Alois Alzheimer

Writers: Brianna Viets and Vijaya Varadarajan

Introduction

Throughout the years of scientific discoveries, researchers around the world have come across a variety of cases that have shaped a diverse range of medical classifications regarding diseases. More specially, German psychiatrist, Alois Alzheimer, was credited with identifying Alzheimer’s disease—one of the most prevalent forms of neurodegenerative dementia. Alzheimer explored this disease with two distinct cases that captured his interest when he uncovered unusual neural deformities within his patients brains. Auguste Deter and Josef F. were affected individuals who had been admitted into the Community Psychiatric Hospital and Munich Psychiatric Hospital due to underlying reasons. In this blog, we will investigate the two cases that brought about the classification of Alzheimer’s disease.

The Case of Auguste Deter

Alzheimer’s first case which ultimately highlighted his career was one with patient Auguste Deter who was 51 years old in 1901 (marking the onset of his examination). When Auguste’s husband brought her into the Community Psychiatric Hospital at Frankfurt am Main, she was experiencing perpetual and heightened intensity of aggressiveness, crying,confusion and memory discrepancies. Not to mention an untreatable wave of paranoia swept her. Dr. Alzheimer had seen nothing of such sorts and was called for further scrutiny. Auguste remained a patient of the hospital for 5 years, until her death on April 8, 1906. Soon after Alzheimer’s extensive autopsy, he was able to dissect her brain, to unravel morphological and histological wonders. He took sliced portions of her brain, stained it via silver salts and examined it under the microscope. There, the infamous tau deposits and neurofibrillary tangles were observed. [1] Let’s take a quick break and zoom a little more into our microscope. 🔬

Figure 1) from: https://www.asccare.com/story-auguste-deter-2/

Figure #2) Neurofibrillary tangles that were identified and sketched by Alzheimer. From: https://nyamcenterforhistory.org/tag/auguste-d/

Figure #3) Each of these images contains a unique view of how immunohistochemistry can show different neurofibrillary tangles. a) This shows diffused core plaques that are filaments of tau tangles, which can build up over time to cause Alzheimer’s. b) As time progresses, these plaques may become denser and may indicate the severity of the neural degenerative disease. Neuritic AD plaques may be inspected through the c) Bielchowsky silver staining or d) Thioflavin S. staining method. Image from: https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-019-0333-5

You’re able to see the above slides because of silver staining. Alzheimer and many scientists use silver staining to see neurofibrillary tangles and tau tangles. Via silver staining, neural tissues are infused with silver nitrate which crystallize the membrane of cells. Targeting the dendrites and soma, the neuron turns black, making evident any abnormalities. Although there are disadvantages of using silver nitrate like creating very dark stains or spilling over to nearby blood vessels, scientists have adapted by using lower quantities of silver nitrate and by infusing gold chloride sublimate. [2] Zooming out… let’s now look at Alzheimer’s case with Josef F. 

The Case of Josef F.

Following the case of Auguste a few years later, Alois Alzheimer published a new case regarding the diagnosis of Josef. in 1911. He described Josef F. as a male who had been admitted into the Munich Psychiatric Hospital for three years, but passed away in 1910. He had been diagnosed with Alzheimer’s disease prior to his death; however, his case was unique in the aspect that his brain did not show any signs of neurofibrillary tangles during examination. When Alzheimer was dissecting his brain to confirm the clinical diagnosis, it was discovered that only plaques had built up instead. During this time period, there was controversy regarding whether cases with “plaque-only” could be included under the category of cases with “plaques with neurofibrillary fibers.” In 1955, a group of researchers decided to delve deeper into the cases of Auguste D. and Josef F. by searching through the archives stored at the Munich Psychiatric Hospital. They used modern neuro-histochemical techniques, which involves the process of using chemical dyes that stain certain parts of the brain, to visual specific areas, such as neural fibers or myelin sheath, that may have been impacted. Once they had completed their reinvestigation of works published by H-J. Moller and M. B. Graeber as well, they came to the conclusion that patients with “plaque-only” cases were at a different stage from other individuals with the same disease who had “plaques with neurofibrillary tangles.” This further allowed them to understand that Alois Alzheimer was the first person to discover these distinct stages in the progression of Alzheimer’s disease. [1]