Alzheimers Disease History

In 1907, Alois Alzheimer, a Munich neuropathologist and clinician, published a report of a woman in her 50s who died in a Frankfurt asylum after a -year illness. Alzheimer wrote that the patient's illness was characterized by progressive cognitive decline (memory and language dysfunction, getting lost) as well as neuropsychiatric symptoms (psychosis, screaming, carrying and hiding objects). On postmortem examination of the patient's brain, Alzheimer noted atrophy as well as large blood vessel arteriosclerosis. Using microscopy and the Bielschowsky silver stain, Alzheimer also found neuronal loss, plaques, glial proliferation, and neurofibrillary tangles, a previously unknown phenomenon. Given the relatively young age of his patient, the unusual clinical features, and the unique neuropathological findings, Alzheimer hypothesized that he had discovered a disease distinctive from senile dementia (Alzheimer, 1907).

TABLE 15.3. Fact Summary—Alzheimer's Disease

Typical age of onset Sex ratio

Primary clinical/behavioral features Primary brain regions affected Neuropathology Neurochemistry Primary treatment

65-85 years Women > men

Progressive memory and cognitive deficits Mesial temporal lobe, hippocampus, entorhinal areas Atrophy, neurofibrillary tangles, neuritic plaques Loss of acetylcholine Cholinesterase inhibitors

By the 1960s and 1970s, the concepts of Alzheimer's disease (AD) and senile dementia had been unified as discussed above. Following this conceptual shift, clinical (McKhann et al., 1984) and pathological (Khachaturian, 1985; National Institute on Aging, 1997) criteria were established for the diagnosis of AD.

When studies of the neuropathology and neurochemistry of AD revealed cholinergic (e.g.,Whitehouse et al., 1981) and other abnormalities, the stage was set for the development of pharmacological treatments. Almost 100 years after Alzheimer's seminal case report, clinicians continue to be confronted with patients closely resembling the woman he described, and such patients and their family members eagerly await the results of extensive research being done on this devastating disease (see Table 15.3).

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