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How Alois Alzheimer Redefined Dementia
How Alois Alzheimer Redefined Dementia
On the 150th anniversary of his birth, learn how Alois Alzheimer identified one of the
worlds deadliest diseases.
June 13, 2014
A photograph of Auguste Deter, the first documented case of Alzheimer's disease, after
she was admitted to the Franfurt hospital where Alois Alzheimer wored!
"arl Deter could tae it no more! #is wife Auguste had $ecome intensel% &ealous,
increasingl% forgetful, disorientated and e'en delusional! (ometimes she screamed for
hours, con'inced someone wanted to ill her!
)he railwa% worer from Franfurt was una$le to $oth care for his wife and eep his &o$!
(o on *o'em$er 2+, 1,01 he admitted Auguste to the #ospital for the -entall% .ll and
/pileptics in Franfurt! )he ne0t da%, she was e0amined $% a 312%ear2old 3erman doctor
specialising in ps%chiatr% and neuropatholog%, Alois Alzheimer, who recorded their
con'ersation!
4(he sits on the $ed with a helpless e0pression! 5hat is %our name6 Auguste! 5hat is
%our hus$and7s name6 Auguste, I think! 8our hus$and6 Ah, my husband. (he loos as if
she didn7t understand the 9uestion! Are %ou married6 o Auguste. -rs D6 !es, yes,
Auguste "! #ow long ha'e %ou $een here6 (he seems to $e tr%ing to remem$er! hree
weeks!:
Alzheimer had o$ser'ed similar mental degeneration in patients with senile dementia!
;ut Auguste Deter was &ust +1 %ears old, nine %ears %ounger than what was then
considered the $eginning of the senile period! Alzheimer was struc not onl% $% her
relati'e %outh $ut also $% how rapidl% her cogniti'e capacities had deteriorated! (he also
appeared distressingl% aware of her plight, declaring 4. seem to ha'e lost m%self!:
Auguste Deter was e'entuall% diagnosed with presenile dementia!
)oda%, she would $e diagnosed with earl%2onset Alzheimer7s disease! Alzheimer7s is the
most common t%pe of dementia, accounting for <2= of dementia cases in the >" for
e0ample, according to the Alzheimers Society. Dementia is now one of the most se'ere
health $urdens worldwide ?see Dementia: the long goodbye@! )he 'ast ma&orit% of
Alzheimer7s cases do in fact present in old age after <+! )he% are characterised $%
progressi'e cogniti'e and ph%sical decline! Alzheimer7s disease has no nown cure and is
ultimatel% fatal!
Dementia Today
Dementia is one of the leading causes of death worldwide, afflicting an estimated
44!4 million people in 2013! ;% 20+0, 13+!+ million people will $e affected,
predicts Alzheimer's Disease .nternational!
.t is estimated that 3 out of 4 dementia sufferers ha'e not recei'ed a formal
diagnosis! Ane stud% from Bhina suggests that ,3= of dementia goes undetected!
Dementia care cost around C<04 $illion in 2010, e9ui'alent to the 1Dth largest
econom% in the world! Alzheimer's Disease .nternational e0pects these costs to
increase D+= $% 2030!
>npaid care pro'ided $% famil% and friends accounts for a$out 42= of the total
costs of dementia care while &ust 1<= comes from direct medical care!
Diet, weight control and e0ercise reduce Alzheimer7s ris, as does 9uitting
smoing, treating depression and sta%ing intellectuall% acti'e!
Anl% 13 of 1,3 countries in the 5orld #ealth Arganisation ha'e national
dementia action plans
)he man who lent his name to this horrific disease was $orn on 14 June, 1D<4 in ;a'aria,
3erman%! After graduating from medical school in 1DD1, he $egan woring at the
Franfurt hospital! Aside from his clinical duties, he and his colleague Franz *issl
meticulousl% in'estigated $rain tissue and the patholog% of the ner'ous s%stem, setting up
an archi'e of patient autopsies! .n 1D,4, Alzheimer married wellE Becilia 3eisenheimer
was a $aner7s widow and the match made him financiall% independent! )his ena$led
him to support his own research!
Alzheimer ept a$reast of Auguste Deter7s case e'en after lea'ing Franfurt in 1,03 to
wor at the Fo%al Gs%chiatric Blinic in -unich under Emil Kraepelin, a founding father
of modern ps%chiatr% who first classified schizophrenia! 5hen Auguste died in April
1,0<, aged ++, Alzheimer ased for her medical records and her $rain to $e sent to
-unich so he could e0amine them!
A ec!liar Disease
>sing a newl% de'eloped techni9ue for staining human tissue, he was a$le to illuminate
the remara$le e0tent of the damage to Auguste7s $rain and ner'ous s%stem! ;etween one
9uarter and one third of the neurons in her cere$ral corte0 had 'anished entirel%! #er
$rain had shrun! )he cere$ral corte0 was thinner than normal! .t was characterised $%
tangled growths ?neurofi$rall% tangles@ and senile pla9ues H deposits of what Alzheimer
descri$ed as 4a peculiar material: which has since turned out to $e am%loid protein!
Briticall%, the de'astating damage to Auguste7s $rain circuitr% seemed to corro$orate
o$ser'ations of her rapid decline into near2total senilit% prior to her death! (enile pla9ues,
first identified in 1D,2, had pre'iousl% onl% $een o$ser'ed in elderl% people! Auguste
Deter7s relati'e %outh and the speed of her decline suggested this was something new!
(i0 months later, on 4 *o'em$er 4, 1,0<, Alzheimer descri$ed Auguste Deter7s case to a
conference of 3erman ps%chiatrists in )u$ingen! 5ithout identif%ing her, he descri$ed
Auguste7s s%mptoms and $rain damage and tentati'el% identified 4a peculiar disease of
the cere$ral corte0!: )he lecture, pu$lished the following %ear, represented the
$eginnings of Alzheimer7s disease research! )he neurofi$rall% tangles and am%loid
pla9ues Alzheimer identified ha'e $ecome s%non%mous with Alzheimer7s disease!
Alois Alzheimer was not the onl% researcher in the field! .n 1,01, Asar Fischer
descri$ed similar findings as did Francesco ;onfiglio a %ear later, and in 1,0, 3raetano
Gerusini pu$lished an article in 1,0, using Auguste Deter as one of four cases! Alzheimer
did not present his second case, +<2%ear2old Johann F!, until 1,11!
;ut $% then the s%ndrome had alread% $een namedE not $% Alzheimer himself, $ut $% his
$oss /mil "raepelin! .n the 1,10 edition of his #andbook of $sy%hiatry, "raepelin stated
that the 4age2independent uni9ue disease process: was distinct from senile dementia and
proposed that it $e termed 4Alzheimer7s disease!:
Iarious theories e0plain "raepelin7s haste to name the disease after his &unior colleagueE
he was competing with the ri'al la$orator% in Grague that had produced Fischer7s worJ
as an ad'ocate of the organic school of ps%chiatr% which held that mental disease has
ph%sical causes he wanted e'idence to counter Freud7s arguments that ps%chological
factors alone could induce mental disordersJ he genuinel% $elie'ed Alzheimer had
disco'ered a new disease and their close colla$oration ga'e him detailed understanding
of the wor! 5hate'er the moti'ation, "raepelin7s stature sealed Alzheimer7s place in
medical histor%!
.n 1,12, "ing 5ilhelm of Grussia signed Alzheimer7s appointment as professor of
ps%chiatr% at the Friedrich25ilhelm >ni'ersit% in ;reslau! ;ut on the wa% from -unich
to accept the appointment he caught a se'ere cold complicated $% endocarditis and was
hospitalised immediatel%! #e ne'er full% reco'ered and died three %ears later! #e was &ust
+1, Auguste Deter7s age when the% first met!
KKcto1l$LL
James )ulloch
httpEMMnowledge!allianz!comM6212+M#ow2Alois2Alzheimer2redefined2dementia