KNOXVILLE, Tenn. — Pat Summitt plays games and puzzles on her iPad to help her remain alert. Her sense of humor remains acute, along with her ambition to win a ninth national championship. But anyone who has been around her can sense inevitable changes seven months after Summitt revealed that she had symptoms of early onset Alzheimer’s disease.
Once she was so fiery that she pounded her hands on the court and had to have her rings re-rounded. As was evident at practice Wednesday, she now appears quieter, more subdued.
As Tennessee prepares to open the N.C.A.A. women’s tournament Saturday against Tennessee-Martin, Summitt’s alma mater, her coaching role has diminished. A basketball coach is not unlike an air-traffic controller who must track the movements of 10 players on the court at once. Summitt can no longer do this, her assistants said. So she prefers to instruct one player at a time, while her longtime assistant Holly Warlick has in effect become head coach.
The usual postseason excitement at Tennessee is tinged with the somber possibility that Summitt’s next defeat might be her last, that her unsurpassed career might end prematurely at age 59, cut short by the inexorable progress of dementia. Nothing has been decided, and there are indications she may want to return. There is also a feeling that this tournament might be more about departure than arrival.
“It’s heartbreaking,” said Alberta Auguste, a guard on Tennessee’s last championship team, in 2008, who has joined former and current players in making a memory book of letters and photographs for Summitt. “Something like that happens to someone you love, it rips your heart out. You just try to be there for her.”
While Summitt remains vital to her team, she has begun to withdraw, insulated by university officials. A great storyteller, open with the news media, Summitt routinely invited cameras into the locker room to record speeches that could be inspiring and blistering. Now, she speaks to reporters once a week, but declines one-on-one interviews and live on-air interviews, except for a postgame radio show. Warlick handles the postgame news conferences.
Sometimes, Summitt does not enter the huddle during timeouts; when she does, she typically defers to Warlick. Summitt also engages referees less frequently, although her rare eruptions draw a loudly appreciative and nostalgic response from Tennessee fans. University officials have expressed some frustration with television coverage, saying that cameras seem to linger on moments of apparent detachment.
Last month, a prized Tennessee recruit for 2013 said that she was having second thoughts, citing uncertainty about Summitt’s coaching future. The local newspaper had written about Summitt’s possible successors, as if her departure were inevitable.
Typically resolute, Summitt has said that she would not hold a pity party for herself. She wears a wristband that says “Fierce Courage” and still possesses her trademark wit. Sometimes at meals, one of her assistants will ask if she picked up the check. Summitt will reply, “Don’t ask me, I’ve got memory problems.”
And even after eight national titles and 1,095 victories over 38 seasons, more wins than any male or female college basketball coach, defeat continues to sting. “Losing is worse than dementia,” Maria Cornelius, a local sportswriter, said Summitt told her.
Since announcing her condition, Summitt has sought to raise both awareness about Alzheimer’s and money toward an eventual cure. She has put a recognizable face on an illness that affects 5.4 million Americans and has perhaps helped remove some of its stigma. Public support for her has been widespread. In December, when the Lady Vols played in New York, a woman approached Summitt in Macy’s and said, “Can I give you a hug?”
Debby Jennings, who has been a spokeswoman for Summitt for 35 years, said that Summitt had indicated a desire to coach next season. “Basketball has always been her true north,” Jennings said.
At practice Wednesday, Summitt was noncommittal. “I haven’t even made any decision about that,” she said. “I’m just trying to win a championship.”
When pressed about returning, she added: “I haven’t suggested that,” and “I love the game. Whether I’m here at U.T., I may or may not coach. It is what it is. I just want to get another championship for this group.”
Later, after a well-wisher expressed hope for Summitt’s return, she laughed and said, “I hope they let me come back.”
Tennessee officials have said they want to do what is best for Summitt and the university. Dave Hart, Tennessee’s athletic director, called Summitt the embodiment of her sport but said the university’s attention was focused on the N.C.A.A. tournament.
“We haven’t delved into anything else,” Hart said.
When the pairings were announced Monday night, Baylor Coach Kim Mulkey seemed wistful that her top-ranked Bears (34-0) were seeded first in the Des Moines Region and that Tennessee (24-8) was seeded second. A former point guard, Mulkey played for Summitt in the 1984 Los Angeles Olympics. With its 6-foot-8 center Brittney Griner, Baylor has dominated the Lady Vols. Two years ago, Baylor ended Tennessee’s season in a regional matchup. Now, more than a season may hang in the balance.
“I didn’t want to see Pat Summitt again,” Mulkey said in an interview on ESPN. “I have so much respect for her and the program.”
Nothing about this season has been normal for Tennessee. The Lady Vols have played inconsistently, delivering a blowout victory over Kentucky, a fellow No. 2 seed in the N.C.A.A. tournament, and winning the Southeastern Conference tournament for the 16th time. But Tennessee also experienced embarrassing defeats against the top seeds Stanford and Notre Dame. Failure to reach the Final Four for a fourth consecutive season would bring the longest drought of Summitt’s peerless career.
Sometimes, Tennessee’s players have underachieved. Sometimes, the complicated coaching arrangement has led to awkward communication on the bench. At one point, several seniors approached Summitt and asked that her muted voice become more familiarly insistent.
“When you hear that voice echoing around the floor, it’s amazing,” the senior star Glory Johnson said. “It’s something you miss, but it comes out once in a while. It makes you go harder.”
While Warlick and her fellow assistant coaches Mickie DeMoss and Dean Lockwood have assumed added responsibility, they are working under one-year contracts with little job security. Warlick, a former Tennessee player who has been an assistant to Summitt for 27 years, said her most difficult challenge had been to avoid giving the impression of a palace coup.
“It’s been really hard for me to get up and openly coach a team on the sideline with Pat sitting there,” Warlick said. “I don’t want the perception to be that I’m taking over and I’m doing this in front of Pat.”
On Sunday, John Adams, the sports editor for The Knoxville News Sentinel, wrote: “You know the program won’t continue as is. It would be too much to ask” of Summitt and her staff “to go through another season like this one.”
Adams suggested that Warlick be named head coach for next season. This would allow Summitt to remain with the team in some manner as long as her health permitted.
Tennessee “will have to make a head-coaching change,” Adams wrote. “But it can keep the staff and coach together. Summitt deserves that much.”
On Wednesday, Warlick said she would be willing to continue the current arrangement another season, saying, “I’m all about being loyal.” Asked if she thought Summitt would return, Warlick said, “My expectation is she’ll be here, but it’s her decision and I’ll support her 100 percent.”
Meanwhile, Summitt and her Lady Vols are six victories from another championship.
“It’s hard seeing her go through this,” Johnson said. “We want to be successful for her. If that’s not enough motivation, I don’t know what is. If we win, I’d put her on my back and do a victory lap.”