REAGAN`S WANE; EX-PRESIDENT'S WORLD SHRINKS AS ALZHEIMER'S TAKES HOLD.

Byline: Lawrence K. Altman The New York Times

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in Bel-Air. He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour.

That night Shultz, the former secretary of state, received a call from Nancy Reagan, who told him that ``something poignant happened today that you would like to know about.''

At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Nancy Reagan went on, ``he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' ''

It has been almost three years since Reagan disclosed that he had the memory-destroying neurological illness known as Alzheimer's disease. And if, at the age of 86, the old movie actor still looks the image of vigorous good health, the truth is that the man behind the firm handshake and barely gray hair is steadily, surely ebbing away.

Reagan still plays golf, works out lightly in his basement and walks amid eucalyptus and day lilies in parks close to home. He puts on a suit and is driven to his office in nearby Century City. As he rides the elevators or walks the corridors, he remains the perfect gentleman, sweeping a hand through the air to let a woman pass by. Well-wishers are ushered into the office and the 40th president of the United States obliges them with a warm welcome and a photo-op.

Communicator silent

But the raconteur of old, ``the Great Communicator'' of American politics, is mostly silent now. When he speaks, it is usually in clipped phrases - rarely more than a sentence here or there.

He appears to recognize few people other than his wife. And while he gamely returns the nods and salutes of passers-by, on most days Reagan does not seem to know why they are hailing him - that for eight years he was the most powerful man in the world.

Reagan's Alzheimer's appears to be in the middle stages; as it has advanced, he has slipped ever further from public view. But interviews over the last several months with more than 20 people who know him well - his White House doctors, friends and some of his closest presidential aides - provide what is perhaps the most detailed picture yet of the progress of his disease and of his life today.

White House years

At the same time, they cast new light on persistent questions about Reagan's mental state as president, questions rekindled by the disclosure, in November 1994, that he had Alzheimer's.

Nearly 70 when he took office in January 1981, Reagan became the oldest president, and throughout his two terms, a series of well-publicized memory lapses and a casual executive style had provoked uncertainty - even ridicule - about his mental competence.

Just when the Alzheimer's began can never be known. But while the line between mere forgetfulness and the beginning of Alzheimer's can be fuzzy, a matter of gradation, Reagan's four main White House doctors say they saw no evidence that he had crossed it as president. They saw and spoke with him daily in the White House, they said, and beyond the natural failings of age, never found his memory, reasoning or judgment to be significantly impaired.

Reagan ``absolutely'' did not ``show any signs of dementia or Alzheimer's,'' said Dr. John Hutton, who cared for him from 1984 until the end of his presidency and remains a close family friend. Extensive mental status tests did not indicate evidence of Alzheimer's until 1993, more than four years after Reagan left office, Hutton said.

Even in hindsight, Reagan's friends and former aides said that they, too, had seen no hint of the deterioration to come. And while they acknowledged that he had occasional memory lapses as president, especially when it came to names, many said he had had these problems for years, certainly since he was governor of California, from 1967 to 1975.

Reagan is believed to be the first president or former president to have Alzheimer's. But the disease - a form of dementia, or senility, that strikes with increasing frequency as people advance beyond their 60s - is a growing public health problem in an aging society.

While Alzheimer's course varies, it is often slow, measured in years; as it advances, abnormal deposits of protein destroy the nerve cells in the brain, obliterating memory. The two approved drugs can do no more than stave off decline for a few months, and only for some people. Ultimately, Alzheimer's is fatal, though many people with the disease die of other causes.

The first significant hints that Reagan was crossing that fuzzy line into dementia, his doctors said, did not come until September 1992, three years and eight months after he left office. From that point on, they described a gradual descent into bewilderment and forgetting that will be achingly familiar to families and friends of the estimated 4 million Americans who share his fate.

Mental lapses

On Sept. 13, 1992, Reagan made a campaign speech for President Bush in Yorba Linda. In suit and tie on that sweltering day, but speaking more slowly than in the past, Reagan drew thunderous cheers from the shirt-sleeved crowd.

Dr. Lawrence C. Mohr, one of the White House doctors in Reagan's second term, was seeing him for the first time in six months, and afterward, the doctor and the former president talked. As usual, Reagan asked about Mohr's family. But Reagan ``was distant,'' he said, and seemed ``preoccupied, which was unusual, because Ronald Reagan is a person who was engaged when he would talk to you.''

At the end of the conversation, the doctor continued, ``Mr. Reagan asked me, `What am I supposed to do next?' There was a blank look on his face.'' Mohr said he guided Reagan away and wondered ``what had caused the change and what was going to happen.''

Now, looking back, Mohr regards that change as the first sure warning of Reagan's Alzheimer's.

It was about a year later, in Reagan's annual checkup at the Mayo Clinic, that formal mental-status tests for the first time raised questions about his recent-memory skills, Hutton said. The doctor said Nancy Reagan would not let him disclose further details of the tests, and added that ``someday they can be documented'' by historians.

But those results led doctors to begin a more intensive regimen of mental testing: The medical statement released along with Reagan's Alzheimer's disclosure said the disease had been diagnosed through repeated observations and testing for a year.

The Alzheimer's almost became evident in an embarrassing way in February 1994 when Reagan spoke to 2,500 people celebrating his 83rd birthday in Washington, D.C. It is believed to have been his last public speech and last visit to the capital.

Before the dinner, Reagan chatted normally with former British Prime Minister Margaret Thatcher and had his picture taken with several other people. But he had difficulty recognizing one of his former Secret Service agents, Hutton said.

This left Hutton and others in the Reagan party worried that the speech might not go well - that Reagan ``might lose his place in the notes and that kind of thing,'' said Caspar Weinberger, who was secretary of defense in the Reagan administration.

A videotape of the event shows that after Thatcher finished her introduction, Reagan hesitated for several seconds as he began speaking.

``I was holding my breath, wondering how he would get started,'' Hutton said, ``when suddenly something switched on, his voice resounded, he paused at the right places, and he was his old self.''

But after the dinner, Hutton related, when Reagan returned to his hotel suite, ``He hesitated just for a moment and looked to Mrs. Reagan and said, `Well, I have got to wait a minute, I am not quite sure where I am.' ''

Nancy Reagan, the doctor said, ``very quickly and simply said, `Now Ronnie, your clothes are down at this end of this room, and you go down there and you will find out where they are.' Once that suggestion was followed, he knew exactly where he was and what he was doing and we were back on track.''

Then, Hutton continued, ``Mrs. Reagan looked at me, and said, `John, do you see what I mean?' '' Nancy Reagan told the doctor ``she was beginning to see these little lapses and was beginning to wonder, was this the beginning of something?''

Mohr said that when he discussed the episode with Hutton, ``this seemed to be a clear progression from what I had experienced.''

Similar episodes followed.

In September 1994, Reagan slipped several times in reading from the TelePrompTer while making videotapes in support of Republican candidates for office.

``You know, I am not remembering things well,'' Hutton recalls Reagan saying.

In October, Lyn Nofziger, a longtime political adviser, went to Reagan's office.

``He greeted me warmly at the door, and there was no question that he knew me and was glad to see me,'' Nofziger said. Still, there was little to talk about. ``So he got up and went around the room showing me all the mementos. But what bothered me was that he assumed that I had never seen them before.

``It was clear to me that he had lost it. But I did not know if it was Alzheimer's or something else.''

On Nov. 5, in a handwritten letter, Reagan told the American people that he had entered the early stages of Alzheimer's disease.

He wrote, ``I now begin the journey that will lead me into the sunset of my life.''

Seeming the same

A shake-shingled guardhouse is perched just inside the pink-azalea-lined drive of Reagan's house at 668 St. Cloud Road, and the compound is entirely shielded from view by high shrubs and a rustic stone wall. All day, vans loaded with tourists roll by on their rubbernecking rounds of the ``Homes of the Stars.''

The other day, John, a driver for Beverly Wood Tours, gestured out the window to the wall and said, ``All this property here is the ex-president, Ronald Reagan.''

One tourist asked, ``Is there anybody occupying that?'' and the driver replied: ``He lives there. That's his home now.''

But, of course, he is hardly the same man.

Physically, Reagan remains in good health. And so far, friends say, he has escaped the extremes of Alzheimer's - belligerence, paranoia, total inability to care for himself. He dresses himself, with help, and ties a Windsor knot; indeed, he is always impeccably dressed. He feeds himself. He is gracious and warm and loves to see people, especially children.

``When you see him and talk to him, you hardly notice any change,'' Shultz said. ``And his physical behavior - he shakes hands, he smiles and his eyes sparkle. It's just that you don't wind up in any meaningful conversation. But to the casual observer - they don't detect anything happening. It's remarkable.''

Still, according to Hutton, the Alzheimer's has advanced since it was diagnosed. Disorientation to time is common in Alzheimer's patients, and Reagan has occasionally got up at 2 a.m. to look for his breakfast, said a longtime friend, Walter Annenberg. Drug therapy was tried but without success.

For a man who once strode the world stage, Reagan's everyday world is tightly circumscribed, a patch of West Los Angeles no more than 10 miles across. His office, at 2121 Avenue of the Stars, is three and a half miles from his home.

Close by, too, are the Los Angeles Country Club, where he plays golf, and the parks where he likes to walk and sit and watch the children.

A bit farther off is the beach at Santa Monica where he sometimes walks and stops on the veranda of a hotel called Shutters on the Beach, and sips iced tea and watches the in-line skaters, the volley ball players and the sea beyond.

But there are no more weekends at the ranch up the coast, north of Santa Barbara (it has been on the market for some time), and the last of the annual New Year's visits to the Annenbergs in Palm Springs was three winters ago. The farthest he goes is the very occasional 80-mile round trip to the Reagan Library and Museum in Simi Valley.

Most weekdays - days scripted by his wife to stimulate him as much as possible - he spends four or five hours at his office. He looks at newspapers and occasionally reads an article aloud, but slowly. A staff member - there are two full- and three part-timers - gives visitors a little tour of the memorabilia, and then there are the photographs.

This summer, Hutton was part of a small delegation from the Uniformed Services University of the Health Sciences in Bethesda, Md., that went to the office to give Reagan an honorary degree. Reagan, dressed in academic gown, remained the consummate actor.

``He played his part just beautifully,'' Hutton said. ``He wanted to look at the framed degree, although I don't know if he really understood the total significance.''

CAPTION(S):

4 Photos

PHOTO (1--color) RONALD REAGAN

(2) Former President Reagan and his wife, Nancy, stopped by the Reagan Presidential Library in 1990 to touch a section of the Berlin Wall now on display at the facility near Simi Valley.

Gus Ruelas/Daily News

(3--4) At left, the former president and first lady appear for the 1991 opening of the Ronald Reagan Presidential Library. Above, Reagan embraces Mikhail Gorbachev, last premier of the Soviet Union, after presenting him with the first Ronald Reagan Freedom Award in 1992.

Daily News