Ich hab mich verloren.
—AUGUSTE DETER, THE FIRST CONFIRMED CASE OF ALZHEIMER’S DISEASE
ALZHEIMER’S DISEASE IS NAMED AFTER A GERMAN psychiatrist and neuropathologist. In a lecture in 1906, Alois Alzheimer reported seeing the characteristic plaques and tangles in the brain of fifty-five-year-old Auguste Deter, a sufferer of early-onset disease who’d died earlier that year. “Ich hab mich verloren [I have lost myself],” she had said to Alzheimer, when first she was admitted to the Frankfurt asylum at age fifty-one.
Alzheimer didn’t discover the disease as such. It had been observed and written about before, notably by an early brain researcher named Beljahow, who reported brain plaques in dementia in 1887. Likewise, the presence of tangles had been announced by other neuroscientists before Alzheimer gave his lecture, but nothing formal had got into the textbooks. What was remarkable and newsworthy about Auguste Deter’s case was her disease’s very early onset. This helped make a splash. It was a sensation. Publicity was the key. Alzheimer’s boss, friend, and coresearcher, Emil Kraepelin, happened also to be a powerful figure in neurology and in science publishing. Today regarded as the father of mental disorder classification, Kraepelin named the disease Alzheimer’s in 1910, in the course of a description in his new textbook. He did so almost casually, in a paragraph of notorious vagueness, referring to “this Alzheimer’s Disease,” a reference that surprised his readers and colleagues. To quibble, the label Alzheimer’s ought in all justice to have been confined to the early-onset variant only, since that’s what the Auguste Deter research was concerned with. It’s also interesting to note that Alzheimer himself didn’t think the late-onset condition ought to be classified as a disease as such. It was his contention that Alzheimer’s happens to all brains in the end—they wear out, like hips and knees—it’s just the speed and volume of plaque growth, he argued, that marks the syndrome out. The speed is remarkable. Neuron loss in Alzheimer’s has been calculated as ten times the speed of that entailed in normal aging.
A sense of theater, a gift for PR, the pressing financial need to impress funding bodies: It’s suggested that all these led Kraepelin to make Alzheimer the eponym. Kraepelin’s battle with his great rival Sigmund Freud, as to whether such disorders were organic or psychiatric in origin, was another factor; Alzheimer had been supportive in putting Freud in his place. It helped that Alzheimer’s time was one of diagnostic breakthrough. Modern Zeiss microscopes (the original slides have been discovered and preserved) and the advent of silver nitrate tissue-staining process (the innovation of Alzheimer’s colleague Franz Nissl), which illuminated slices of the brain as never before, meant Alzheimer’s work had the benefit of technological advance over that of his rivals.
Alzheimer had left Frankfurt and was working for Kraepelin in Munich by the time Auguste Deter died in 1906. Her brain and spinal cord were sent to him by train in a box.
Her case was unusual and even today would be regarded so, not only because she was so young—fifty-one is very early onset and fifty-five a very early dementia death—but also because it came on so aggressively and fast. The polite confusion she showed on admission very quickly declined into raving and wailing and wordless wounded animal misery. A stark black-and-white photograph of her while in the asylum shows a woman who appears to be in her seventies, her brow furrowed into deep ridges, her face ravaged and baggy, a bewildered look in her eyes.
ALZHEIMER’S OWN RECORD of their first conversation survives. He writes that she looks helpless. He asks her name.
“Auguste,” she tells him.
“And what is your husband’s name?”
“Auguste.”
“Your husband?”
“Ah, my husband.”
She doesn’t appear to understand that it’s a question.
“Are you married?” he persists.
“To Auguste,” she says.
“How long have you been here?” he asks her.
“Three weeks,” she says with confidence (though in fact she was admitted the day before).
She can still identify a pen, bag, key, diary, and cigar.
She is given pork and cauliflower for lunch, but when asked what she’s having, answers “Spinach.” When asked again she says, “Potatoes and horseradish.”
He notes that objects shown to her are forgotten about almost immediately. In between she seems to have an obsessive interest in twins.
He asks her to write her name. She starts to write “Frau” and then gives up. Several attempts are made to write Auguste. First Augh. Then Auguse D, leaving out the t. That evening, Alzheimer writes, her conversation is full of non sequiturs and obsessive elements like perseverations, in which sufferers return to a subject, an idea, a phrase, again and again without making their meaning clear. (It’s not so much that they persevere with a subject, but that the subject perseveres with them.)
THERE’S AN IRONIC footnote to the story. Auguste Deter’s cause of death appears principally to have been arteriosclerosis of the brain: what’s now classified as vascular dementia, rather than Alzheimer’s disease. There’s also a poignant footnote. Auguste’s husband, on delivering her to the Frankfurt asylum, complained about her unreasonable jealousy. She was convinced, he said, that he was having an affair with a neighbor and had become irrational about it. Apparently he married this neighbor the year after Auguste died. Just because you’re paranoid, it doesn’t mean they’re not out to get you.
On his way to a new job in Breslau in 1912, Alzheimer became ill on the train with a sore throat, which led in turn to rheumatic fever. He died in 1915 of heart failure, in effect from complications of tonsillitis. He was fifty-one.