November 04, 2012

The History of Alzheimer's Disease

Who Was Alzheimer?

Alois Alzheimer (1864 – 1915) was born in Markbreit in Germany and studied Medicine at the Universities of Würzburg and Berlin.  After working in hospitals in Frankfurt and Heidelberg he joined the Munich Psychiatric Clinic of Emil Kraepelin (1856-1926) as head of the Anatomy Department.  He worked in Munich from 1904 until 1912 when he was appointed Professor of Psychiatry and Neurology at the University of Breslau, now Wroclaw, in Poland.

The Story of Auguste D:

Alzheimer first described his now famous disease at the 37th Conference of Southwest German Psychiatrists in Tübingen on November 3rd and 4th 1906.  His presentation was called “A peculiar disease of the cerebral cortex.” He described a 51-year old woman, Auguste D, who had been admitted to the state asylum in Frankfurt.  She had become jealous of her husband and had also developed memory impairment.  She was suffering from cognitive and language difficulties, auditory hallucinations, delusions, paranoia and aggressive behaviour.  Her condition steadily declined and after four and half years of illness she died on the 8th of April 1906.

Alzheimer asked for her records and brain to be sent to Munich.  He had moved there to work with Emil Kraepelin, one of the foremost German Psychiatrists of the time.  As well as finding arteriosclerosis (hardening of artery walls) Alzheimer described curious fibres called "fibrils" in nearly a third of the nerve cells in the cerebral cortex. He also described depositions of a peculiar substance in the cerebral cortex, which we now call amyloid plaques.  He also noticed that many nerve cells seem to have simply disappeared.

Was Alzheimer a "Sculptor"... or a Botanist?!

The historical aspects of this disease have been carefully documented by Berrios (GE Berrios; Alzheimers Disease: A conceptual history. Int.J.Ger.Psych 1990;5:355-365).  He describes two interesting metaphors concerning the classification of disease.  He suggests that we could either consider Alzheimer, in describing these findings, as "..cataloguing species in an exotic garden," or alternatively behaving as "..a sculptor, carving a shape out of formless matter and creating a clinical form."

In a sense, the disease continued to be “sculpted” throughout the last century.  As Berrios notes, “…as the cognitive paradigm consolidated, a clear move towards narrowing down the syndrome by, for example, dismissing the presence of delusions and hallucinations can be detected.  Likewise arteriosclerosis was quietly dropped, and eventually became an exclusion criteria.”

However, we now know that there is considerable overlap between arteriosclerosis, Vascular Dementia and Alzheimers Disease.  We will take a brief look at this in our next update.

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