Alois Alzheimer
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| Alois Alzheimer |
Alzheimer's disease is a neurodegenerative disorder. It is characterized
clinically by a progressive decline of several cognitive functions and it is
the most common cause of dementia. The prevalence of this disease is expected
to increase during the next decades because of the increasing of the human age
population. It is one of the greatest burdens in modern medicine. Emil
Kraepelin, a German psychiatrist, first described the symptoms of Alzheimer’s
disease in the early 1900s. Alois Alzheimer, another German psychiatrist, who
worked in Kraepelin’s laboratory, later described the neuropathological
features. The description of this disease is his most known contribution to
Neuroscience. However, the research on this disease represents only a small
part of Alzheimer's interests, which also included the histopathology of the
cerebral cortex in the mentally ill. Who is Alois Alzheimer and what were the
main stages of his carrier? Alois Alzheimer was born on the 14th of June 1864
in Markbreit a small Bavarian village, Southern Germany where his father was
notary. Excelling in science at school, he studied medicine in Berlin, Tubingen
and Wurzburg where he wrote his doctoral theses on ceruminal glands and
graduated with a medical degree in 1887. In December 1888, he began his medical
career as a resident at the Hospital for the Mentally ill and Epileptics in
Frankfurt am Main where he stayed for seven years and was subsequently promoted
to senior physician. Later Alzheimer worked seven more years as an assistant
physician at the Municipal Hospital for Lunatics and Epileptics also called
Asylium in Frankfurt headed by Emil Sioli. Here he made his education in
psychiatry and devoted himself to his main interest, neuropathology. He became
interested in research of the human brain cortex. He found himself in a unique
position and was able to contribute to the development of a modern clinical
service and to create a scientific patient database. He set up an archive of
autopsy cases which would prove to be useful to him during his career. One year
after Alzheimer started to work in the Asylium, the neurologist Franz Nissl
joined the team. Nissl was known for his revoutionary “Nissl staining” method
for nerve cells which is still used in routine and experimental neurohistology
laboratories around the world. A close friendship arose between the two
scientists, working with the patient during the day and spending evenings
discussing findings over the microscope. They worked together on an extensive
investigation of the pathology of the nervous system. They studied more
particularly the normal and pathological anatomy of the cerebral cortex and
presented their result in a major six volume work entitled “Histologic and
Histopathologic Studies of the Cerebral Cortex” published between 1906 and
1918. Alzheimer’s efforts were
more concentrated on the patient material while Nissl worked on
experimental studies of the reaction of nerve cells after sectioning
axons.Nissl's strong influence on his work was acknowledged by Alzheimer in the
following beautiful manner: “I shall mention Nissl's name as often as
scientific works by him on the topic under discussion are known to me. However,
Nissl's share in these studies does not end with that. The amicable scientific
interactions which I was allowed to entertain with him over the last 15 years
have given me so much stimulation that I must concede – to give but one example
– that none of the following ideas that might enhance our knowledge has been
conceived without his direct or indirect participation.” Alzheimer was known
for his great capacity of description of his microscopical observation. In
April 1894, Alzheimer married a banker’s widow Ceacilia Geiseinheimer and they
had three children. This marriage made him financially independent so he became
able to support his own research. Ceacilia died in 1901 after seven years of
marriage.
more concentrated on the
patient material while Nissl worked on experimental studies of the reaction of
nerve cells after sectioning axons.Nissl's strong influence on his work was
acknowledged by Alzheimer in the following beautiful manner: “I shall mention
Nissl's name as often as scientific works by him on the topic under discussion
are known to me. However, Nissl's share in these studies does not end with
that. The amicable scientific interactions which I was allowed to entertain
with him over the last 15 years have given me so much stimulation that I must
concede – to give but one example – that none of the following ideas that might
enhance our knowledge has been conceived without his direct or indirect
participation.” Alzheimer was known for his great capacity of description of
his microscopical observation. In April 1894, Alzheimer married a banker’s
widow Ceacilia Geiseinheimer and they had three children. This marriage made
him financially independent so he became able to support his own research.
Ceacilia died in 1901 after seven years of marriage. In 1895 Nissl moved to
Heidelberg to work with the most important german psychiatrist of that time
Emil Kraepelin. Later, he succeeded him as director of the clinic there. The
same year Alzheimer became the director of the Asylium in Frankfurt. His
studies included a wide range of subjects such as clinical studies of manic depression
and schizophrenia. During his stay in Frankfurt, Alzheimer met a 51 years old
woman, Auguste Deter who had been admitted in 1901. She was suffering of
disorientation, impared memory and troubles in reading and writing. The
symptoms increased to hallucinations and to loss of higher mental functions.
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| Auguste Deter |
Deter died in 1906 four years after Alzheimer had left Frankfurt, but her brain
and all the records he had made were sent to him to Munich. This woman is known
as the first descripted case of Alzheimer’s disease.In 1902 Kraepelin invited
Alzheimer to work with him in Heidelberg. One year later, they moved together
to the university psychiatric clinic in Munich where his life as a scientist
reached its peak. In 1904 he published his habilitation Auguste Deter
thesis on the
histopathology of the general paralysis of the insane based on 170 clinically
typical cases. Alzheimer showed how the histological diagnosis can be used to
answer clinical questions. Importantly, in this study Alzheimer noticed that
the degenerative process that underlies this illness takes place independently
from the inflammatory reactions. However, the exact nature of the disease
process has remained enigmatic. Very little of Alzheimer's teachings had to be
revised and, though 100 years old today, they have not been corrected or
amended but only confirmed. At a meeting of the South-West German Society of
Alienists in November 1906 in Tubingen, Alzheimer described “a peculiar disease
of the cerebral cortex”, the clinical and neuropathological features of August
Deter. The pathological and anatomical investigation for the brain showed a
thinner cerebral cortex usually seen in elderly people. He noted two further
abnormalities in the brain: neurofibrillary tangles which represent changes in
the cytoskeleton of nerve cells which are often associated with cell death, and
amyloid plaques which are extracellular deposits of a neurotoxic substance. In
his presentation, Alzheimer made the assentation that her dementia was related
to lesions in her brain. The speech was published the following year. The
importance of this case lies in the fact that it marks the beginning of
Alzheimer disease research. Today the neurofibrillary tangles first described
in her brain represent an important topic of neuroscience research. Alzheimer’s
second case was a demented 56 years old man, Johann F. who was admitted to the
university psychiatric clinic on September 12 1907. He died three years later.
The autopsy of his brain showed changes similar to those of the first patient.
E. Kraepelin proposed that the syndrome should be called “Alzheimer’s disease”.
In 1908, Alzheimer joined the staff of the Psychiatric Institute as associate
professor and became the director of the clinic’s anatomical laboratory.
He
trained students from various countries. Alzheimer spent ample time with each
one of them explaining things. Those who attended have described it as an
unforgettable sight when Alzheimer with his large head bowed over the
microscope with the pince nez dangling in a string around his neck, always with
a cigar, which would be put down as he commenced his explanations. It is said
that at the end of the day there would always be a cigar stump at every
student's bench by the microscope, marking his tour in the laboratory.
Alzheimer’slaboratory
lzheimer's research was
characterized by a close interaction between the anatomical observation and the
clinical experience. Difficulties simulated him to find new ways to explore the
cases he was working on. He was meticulous and he never published before he was
totally sure of his results and that he had something truly important to say.
He was able to present his research work very clearly and to convience the
scientists about the importance of his result and it seems that he never had to
fight for the recognition for his work. His colleagues had a high esteem for
his work and also for his personality. Robert Gaupp, then head of psychiatry at
Tübingen wrote: “Alzheimer was a man with a clear head and unusual creative
powers who took greatest pains over his work and had a strong sense for
scientific truth. The right training provided, this combination of talents had
to result in outstanding achievements in the field of science. This was
complemented by his warmhearted interest in the fellow man, his mentality of a true
physician, and the great enjoyment from combining science and medical practice.
Although he mainly worked in a small, infinitely difficult specialist field, he
always made sure that his research could not endanger the clinician and
physician in him”. Through his early histopathological research in psychiatry,
Alzheimer became one of the founding fathers of neuropathology, nurturing a
unique brain research tradition in Germany that lasted for almost a century.
Alzheimer always thought of himself as a physician and was able to combine his
innovative research with the demanding clinical duties of a psychiatrist
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| Alzheimer laboratory |
With affection,
Ruben
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