbands pension, now $2,450 a month, fell well below their living costs. She said that if it were not for the funds from the 88 Plan, she would have to sell her home, particularly when her husband needs institutionalization. The paradox of veterans of the N.F.L., a $6 billion-a-year business, struggling to pay medical bills is compounded by another, far less obvious fact. Dr. Perfetto said that she had trouble finding a home that would accept Mr. Wenzel because victims of Alzheimers-type diseases occasionally become violent, and former football players of his size (6 feet 2 and 215 pounds) are difficult for staff members to subdue. "These facilities are used to older people who are fairly decrepit who have strokes or blindness or use a walker, that sort of thing," Dr. Perfetto said. Dr. Perfetto said that while she hoped to receive assistance from the 88 Plan, she remained cautious. Many former N.F.L. players and their families have complained that the leagues disability insurance system is far too strict, with thresholds too high and hurdles too numerous for the deserving to get help. This skepticism is shared by Sharon Hawkins, who will be applying for 88 Plan assistance on behalf of her husband, Wayne, a former offensive lineman for the Oakland Raiders from 1960-69 who receives at-home care for his increasing dementia. "I'm full of hope that we'll be able to get it," Mrs. Hawkins, who lives in Reno, Nev., said in a telephone interview. "Until something has really happened the way they say it will, I'm reserving judgment." Gene Upshaw, executive director of the N.F.L. Players Association and the target of many veterans' dissatisfaction with the disability system, said in a telephone interview that he understood Mrs. Hawkins's doubt and agreed that there was too much red tape. He said that even though 88 Plan awards would be determined by the same six-member panel (split evenly among appointees of the league and the union) as the league's existing disability plan, he pledged that the 88 Plan would be handled differently. "There will not be any red tape," Upshaw said. "There will not be any hurdles to overcome." No Memories at All Meeting up with old teammates is supposed to ease the pain among hurting N.F.L. veterans, but that was not the case with Mr. Mackey and Mr. Wenzel. They played together on the 1972 Chargers, even blocking on the same offensive line, but neither has any memory of it. Neither remembers playing for the Chargers at all. Even after spending two hours together, and being reintroduced several times, neither man knew the other's name. "Do you remember playing with Ralph at all, John?" Mr. Mackey was asked. "Who's Ralph?" Mr. Mackey replied. "The guy sitting to your left." You're Ralph?" he asked Mr. Wenzel. "Yes." "I'm John Mackey," he declared, staring blankly ahead. Sylvia Mackey and Eleanor Perfetto looked on, hoping to see some glint of recognition in their husbands' eyes. But the only sign of recognition in the room was between the two women when they turned to look at each other and smiled sadly, their connection only growing as their husbands' disappeared.