DR. ALOIS ALZHEIMER
In November 1901 Mrs. August D., age fifty-one, was admitted
to the Asylum for the Insane and Epileptic in Frankfurt am Main with advanced dementia.
Her husband, a railway clerk, had been aware of her deterioration for about
eight months. The senior
physician
of the Asylum, Dr. Alois Alzheimer, saw this as an unusual case and examined
her in detail. In time, Mrs. Auguste D's problem would make the name Alzheimer a household word.
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| Auguste D, Alzheimer's original case (Wikipedia) |
Alois Alzheimer was
born in Marktbreit, Germany, not far from Würzburg. Son of a notary, he
received his secondary education at a gymnasium, then studied medicine in
Berlin, Würzburg, and
Tübingen. He was an enthusiastic fraternity member and while
fencing sustained a large gash over his left face. Since then he only allowed
photographs from his right side. He took an interest in histology, having
studied under the pioneer histologist Alfred von Kölliker, and in neuro-psychiatry,
seeking an organic basis for mental illness. He obtained a position at the
above-mentioned Asylum in Frankfurt, working under Dr. Emil Sioli.
 |
| Alois Alzheimer (Wikipedia) |
Emil
Sioli was an early advocate of “open therapy” – substituting relaxing warm
baths for restraints and using activities such as crafts and gardening as
therapy in a time when almost no helpful medicines were available. Alzheimer
was soon joined by
Franz Nissl, already known for his development of a neuron
stain. He and Alzheimer became life-long friends and colleagues. They worked
together on many histologic projects (usually at night, after clinical duties),
published extensively, and both became recognized authorities in
neuropathology.
 |
| Franz Nissl (Wikipedia) |
In 1892 Wilhelm Erb
(of Erb’s paralysis) asked Alzheimer to travel to North Africa to care for a
wealthy patient. The patient died en route to Europe but his widow, Cecilie,
was taken with Alzheimer and eventually proposed to him. They were married in
1894 and lived happily until her relatively sudden death of unknown cause seven
years later.
Alzheimer moved briefly
to Heidelberg and in 1903 accepted a position under the famous
psychiatrist Emil Kraepelin at the Royal Psychiatric Clinic in Munich. Since Kraepelin could not find funds for him Alzheimer, now wealthy, worked for no remuneration (imagine that today!). He built a large laboratory, mainly at his own
expense. His genial personality and modern lab attracted excellent scientists
such as Hans Creutzfeldt, Alfonse Jakob, and Frederik Lewey (Lewey bodies).
Alzheimer published on histologic findings in alcoholism, epilepsy, and mental
retardation, and was promoted to “chief physician”, finally earning a modest
salary.
About one third of patients
in mental hospitals at the time suffered from general paresis. Most female
patients were prostitutes and among males military officers, salesmen, and
firefighters predominated. Priests were rarely afflicted. Syphilis was
suspected as the cause but the evidence was circumstantial. To teach at the University of Munich Alzheimer had to submit a Habilitation thesis. He had
studied 320 cases at autopsy over seven years and selected 26 for the thesis. The work,
published in 1904, was considered a landmark paper. The very next year the treponema of syphilis was discovered by Fritz Schaudinn and Erich Hoffmann, and the year after that Wassermann announced a diagnostic test for syphilis.
 |
| Inflammatory thickening of pia mater in paresis (from Alzheimer, Reference 5, Hathi Trust) |
Back at the Asylum in
Frankfurt, Auguste D. was deteriorating, and died in April, 1906. Alzheimer received her brain in Munich and on examination he found plagues, fibrillary tangles, and a
paucity of neurons.
Dr. Alzheimer
presented the case of Auguste D. at a lecture in November, 1906, during a meeting of the Southwest German Psychiatrists. Much of the meeting was taken up with
criticisms of Freud’s theory of the sexual basis for hysteria. Alzheimer’s
paper, despite numerous illustrations, provoked no discussion. It was
published the following year (1907) without illustrations in a German journal
of psychiatry and “psycho-forensic” medicine. Alzheimer asked a coworker, Dr.
Gaetano Perusini, to watch for similar cases at the Clinic, and after three
more turned up the four were published in a serial work on the histology and
histopathology of the cerebral cortex edited by
 |
| Plaque and fibrils seen by Alzheimer (from Reference 6, Hathi Trust) |
Alzheimer and Franz Nissl. Three years later Emil Kraepelin, in the eighth edition of his popular psychiatry textbook, formally named the disorder “Alzheimer’s disease”.
Before long other reports drifted in, and
eventually the gap between “pre-senile” dementia and the dementia of old age (“senile
dementia”) narrowed. Today the disease is referred to as dementia of the
Alzheimer type or Alzheimer’s dementia. The advancing age of the population plus a few cases in celebrities such as Rita Hayworth and Ronald Reagan have assured
the disorder a prominent place in the public eye.
In 1912, at the age
of 48, Alzheimer was appointed full professor of psychiatry in Breslau, a
prestigious post. Unfortunately his health began to fail shortly after and he
died in 1915 of kidney failure.
Was Alzheimer
really the first to characterize the pathology
of early dementia? In the journal
Brain, 2009, Michel Goedert writes
about Oskar Fischer, a Czech investigator at the now defunct German University
in Prague, who made almost simultaneous observations. In 1907 – the same year
as Alzheimer’s first publication on dementia, he reported on 16 cases of senile
dementia (called “presbyophrenia” by him), 12 of whom had neuritic plaques and
neurofibrils. Later papers of 1910 and 1912 enlarged the findings. The plaques
were, in fact, often called “Fischer’s
plaques”, and "presbyophrenic dementia" and "Alzheimer’s disease" were terms used interchangeably for several years. While Fischer felt that the plaques and
fibrils were important in causing dementia, Alzheimer, mentioning Fischer, was
less convinced of the causative role of plaques.
 |
| Oskar Fischer (Wikipedia) |
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| Plaque and fibrils by Fischer (from Reference 7, Hathi Trust) |
Fischer, being
Jewish, was eventually let go from the German University and perished in a
concentration camp. After the war communism ruled in Czechoslovakia and the
German University was never reopened. It is not surprising that Fischer’s name
was forgotten until Dr. Goedert rescued him from archives in Prague.
SOURCES
1. Maurer,
K and Maurer U, Alzheimer: The Life of a
Physician and the Career of a Disease (Eng trans) 2003; Colombia
Univ Press, NY.
2. Maurer
K, et al, “Auguste D and Alzheimer’s Disease” 1997; Lancet 349:1546-9.
3. Goedert,
M and Ghetti, B, “Alois Alzheimer: His Life and Times”. 2007; Brain Pathology 17: 57-62.
4. Goedert,
M. “Oskar Fischer and the Study of Dementia” 2009; Brain 132: 1102-11.
5. Alzheimer,
A. “Histologische Studien zur Differentialdiagnose der progressiven Paralyse” (Histologic
studies in the differential
diagnosis of general paresis). 1904; Histologische
und
Histopathologische
Arbeiten. F
Nissl, ed. 1: 1-297.
6.
Alzheimer, A, “Über eigenartige Krankheitsfälle des späteren Alters”1911; Zeitschr für die
gesamte Neurologie u Psychiatrie 4: 356-85.
7. Fischer,
O. “Miliare Nekrosen mit drusigen Wucherungen der
Neurofibrillen, eine regelmässige Veränderung
der Hirnrinde bei
seniler Demenz” (Miliary necroses with plaque-like growths in
the
neurofibrils, a regular alteration
of the cerebral cortex in senile
dementia) Monatsschrift Psychiatrie und Neurologie 1907; 22:36-
72.
8.
Perusini, G, “Über klinisch und histologisch eigenärtige psychische Erkrankungen
des späteren Lebensalters”. 1909; in Histologische
und Histopathologische Arbeiten. F Nissl, A Alzheiner, eds. 3: 297-351.
