German physician Alois Alzheimer (1864–1915) was the first medical professional to identify an unusually early onset form of dementia. In 1906, after tracking the sad decline of an otherwise healthy patient in her fifties, Alzheimer conducted an autopsy and discovered unusual protein deposits in the woman's brain tissue.
Alzheimer's full name, Aloysius, is a popular variant of Louis or Ludwig in the southern German state of Bavaria, where he was born on June 14, 1864. Alzheimer's family was originally from Marktbreit, where his father Eduard had been the local notary public. They later moved nearer to Aschaffenburg, a large Bavarian city that boasted the prestigious Royal Humanistic Gymnasium, founded in 1620. In 1883, Alzheimer set off for Berlin, the capital of imperial Germany, to begin medical school at the city's university. After one term at the University of Berlin, he transferred to the University of Würzburg, where his brother Karl was already a student. He completed his 1887 graduate thesis on cerumen, or earwax, and was licensed to practice medicine a year later.
In the first decade of his career, Alzheimer became intrigued by dementia, a not-uncommon condition in elderly patients but one whose root physiological cause remained invisible to medical diagnostic tools of the era. In 1898 he submitted a research paper positing that atherosclerosis, or hardening of the arteries, was the culprit, and this paper was published in an issue of Monatsschrifte für Psychiatrie (Monthly Journal of Psychiatry).
Alzheimer found another important mentor in Dr. Emil Kraepelin, a prominent psychiatrist and early proponent of the theory that some mental illnesses have a biological component. Kraepelin's research and writings during his time at the nearby University of Heidelberg marked an important shift in the treatment of mood disorders, which he argued were separate from symptoms of psychosis and dementia. Like Hoffmann, Kraepelin advocated for a humane treatment of those suffering from such psychiatric disorders. He invited Alzheimer to come to Heidelberg and conduct a research project in the mid-1890s under his supervision. When Kraepelin was offered a teaching post at the University of Munich in 1903, it came with the directorship of the Royal Psychiatric Hospital, and Kraepelin arranged for Alzheimer's appointment to a research post at the hospital's anatomical laboratory.
Alzheimer retained ties to the Irrenschloss when he relocated to Munich because of a particular patient there, a woman admitted in 1901, at the age of 51, after exhibiting signs of unusual behavior and short-term memory loss. Auguste Deter had exhibited no signs of problematic behavior or distress previously; now, after 28 years of marriage, she began to suspect her husband was having an affair with a neighbor. The fact that she stopped doing housework was easily covered up by her husband and daughter, but her bizarre outbursts toward neighbors prompted concern and she was taken for a physical examination. The family doctor recommended commitment, and Auguste came to the Irrenschloss in November of 1901.
Alzheimer's first interview with Frau Deter occurred on the day after she was admitted. When asked her name, she replied “Auguste,” but when he asked her surname she also replied “Auguste.” He asked if she knew the name of her husband, to which her answer was “Auguste.” Alzheimer removed a cigar, key, and a pencil from his coat pocket and she was able to identify each one of them by their correct name. Over the next several weeks, he repeated the interview assessment process, taking careful notes. Frau Deter struggled with short-term memory and exhibited signs of confusion, but she could still write words and correctly calculate basic math sums. Alzheimer was struck by the fact she could state her name aloud but was unable to write it. Frau Deter's famous self-assessment would become one of the most haunting catchphrases of the disease her physician diagnosed after her death: “I have, so to speak, lost myself,” she told him on November 29, 1901, according to Konrad and Ulrike Maurers's Alz-heimer: The Life of a Physician and the Career of a Disease.
Although she was an otherwise healthy middle-aged woman, Frau Deter's condition deteriorated sharply over the next several months. Recording his last meeting with her, in June of 1902, Alzheimer reported that she “continues to be hostile, screams, and lashes out when one wants to examine her.” Frau Deter “also screams spontaneously, often for hours, so that she has to be kept in bed,” he wrote, according to the Maurers.
In the anatomical laboratory of the Royal Psychiatric Hospital in Munich, Alzheimer carried out his important examination of the late Frau Deter's brain. Working with two visiting Italian scientists, Drs. Gaetano Perusini and Francesco Bonfiglio, he observed large sections that seemed to be atrophied and others that were clogged with fibrils, dark and fibrous tangles. On the cerebral cortex were gumlike deposits. By using a recently developed silver stain, Alzheimer was able to identify a protein, tau, in both the fibrils and the deposits of plaque. Other neurologists had seen evidence of similar brain decay in other postmortem exams, but these were much older patients who had not been diagnosed with presenile dementia. In contrast to patients in their 70s and 80s, Auguste Deter had been 55 at the time of her death. Alzheimer also looked at previous brain tissue samples of dementia and affirmed that she had endured a much more extensive neuron death and damage than previously seen.
Alzheimer was firmly convinced that he had discovered a disease not previously known to his scientifically advanced medical community in Germany. He wrote a research paper and presented it at the 37th annual conference of an organization of psychiatrists licensed to practice in southwest Germany. The meeting was held in the university city of Tübingen on November 3, 1906. His paper, “Concerning a Unique Disease of the Cerebral Cortex,” failed to excite the 90-plus conference attendees, and it was barely mentioned in the official proceedings of the event. His lecture first appeared in print in 1907 in the professional journal Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtliche Medizin and was later reprinted in Alzheimer: 100 Years and Beyond. “On the whole, it is evident that we are dealing with a peculiar, little-known disease process,” he stated. “In recent years these particular disease processes have been detected in greater numbers. This fact should stimulate us to further study and analysis of this particular disease. We must not be satisfied to force it into the existing group of well-known disease patterns. It is clear that there exist many more mental diseases than our textbooks indicate.”
It was Kraepelin who first dubbed the incurable condition Alzheimer's disease in the eighth edition of his Lehrbuch der Psychiatrie (Handbook of Psychiatry). Released in 1910, this new edition of Kraepelin's widely read work included Alzheimer's discovery in a section on senile and presenile dementia. Alzheimer's research findings first appeared in English translation in 1912, and he continued to carry out research gleaned from other postmortem braintissue samples at his lab in Munich.
The interest in Alzheimer's discovery led to his hiring as an assistant professor at the University of Munich. A year later, in 1910, he cofounded the journal Zeitschrift für die gesamte Neurologie und Psychiatrie, which in 1911 published a more extensive study of patients suffering from this unusual form of presenile dementia. In July of 1912, he accepted a post at the University of Breslau (now Wrocław, Poland), as chair of its department of psychiatry and director of the affiliated Neurological and Psychiatric Clinic. While traveling to Breslau a month later, he fell ill aboard a train, and his health never recovered. Likely contracting an infection, he succumbed to rheumatic fever and eventually organ failure. Bedridden in October of 1915, Alzheimer died of heart failure two months later, on December 19, 1915, aged 51. His wife Cecille Simonette Geisenheimer, whom he married in 1884, predeceased him.
Descendants of the Alzheimers’ children, Gertrud, Hans, and Maria, eventually established a museum in Alzheimer's birthplace of Marktbreit. Remarkably, the original tissue samples and case file on Frau Deter survived two world wars and were discovered in Munich and Frankfurt archives in the 1990s. Alzheimer's careful note-taking, along with the outpouring of eulogy tributes from colleagues, reveal the compassion and dedication he showed during a career foreshortened by overwork. “Alzheimer's name is associated with one of the cruelest diseases and the mere mention of his name conjures up associations of inexorable mental decline,” wrote Ralf Dahm in an essay published in Alzheimer: 100 Years and Beyond. “However, it was his genuine interest in the troubles of his patients and his realization of the pathological basis of the disease named after him that paved the way to a better understanding of the pathological process that might ultimately lead to ways of treating or preventing it.”
Ingram, Jay, The End of Memory: A Natural History of Aging and Alzheimer's, Thomas Dunne Books/St. Martin's Press, 2014.
Junker, Mathias, and others, editors, Alzheimer: 100 Years and Beyond, Springer Science & Business Media, 2006.
Maurer, Konrad, and Ulrike Maurer, Alzheimer: The Life of a Physician and the Career of a Disease, translated by Neil Levi with Alastair Burns, Columbia University Press, 2003.
American Scientist, March-April 2010, p. 148.
Dementia, November 2006, p. 571.❑