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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
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
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!
James )ulloch