November 3, 1906: Alois Alzheimer presents a novel kind of early-onset dementia
110 years ago, on November 3, 1906, German psychiatrist Alois Alzheimer reports for the first time before a congress in Tübingen about a novel kind of early-onset dementia accompanied with massive loss of cerebral matter, deposition of amyloid plaques and occureence of neurofibrillar tangles in the cortex.
In 1901, Alzheimer was introduced to a 51 year-old patient of the Frankfurt mental asylum called Auguste Deter.
She had been taken there by her husband after she had shown disastrous changes in her personality and had become unable to lead the household over the course of only one year. Alzheimer recorded the first interrogation with Auguste Deter as followed:
„What is your name?“
Alzheimer: „Family name?“
Alzheimer: „What’s the name of your husband?“
Deter (hesitant): „I believe… Auguste.“
Alzheimer „Your husband?“
Deter: „Oh, I see.“
Alzheimer: „How old are you?“
Alzheimer: „Where do you live?“
Deter: „Oh, you have been visiting us before.“
Alzheimer „Are you married?“
Deter: „Oh, I am so confused.“
Alzheimer: „Where are you here?“
Deter: „Here and everywhere, here and now, you must not take offense.“
Alzheimer: „Where are you here?“
Deter: „We will be going to live here.“
Alzheimer: „Where is your bed?“
Deter: „Where might it be?“
Alzheimer: „Write down number five.”
Deter: *writes down ‘a woman’*
Alzheimer: „Write down number eight.”
Deter (while writing down ‘Auguste’): „I have lost myself, so to speak.”
It was obvious that Auguste Deter was very well aware of her helplessness and very distressed about it, with her mood rapidly changing between anxiety, weepiness, mistrust and denial. Alzheimer became highly interested in this case as she was only 51 years old, much younger than most patients with dementia. He refused to give her away to another asylum, even after he had moved from Frankfurt to Munich, and even though she became aggressive against the other resident patients. In his notes, Alzheimer called her condition the “disease of forgetting”.
On April 9, 1906, Alzheimer was informed that Auguste Deter had died from a sepsis, untreatable in the days before antibiotics. In the final stages of her disease, she was unable to walk and bound to bed, where she developed decubitus, which became infected. Alzheimer had her brain sent to Munich and investigated it microscopically with the help of two Italian physicians, using state-of-the-art staining techniques. These investigations were the foundation of the characterization of Auguste Deter’s condition as a newly discovered disease. His initial talk in Tübingen, however, left the audience unimpressed, and he was sent away without further discussion, questions or comments. Two papers describing the condition and the associated pathological histology were published soon, and in 1910, Alzheimer’s boss, Emil Kraepelin referred to the syndrome as “Alzheimer’s disease” in a book chapter, a name that remained.
Alzheimer died in 1915 from complications of what probably was a streptococcus infection in 1912, causing heart, kidney, and rheumatic conditions. Due to his short life, he was never able to discuss his findings with a broad scientific community.
In the early 1990s, medical researchers began doubting whether Alzheimer’s observations matched with today’s diagnosis of Alzheimer’s disease. Through lucky circumstances, Alzheimer’s notes and his original microscopic slides were found in 1997 in an extremely well-preserved state, so that all doubts could be removed.