History of Alzheimer’s: Major Milestones

 December 30, 2013

 Alzheimer's Statistics
 Alissa Sauer
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There is admittedly a lot we don’t know about Alzheimer’s. 100 years after its
discovery, we still don’t know exactly what causes this neurodegenerative disease and
we do not have a cure. However, it is important not to lose sight of how far we have
come since Dr. Alois Alzheimer noted the unique symptoms in 1906.

1906: Alzheimer’s Disease is first described by Dr. Alois Alzheimer in his patient
known only as Auguste D. The patient experienced memory loss, paranoia, and
psychological changes. Dr. Alzheimer noted in the autopsy that there was shrinkage
in and around nerve cells in her brain.
1931: The electron microscope is invented by Max Knoll and Ernst Ruska, allowing
magnification up to 1 million times. This invention allowed scientists to study brain
cells with greater detail.
1968: Cognitive measurement scales are created which allows researchers to
measure impairment and estimate the volume of damaged brain tissue.
1974: Congress establishes the National Institute on Aging (NIA). To this day, the
NIA supports Alzheimer’s research.
1983: November of 1983 was declared the first National Alzheimer’s Disease Month
indicating a greater awareness of the disease.
1984: The NIA begins to fund Alzheimer’s Disease Centers and establishes a
nationwide network for Alzheimer’s research.
1993: The Food & Drug Administration (FDA) approves the first Alzheimer’s drug,
Cognex. The drug targets memory loss and dementia symptoms. Today, there are a
total of five drugs approved to treat Alzheimer’s.
1994: Former President of the United States Ronald Reagan announces that he has
been diagnosed with Alzheimer’s Disease. This leads to greater awareness about the
disease.
2003: The NIA begins a National Alzheimer’s Disease Genetic Study to hopefully
identify risk genes for the disease.
2010: Alzheimer’s becomes the sixth leading cause of death in the United States.
2011: President Barack Obama signs the National Alzheimer’s Project Act which
provides a national framework to support and fund Alzheimer’s research.
2013: The G8 Dementia Summit in the United Kingdom launches an international
effort to fight Alzheimer’s and find a cure by 2025.
We still have a lot of work ahead of us in the fight against Alzheimer’s. It’s important
to reflect on the past 100 years as we look ahead to the next 100 years and continue
to fund and support research initiatives.
Alzheimer’s Disease — A Brief History & Description

Alois Alzheimer and Auguste Deter

The brain disease that has come to be known as Alzheimer’s disease was first described in November of
1901. The chain of events began when Karl Deter brought his wife, Auguste, to the Städtische Heilanstalt
für Irre und Epileptische (City Hospital for the Mentally Ill and Epileptics) in Frankfurt, Germany.
 Auguste Deter – taken in 1906 shortly before her death, during her stay at Frankfurt’s City Mental Institution.
Auguste’s behavior made it almost impossible for Karl to work anymore. She would sometimes wake up
in the night and scream for hours. Knowing what we know now of Alzheimer’s disease, she undoubtedly
needed a lot of personal care.

Upon her admission, she was interviewed by a resident at the hospital, a young doctor named Aloysius
Alzheimer. He had joined the staff at the hospital thirteen years earlier and was pursuing his interests in
psychiatry and neuropathology. Auguste Deter had problems with memory and with reading and writing,
and she showed signs of disorientation. She was diagnosed with presenile dementia.

In that initial interview, Dr. Alzheimer asked questions very similar to those that would be asked by a
doctor today who was screening for the disease that was named for him. The patient file for A. Deter
survives today. In it, a note written by the doctor on November 26, 1901 includes this paragraph:

She sits on the bed with a helpless expression. What is your name? Auguste. What is your husband’s name?
Auguste. Your husband? Ah, my husband. She looks as if she didn’t understand the question. Are you married? To
Auguste. Mrs D? Yes, yes, Auguste D. How long have you been here? She seems to be trying to remember. Three
weeks. What is this? I show her a pencil. A pen. A purse, key, diary and cigar are identified correctly. At lunch she
eats cauliflower and pork. Asked what she is eating she answers spinach. When she was chewing meat and asked
what she was doing, she answered potatoes and horseradish. When objects are shown to her, she does not remember
after a short time which objects have been shown. in between she always speaks about twins. When she is asked to
write, she holds the book in such a way that one has the impression that she has a loss in the right visual field. Asked
to write Auguste D., she tries to write Mrs and forgets the rest. It is necessary to repeat every word. Amnestic
writing disorder. In the evening her spontaneous speech is full of paraphasic derailments and perseverations.

During her stay, Deter’s condition worsened. She experienced cognitive decline and hallucinations, and
eventually lost almost all cognitive ability. When she died on April 8, 1906, Alois Alzheimer was working at
Royal Psychiatric Clinic in Munich with Emil Kraepelin. Upon learning of her death, Alzheimer requested
that her records and her brain be sent to him in Munich. Auguste Deter was 55 years old when she died.
Alzheimer’s Discovery

Aloysius Alzheimer
Later in 1906, Alois Alzheimer presented the results of the autopsy of Frau Deter’s brain to the South-
West German Society of Alienists. In his speech he described two abnormalities or the patient’s brain,
neurofibrillary tangles and amyloid plaques, the plaques and tangles that have become synonymous with
Alzheimer’s disease.

The tangles are insoluble aggregates of tau protein. Plaques (known as senile plaques) are deposits of
another protein, amyloids. It is still not completely clear what role these two proteins play in the
development and progression of Alzheimer’s disease; it is commonly agreed that there is an association,
since these plaques and tangles are present in all cases of the condition.

Also characteristic of the disease that was named after Alois Alzheimer is the loss (atrophy) of brain
mass. Specifically associated with AD, and probably somehow linked to the plaques and tangles, is the
eventual degeneration of these critical areas of the brain:
Brain Functions

A representation of a normal brain on the left, and one affected by Alzheimer’s disease on the right.Read more about the
Alzheimer’s brain.
 Temporal lobe – speech, memory, hearing.
 Parietal lobe – sensory integration, spatial sense, navigation.
 Frontal cortex – involved with, among other things, problem solving, memory, language, judgment, is
thought to be the center for our personality. Damage to areas in the frontal cortex often leads to personality
changes.
 Hippocampus – short term memory, spatial navigation.
 Cingulate gyrus – emotion formation, memory, learning.
The correlations between these brain functions and the common symptoms of Alzheimer’s disease are
obvious. Read more about the Alzheimer’s brain.
Some Common Symptoms of Alzheimer’s Disease

It has been reported that the first sign that something was not right with Auguste Deter was an
unwarranted jealousy directed at her husband. Delusional thinking, like Auguste’s doubt of her husband’s
fidelity, is a common manifestation in most types of dementia. Other symptoms that led to her
incarceration at the City Hospital in Frankfurt included:

 Memory impairment that worsened quickly

 Loud screaming and shrieking with no obvious reason
 Trouble reading and writing
 Disorientation and confusion, even in the familiar setting of her own home
 Seemed to fixate on and hide various objects
 She could identify objects, but quickly lost the memory of having seen them
 Declining comprehension – she didn’t understand simple questions asked of her
She eventually lost the ability as well as the incentive to care for herself. Her husband was forced to
hospitalize her. In the next 4½ years hallucinations were added to this list, and the original symptoms
grew more severe until she lost almost all cognitive ability.

More Symptoms of Alzheimer’s Disease

The Alzheimer’s symptoms that people hear about most frequently and are most familiar with are memory
loss and getting lost. The jokes about memory loss and aging, somewhat less popular now than they
were a few years ago, have helped bring our attention to the problem of memory loss. Wandering, and
becoming confused and lost, have become familiar symptoms because of the news stories and alerts that
we hear all too often.

 Misplacing items – Often the patient hides important (to him) things, then forgets that he hid them.
  Language difficulties – He might have trouble finding the right words, particularly proper names and
nouns, and will often use words that sound the same, or even make up words in place of the word lost from
his repertoire. He may have trouble completing sentences, perhaps forgetting how the sentence started
before he has a chance to finish it.
 Conversations become irrelevant – He will say things that seem totally unrelated to the conversation at
hand, or provide answers that seem to have nothing to do with a question asked. He may become less willing
to participate in conversations, perhaps aware of his difficulty, and wanting to avoid embarrassment.
 Simple tasks become difficult or impossible – Even things that he has been doing for years. Arithmetical
and mathematical procedures can get especially confusing, making familiar activities, like reconciling the
checkbook, not only difficult, but aggravating.
 Temporal confusion – He may lose awareness or conception of the time, the day, or even the season. He
might wake up in the middle of the night, and call someone thinking it is the middle of the day. He might
puton his winter coat to go out in the summer, or shorts on a frigid day in January.
 Sleep disorders – The brain controls the rhythms that influence our wake-sleep cycle. The neurological
damage of Alzheimer’s disease can disrupt these rhythms resulting in sleep problems. Light Therapy is an
effective treatment in many cases of Alzheimer’s related sleep disorders.
 Physical impairment – Muscular movement becomes slow and unsteady, balance is impaired, and walking
becomes difficult. As these conditions worsen, safety can become an important issue. Complications from
broken bones from falls and other accidents rank fairly high in actual cause-of-death in Alzheimer’s deaths.
 Agitation, depression, anger – These are very common behaviors in Alzheimer’s, and can at times be the
most difficult to deal with.

If she were alive today with the same symptoms, Auguste Deter would be diagnosed with early-onset
Alzheimer’s disease. This form of the disease accounts for less than 10% of all cases of the disease.
Whereas Alzheimer’s disease, almost by definition, is often first noticed at about the age of 65, early-
onset or younger-onset AD of the non-Familial type strikes people in their 50’s or early 60’s.

About half of all early-onset Alzheimer’s is Familial Alzheimer’s disease. Making up less than 5% of all
Alzheimer’s is of the Familial Alzheimer’s type, it is distinguished from other forms of the disease because
of a genetic factor. Familial AD often appears in much younger people, sometimes as early as the age of
16, and requires that at least two first-degree relatives (parent, sibling, or offspring) be diagnosed with
AD.

Because of its genetic connection, many researchers are concentrating on this particular form of the
disease in their search for causes and cures. This avenue of investigation perhaps holds the most
promise in the quest for a cure for this terrible disease.

Everyone, every family, every situation involving Alzheimer’s disease is unique. The list of symptoms is by
no means complete, and not everyone with Alzheimer’s will manifest all of the symptoms in the list.
Everyone with the disease progresses through it at a different rate and in a different way.

Also, if you recognize any of these symptoms in yourself do not assume that you are in the early stages
of the disease. We all misplace things occasionally, forget names or what we had for dinner last night, or
stumble over our own feet once in a while. Some of the symptoms, like forgetfulness, are normal
conditions of the aging process. Normally, things forgotten are later remembered. Memories lost to
Alzheimer’s disease are very often lost forever.
If you would like to see anything added to this list of symptoms or to the behaviors, please contact us with

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