Neurological history: Alois Alzheimer « Online newspaper of …
The author: Professor Yasser Metwally
INTRODUCTION
April 19, 2010 — Aloysius “Alois” Alzheimer, (14 June 1864 – December 1915) was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of “presenile dementia”, which Kraepelin would later identify as Alzheimer’s disease.
Alzheimer was born in Marktbreit, Bavaria. His father served in the office of notary public in the family’s hometown. Alzheimer attended Aschaffenburg, Tübingen, Berlin, and Würzburg universities. He received a medical degree at Würzburg University in 1887. In the following year, he spent five months assisting mentally ill women, before he took an office in the city mental asylum in Frankfurt am Main: the Städtische Anstalt für Irre und Epileptische (Asylum for lunatics and epileptics). Emil Sioli was the dean of that asylum (1852-1922). Another neurologist, Franz Nissl (1860-1919), began to work in that same asylum with Alzheimer, and they knew each other. Much of Alzheimer’s later work on brain pathology made use of Nissl’s method of silver staining of the histological sections. Alzheimer was the co-founder and co-publisher of the journal Zeitschrift für die gesamte Neurologie und Psychiatrie. He never wrote a book that he could call his own.
In 1901, Alzheimer observed a patient at the Frankfurt Asylum named Mrs. Auguste Deter. The 51-year-old patient had strange behavioral symptoms, including a loss of short-term memory. This patient would become his obsession over the coming years. In April 1906, Mrs. Deter died and Alzheimer had the patient records and the brain brought to Munich where he was working at Kraepelin’s lab. Together with two Italian physicians, he would use the staining techniques to identify amyloid plaques and neurofibrillary tangles. A speech given on 3 November 1906 would be the first time the pathology and the clinical symptoms of presenile dementia would be presented together. Through extremely fortunate circumstances the original microscope preparations on which Alzheimer based his description of the disease were rediscovered some years ago in Munich and his findings could thus be reevaluated.
The ancient Greek and Roman philosophers and physicians associated old age with increasing dementia. It was not until 1901 that German psychiatrist Alois Alzheimer identified the first case of what became known as Alzheimer’s disease in a fifty-year-old woman he called Auguste D. Alzheimer followed her until she died in 1906, when he first reported the case publicly. During the next five years, eleven similar cases were reported in the medical literature, some of them already using the term Alzheimer’s disease. The disease was first described as a distinctive disease by Emil Kraepelin, who included Alzheimer’s disease, also named presenile dementia by Kraepelin, as a subtype of senile dementia in the eighth edition of his Textbook of Psychiatry, published in 1910.
For most of the twentieth century, the diagnosis of Alzheimer’s disease was reserved for individuals between the ages of 45 and 65 who developed symptoms of dementia. The terminology changed after 1977 when a conference on AD concluded that the clinical and pathological manifestations of presenile and senile dementia were almost identical, although the authors also added that this did not rule out the possibility of different aetiologies. This eventually led to the diagnosis of Alzheimer’s disease independently of age. The term senile dementia of the Alzheimer type (SDAT) was used for a time to describe the condition in those over 65, with classical Alzheimer’s disease being used for those younger. Eventually, the term Alzheimer’s disease was formally adopted in medical nomenclature to describe individuals of all ages with a characteristic common symptom pattern, disease course, and neuropathology.
Since German was lingua franca of science (and especially of psychiatry) of the time, Kraepelin’s use of Alzheimer’s disease in a textbook would make the name famous. By 1911, the disease was being used by European physicians to diagnose patients in the US.
In mid-December 1915, Alzheimer fell ill on the train on the way to the University of Breslau, where he had been appointed professor of psychiatry in 1912. Most probably he had a streptococcal infection and subsequent rheumatic fever and kidney failure. He died of heart failure at the age of 51 in Breslau, Silesia.
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