The lines on her face indicate that Sister Miriam is well into her 80s. But she tells a visitor that she is 40. 

It isn't a concession to vanity. In her mind Sister Miriam truly is 40. Minutes later, she is a young girl, walking through the fields with two of her siblings near the Irish village where she grew up. A torrential rain ensues and she prays to God to rescue them from the coming flood. He does.

Sister Miriam-not her real name-is beginning to suffer from a form of dementia. She lives in a community for the elderly on the East Coast, a facility much like many of the institutions she helped to lead in her younger years. One of those facilities was located in a Midwest city prone to flooding, perhaps explaining her current obsession with water.

Besides her memories, Sister Miriam lives in the present.

"I go through the building here three times a day," she tells her visitor. "I see if it's tidy, that everything is in order." She says she prays six times a day, "to help me to be a good person and to be very kind in every which way."

She is convinced that God is watching over this facility. Recently she encountered a depressed resident who was crying, saying that no one loved her. Sister Miriam took her hand and assured her that she was loved by an eternal God.

Sister Miriam may not, at times, make sense to some people. She may well be in her own world. Yet God is real to her, a presence who is loving yet demands a moral accounting-she often talks about God frowning upon violent behavior. Her religious imagination is as alive as ever.

That would not be surprising to Father John Malecki, a priest of the Diocese of Albany, New York and a psychologist who completed a doctoral dissertation on the spiritual lives of Alzheimer's patients.

Working as a chaplain at Teresian House, an Albany facility that cares for the elderly with dementia, he developed techniques to draw out the religious imagination of the patients. Most were judged to be in the middle stages of Alzheimer's. At first he found himself correcting the patients, bringing them back into present reality, an often-understandable reaction among those first encountering Alzheimer's patients. But as he continued his research, he found it better to just go along with them, to follow where their imaginations led.

He found that talking about patients' feelings in regular conversation was often impossible. So he used other means. He asked them to draw images. Some drew evergreens, which in Jungian psychological terms is sometimes seen as a symbol of life everlasting. He told them symbolic stories, including one about a man and his son who worked tirelessly to dig away a mountain that blocked their view of a beautiful valley.

What did the mountain represent? A patient responded quickly: "It's like our illness that keeps us from seeing the wonderful valley. But we hope and pray and persevere that we will see that valley."

He retold other patients the story of the Prodigal Son in the gospels. One nailed the symbolism. "God loves us with no strings attached," she said. Often, said Malecki, the response to religious stories was as on target as it would be from people without Alzheimer's.

Others saw their condition as an ongoing struggle with the Almighty. "Sometimes I fight with God and, at other times, I have the picture of embracing God in love," one patient told Malecki.

Even when dementia makes people unable to articulate and sense what is happening to them, Malecki notes that the religious imagination remains.

For Catholic patients the symbols of the Mass retained their power. He found, however, that taking the residents to a liturgy in a church or chapel disoriented them, moving them away from familiar surroundings. Yet when he celebrated Mass in their rooms, they recognized the familiar symbols of the chalice and the Eucharist.

Maggie Hume of Clifton Park, New York, says that Malecki's research helped her when she was taking care of her late mother who had Alzheimer's. She found herself more willing to listen to her mother's stories by "not looking at the person with a condition, [but by looking] at the person."

Carmelite Sister Peter Lillian of Germantown, New York, who ministers to people with Alzheimer's, has also found that Catholics with the disease often connect with symbols, such as the habit she wears as a member of her religious community. She finds that when she walks the halls patients will sometimes break out in a spontaneous recitation of the rosary, drawing upon some of their earliest religious imagery.

Holy Cross Family Ministries, based in North Easton, Massachusetts, has produced a guide to the rosary for those with Alzheimer's and their caregivers. The book notes that even when patients cry out in sometimes disturbing, inarticulate ways, their religious sense remains alive. "The disease does not kill the soul," says Malecki. "The spiritual life is growing." The protective and loving God that Sister Miriam prays to remains as alive as ever.