Carl didn’t know what was happening to his wife.  The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years. The marriage produced one daughter, Thekla, and their marriage had always being harmonious; that is, until one Spring when Auguste suddenly exhibited signs of jealousy.

Auguste accused Carl of going for a walk with a female neighbor, and since then, she had been increasingly mistrustful. Carl thought that her jealousy was unfounded. Over the next several months, Auguste’s memory began to fade. The once orderly and industrious homemaker was making uncharacteristic mistakes in preparing home meals – a task that she had probably performed countless times. She wandered around the apartment in a restless, aimless manner, leaving housework unfinished. She became convinced that a cart driver who frequented their house was trying to harm her and that people were talking about her. She started to inexplicably hide various objects in the house. The couple’s neighbors sometimes discovered Auguste ringing their doorbells for no reason.

Auguste had never been seriously ill. She was an otherwise healthy 51-year old woman who did not drink alcohol nor suffered from any mental illness. By November of 1901, an overwhelmed Carl brought his wife to the local mental institution. The physician’s admittance note described her as suffering from a weak memory, persecution mania, sleeplessness, and restlessness that rendered her unable to perform physical or mental work.

While reviewing the daily admissions, the senior physician at the Asylum for the Insane and Epileptic in Frankfurt am Main came across Auguste’s clinical notes. The unusual case seemed to stick out and the psychiatrist sensed that there was something special about Auguste. It was the case that he had been waiting for. Dr. Alois Alzheimer decided that he should see Auguste for himself.

Over the next several months, Dr. Alzheimer interviewed and examined Auguste, whose condition continued to deteriorate. He asked her to name common objects, perform simple arithmetic, tell him where she lived, what year it was, the color of snow, the sky, grass, and so on. Alzheimer maintained a detailed record and even arranged for Auguste to be photographed.  One photo reveals a woman with a deeply furrowed forehead and heavy eye bags. She was wearing a white hospital gown and her face exhibited a somewhat tired, blank expression with perhaps a hint of fear. Her hands were draped over her raised knees, with the fingers securely interlocked.

What struck Dr. Alzheimer was Auguste’s relatively young age. He had seen cases of mental deterioration in much older patients and had theorized that thickening of the brain’s blood vessels led to brain atrophy. It was unusual, however, to see the condition in a person who was only fifty-one years old.  Dr. Alzheimer had only encountered one other case similar to Auguste’s. The autopsy findings on that patient revealed shrinkage in specific brain cells but no significant blood vessel thickening.

Dr. Alzheimer continued his daily visits and thorough conversations with Auguste. There was no cure, of course, and the limited treatments included the use of sedatives and warm baths. At times, Auguste had to be placed in isolation after she groped the faces and struck other patients in the clinic. She wandered aimlessly, sometimes screamed for hours, and became increasingly hostile. By February of 1902, her condition had advanced to the point that long conversations and physical examinations became impossible.

Auguste died on April 8, 1906, nearly five years after her illness began. The official cause of death was blood poisoning due to bedsores. Dr. Alzheimer suspected that behind her mental illness was a strange disease, and that perhaps examining her brain would offer some clues.  When he examined the brain sections under the microscope, his suspicion was confirmed. Dr. Alzheimer described changes in the neurofibrils – the protein filaments found in brain cells. He also saw peculiar deposits that he referred to a ‘millet seed-sized lesions.’ These histopathologic findings – now known as neurofibrillary tangles and amyloid deposits – characterize the brains of Alzheimer’s disease patients.

Dr. Alzheimer’s discovery was not immediately well received. In fact, the first time he presented Auguste’s case and autopsy findings during a German Psychiatry conference in 1906, the reception from the audience was rather cold. This was the time when psychoanalysis and the Freudian views on the relation between childhood trauma and mental illness were, in today’s parlance, the ‘trending’ topics. Correlating mental or neurologic disorders with histopathologic findings was not yet firmly established nor accepted.

Emil Kraepelin, one of the most prominent psychiatrists in the early 1900s, first mentioned the term ‘Alzheimer’s Disease’ in the 1910 edition of his textbook on Psychiatry. The disease was of course still poorly understood, but one of the most famous medical eponyms was born. The rest, as the saying goes, is history.

It began with an unusual case file that stood out on that morning in November of 1901. On that day, towards the end of their initial conversation, Dr. Alzheimer instructed Auguste to write her name. The 51-year old railway clerk’s wife, who had always been healthy and organized, managed to write ‘Mrs.’, and then nothing more.

First published in 2014.

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