In conjunction with his 153rd birthday – we take a look at the contributions made by renowned German psychiatrist, Alois Alzheimer, who is credited as being a medical pioneer. He has successfully described the clinical and micro-anatomic features of a brain disease that erases the memories of millions of people, annually.

It is common knowledge that the memory loss and impairment of cognitive functions that are linked to dementia usually occur in the elder. This can result from trauma to the head and brain, cerebrovascular events like strokes, metabolic and endocrine illnesses and various other conditions.

Prior to gaining this knowledge, doctors were clueless as to the causes of dementia for centuries. Despite the fact that autopsies were performed at various points of history, the brain was not always studied and was poorly understood.

Experts began to thoroughly look for the anatomical seat of particular diseases by the mid-nineteenth century. Thus, the term “senile dementia” came about to depict the pathology of many entities all grouped together.

Alois Alzheimer, a pioneer of modern medicine. Photo Credit: Archive for History of Psychiatry, Department of Psychiatry University of Munich
Alois Alzheimer, a pioneer of modern medicine. Photo Credit: Archive for History of Psychiatry, Department of Psychiatry University of Munich

Asylum patient aided in deciphering brain disease


Born in Bavaria, Germany in 1864, Dr Alzheimer attended the Royal Humanistic Gymnasium and studied medicine in Berlin under the famed anatomist Heinrich Wilhelm Gottfried von Waldeyer, Tübingen and Würzburg.

In 1888, he worked as a clinical assistant for 14 years at the Municipal Asylum for the Insane and Epileptics (Städtischen Anstalt für Irre und Epileptische) in Frankfurt. Working with other scientists, he used the deceased psychiatric patients there to develop the skill of preparing and staining microscopic specimens of brain and nervous tissue.

The key to understanding the anatomical mystery of Alzheimer’s disease came in the form of Auguste Deter. She was a patient who came to Alois’ attention on 26 Nov 1901 – merely a day after her admission to the asylum. Dr Alzheimer found her with a helpless – if not confused – look on her face while sitting on the bed in her room and continued to study her comprehensively.

Her husband reported that she was happily married for over 28 years, but she started developing changes in her personality when she was 51 years old. These behavioural modifications were expressed as progressive memory loss, jealously towards her husband, paranoia, shouting spells, a fear of being murdered and suicidal ideations.

Dr Alzheimer ended up leaving the asylum and went to work at the Royal Psychiatric Clinic at the University of Munich. He supervised the famous Anatomical Laboratory founded by Dr Emil Kraepelin, the father of scientific psychiatry and an advocate of associating psychiatry with the emerging science of neuropathology. Dr Alzheimer continued to monitor Deter’s disastrous progress from a distance. Her health deteriorated at an accelerated pace during her admission. Soon, she was unable to speak and spent most of her last months in bed depressed and in a foetal position.

After five years in the asylum, she succumbed to severe sepsis in 1906. It was believed to have been secondary to a bedsore extending from her sacral spine to the left hip. 

The Anatomical Laboratory in University of Munich was where Alzheimer conducted his brain disease research. Photo credit: Archive for History of Psychiatry, Department of Psychiatry University of Munich
The Anatomical Laboratory in University of Munich was where Alzheimer conducted his brain disease research. Photo credit: Archive for History of Psychiatry, Department of Psychiatry University of Munich

Brain tissue studies and a failed presentation


After Deter’s death, he asked his peers in Frankfurt to send over her brain. Upon studying the slides of her brain tissue, Dr Alzheimer described the classic pathological features of the disease that were a massive loss of neurons and the presence of amyloid plaques and neurofibrillary tangles.

On 3 November 1906, Dr Alzheimer presented his findings on “A peculiar severe disease process of the cerebral cortex” in a meeting of the Southwest German Psychiatrists, in Tübingen. Silence followed, and the scientists in the audience showed a greater interest during the next presentation on compulsive masturbation.

The chairman on that day was quoted saying, “So then, respected colleague Alzheimer, I thank you for your remarks, clearly there is no desire for discussion.”

Honoured after death


Under Dr Kraepelin’s wing, Dr Alzheimer slogged in obscurity, and published three more cases in 1909 and a “plaque-only” variant in 1911. In 1910, Dr Kraepelin credited him by naming the brain condition “Alzheimer's Disease” in his book Psychiatrie. Sadly, Dr Alzheimer died on 19 December 1915 from bacterial endocarditis. He was 51.

Dr Alzheimer never thought that his encounter with Deter would affect the lives of millions and pave the way for international research efforts.

He was known not just for his groundbreaking characterisation of a major brain disease but also as a role model. By forming a close clinical relationship with his patients and utilising new tools to link symptoms to physical brain changes, he set the bar for neurodegenerative disorders research, advancing it to what it is today. MIMS

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Sources:
http://www.pbs.org/newshour/updates/dr-alzheimer-patient-helped-reveal-devastating-disease/
http://www.alz.org/research/science/major_milestones_in_alzheimers.asp
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181715/