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Ao e se utilizar este breve artigo como referência, não esquecer do crédito a autora Dejanira Alexandrino. Muito obrigada!
Dejanira Alexandrino
Instructor Yvan Prkachin
HSCI- 176 - Mind and Brain: Themes in the History of Neuroscience
Harvard Summer School 2019
An Analysis of the first documented report on Alzheimer’s Disease in 1906
My objective is to review the findings reported on the first patient named Auguste D. who was diagnosed with Alzheimer’s disease, compare those findings with his second patient, who also suffered with same neurodegenerative disorder. In addition, a brief biography of Dr. Alois Alzheimer and my impressions to his approach considering the historic era and technological advances in Germany during early twenteenth century. Furthermore, I would like to explore these articles not only as student but also as a caregiver of a loved one affected by this disease.
Dr. Alois Alzheimer was born in 1864 into a traditional Catholic family, in a small village in Germany. He had a a solid support system, which giving him a good foundation to perform well in school. He has started his training in Wurzburg (1883-1885), interested in anatomy and working with microscopes. No training in psychiatry.
After his graduation, “German families had an unusual approach to the care of a mentally ill relative: they engaged the young doctor to travel with a patient” ( Hippus and Neundörfer, 2003, p.102). It was not clear in the article where they traveled to, if there were stops in private clinics outside Germany, no description of treatments provided, or visitation to patient’s relatives living in remote areas of the country.
The article suggested this close observation has influenced the young doctor to become a psychiatrist. It reminded me of how many Neurologists in the past, like Dr. Hughlings-Jackson who observed his wife epileptic seizures and had become a devoted researcher, his close and daily observations lead to better understanding of seizure patterns, contributing to reliable documentation, and consequently, it open the doors to innovations for treatments. When a professional also live personally with those conditions, there is a sense of compassion and empathy when combined with medical knwoledge, passion for investigation, and great technique; all those aspects, may unleash an unstoppable and motivated professional.
Alzheimer M.D., first applied to work at Frankfurt am Main in 1888 and was accepted by medical director Dr. Sioli. After working together for 15 years, Dr. Alzheimer was described as a great neuropathologist and clinical psychiatrist.
Professionally, he built a long-lasting relationship with Nissl ( 1860-1919) a neuropathologist in Munich, known for now called Nissl bodies that is found in dendrites and in the nerve cell bodies. Nissl along with Alzheimer “made a detailed study of dementia paralytica, paying special attention to rod cells” (Sons, 2008).
Another important supportive figure in his career was Emil Kraepelin ( 1856-1926 ) creator of nosology and one of the most important figures in the history of modern scentific psychiatry. In 1903, he joined Kraepelin research team in Heidelberg. His peers described Alzheimer as meticulous, perfectionist, perhaps a better researcher than a clinician. One of his main contributions was “the histology of general paralysis of the insane” (Berrios, 1990, p.356).
During late nineteenth and early tweenteenth century, Germany experienced prosperity. The nation benefited from pharmacology innovations, electricity, development of neurohistological techniques, including electron microscopy. The medical society carried themselves with a sense of pride. Also, influenced by many advancements of science around the world such as Rokinstanky (Vienna, 1878) ideas from the 19th century were seriously considered, he’d state that all diseases should to pathology after dying, marking the origin of authopsy and also benefits from the neuron doctrine (Ramon y Cajal circa 1894).
In 1901, at Frankfurt am Main asylum, a patient named Auguste Deter was brought to the asylum by her husband. She had been presenting delusional jealousy, worsening amnesia, rapid loss of memory, apraxia, and psychosocial imcompetence, disorientation, and hallucinations. Dr. Alzheimer had become interested in the patient’s case from the time of her admission. During physical examination her patellar reflexes and pupils were normal. “The 51-year-old patient Alzheimer described had a progressive presenile dementia with a general cortical atrophy” (Stelzmann et al., 195, p.430). In Frankfurt am Main asylum, Auguste D. was a first patient diagnosed with Alzheimer’s in 1906.
She died from septicemia after living for four an half year with symptoms. “The autopsy findings revealed senile plaques, neuronal loss, neurofibrillary tangles, and arteriosclerotic changes” ( Stelzmann et al., 195, p.430).
In 1906, he has been informed of the death of Augustine D. by Dr.Sioli. “An autopsy has been arranged and he gave Dr. Alzheimer her brain material for investigation” ( Hippius and Neundörfer, 2006, p.106).
In the 1900s, dementia was not necessarily associated with an old age but described as any psychological decline associated with chronic brain disease ( Berrios, p.357).
Her case was reported formally by Alzheimer in 1906 at the Tübingen meeting at South West German Psychiatrists. The case was published in 1907 and Kraepelin named a new disease after Alzheimer without much scientific evidence. It was not clear why Kraepelin decided to create a new disease, the article suggests, perhaps as a social phenomenon or as a way for him to obtain his laboratory expansion in Munich.
Dr. Alzheimer’s lecture was slightly ignored due to personal disputes of the chairman Dr. Hoche (1906) with Kraepelin. It’s quite shameful personal differences affect the progress of science. Unfortunately, despite expected rationality , the academics of science were not immune to egocentrism, vanity, and pride.
After his lecture, alinenists were skeptical of his findings “the mirage caused by an anachronistic reading was only dispelled by exploring the history of many terms and issues the played supporting cast to Alzheimer’s disease: these include dementia, ageing, neuronal theory, methods of visualizing brain tissue, academic psychiatry, departmental rivalries, senile psychosis, and cerebral arteriosclerosis”. ( Berrios, 1990, p.355).
The existence of neurofibrils in the cortical cells of senile dementia patient was known for years (Berrios, 1990, p.359). The question, maybe, was the novelty in Alzheimer’s description was that dementia of the senile type could also occur in a young person.
First twelve documented cases of Alzheimer’s diseases show it affected more women than men up to 1912.
Johann F. was Alzheimer’s second patient who died after three years of illness. The case has been documented in 1911 and his post mortem brain findings “reveal plaques but no neurofibrils” (Kluneman et al., 2002, p.520).
In 1995 the material of both cases ( Auguste D. and Johann F.) was reinvestigated and “the conclusion was that plaque-only cases and cases with plaques and neurofibrillary tangles are just different stages in the development of the same diseases process” ( Hippius and Neundörfer, 2006, p.106).
There was not much focus on treatment or innovations in therapy discussed or utilized on those patients. It’s known they were institutionalized and mentally impaired patients during this period were treated with more humanity.
As a critical reader, one may wonder the real motivations behind certain studies. For instance, by reading his personal notes and witnessing his rapid career advancements. Is Dr. Alzheimer only trying to consolidate his talent for anatomy and prove if staining techniques really work? Apparently, providing innovations for treatment or improving the quality of life of his patients did not seem a priority. One have to take in consideration he had ambitions on becoming a director of a Psychiatric Hospital. He has written numerous papers and was quite frustrated when he couldn’t dedicate himself entirely to research.
Considering his personal life, Dr. Alzheimer got married to a wealthy woman in Frankfurt. She died in 1901, but he remained financially stabled and even work on his research without pay.
Followed by the death of his wife, he has become a single father, however, he could count on a good family support so he was able to give continuity to his professional life with increased commitment. One can also assume that it was his way of dealing with grief. Anytime, you lose someone dear to your heart, you are confronted by your own mortality and filled with a sense of urgency. Death itself has a humbling power which apparently contributed to his empathy and sense of social responsability to patients.
In 1912, his dream came true by being appointed to University of Breslau psychiatry chair. Unfortunately, it was short lived. He died of a heart failure at age 51, before drawing important conclusions from many of his research.
If in 2019, dementia is still a puzzle, I can only imagine the impact of such diagnosis on family members and medical personnel in the beginning of the twentheeth century when answers and support were scarce.
As a doctor, I am positive Dr. Alzheimer had tried to stay one step ahead of this disease throughout his observations. Certainly, Dr. Alzheimer was “ahead of his time in his interest in this phenomenon and his power of observation and deduction have not been disproved over time” (Stelzman et at., 1995, p.430).
On a personal level, as a caregiver of a loved one who used to be a brilliant Aerospace Engineer, I keep hopeful that neuroscientists reach breakthroughs in Alzheimer’s research and we may be able to envision a possible date with a cure.
References
Berrios, G.E. Alzheimeir’s Disease: A Conceptual History. 1990. International Journal of Geriatric Psychiatry. 5: 355-365.
Hippius and Neundörfer. The discover of Alzheimer’s disease. 2003. Dialogues in Clinical Neuroscience. 5 (1), 101-108.
Klünemann, Hans H. et al. Alzheimer’s second patient: Johann F. and his family. 2002. Annals of Neurology. 52 (4), 520-523.
Sons, C.S. Nissl, Franz. Complete Dictionary of Scientific Biography. 2008. Retrieved from https://www.encyclopedia.com/science/dictionaries-thesauruses-pictures-and-press-releases/nissl-franz.
Stelzmann et al. An english translation of Alzheimer’s 1907 Paper “Uber eine eigenartige Erkankung der Hirninride”. 1995. Clinical Anatomy University of Florida. 8:429-431.
