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Alzheimer disease is now one of the best-known names in medicine. It began with one patient, careful notes kept over five years, and a lecture almost nobody responded to. This post tells the story of Alois Alzheimer and Auguste D., explains what he saw in her brain, and ends with what students can learn from how he worked. It is a history of science, not medical advice.
Who was Alois Alzheimer?
The clearest account is a 2003 history by Hanns Hippius and Gabriele Neundörfer of Munich's psychiatric clinic, where Alzheimer worked. Alzheimer was born on 14 June 1864 in Marktbreit, near Würzburg in Bavaria. He studied medicine in Berlin and Würzburg and became interested in microscopes early.
In 1888 he joined the city hospital for mental and epileptic patients in Frankfurt, where he worked for 15 years. There he became close friends with Franz Nissl, who had developed a staining method for brain tissue that is still in use. Nissl encouraged him to do research alongside his clinical work.
In 1902 the psychiatrist Emil Kraepelin brought him to Heidelberg, and then to Munich, where Alzheimer ran a modern laboratory for studying brain tissue. Many later leaders of the field trained with him, including H. G. Creutzfeldt, A. Jakob and F. H. Lewy. In 1912 he became professor of psychiatry in Breslau. He died there on 19 December 1915, aged 51.
Who was Auguste D.?
Hippius and Neundörfer describe how in March 1901 a man in Frankfurt noticed that his 50-year-old wife had become suspicious and paranoid, then developed sleep problems, memory disturbances, aggression, crying and growing confusion. She was admitted to the Frankfurt hospital, and on 26 November 1901 Alzheimer examined her.
He was struck by her case and recorded it in detail from the start. When he moved away, the hospital director promised to keep him informed. Auguste D. died on 8 April 1906, and her brain was sent to Alzheimer in Munich.
What did Alzheimer see in her brain?
Under the microscope he found two distinctive features, now known as plaques and neurofibrillary tangles. A 2011 history in the Journal of Medical Biography summarises his report of an atrophic (shrunken) brain with neurofibrillary deposits.
On 3 November 1906 he presented the case at a meeting of south-west German psychiatrists in Tübingen. The chairman invited no discussion, and the meeting moved on to talks on psychoanalysis that drew long debates. A local newspaper gave his lecture two lines. He published the case in 1907 as "Über eine eigenartige Erkrankung der Hirnrinde", "On a peculiar disease of the cerebral cortex"; an English translation appeared in Clinical Anatomy in 1995.
How did the disease get his name?
Kraepelin recognised the importance of the findings. In the 8th edition of his textbook Psychiatrie, whose volumes came out in 1910, he called the illness "Alzheimer's disease". The Italian Gaetano Perusini, working in Alzheimer's lab, published four cases in 1909.
There is a twist. In 1911 Alzheimer described a man, Josef F., whose brain showed plaques but no tangles. For decades people argued whether such cases were the same disease. In 1995 Konrad Maurer found Auguste D.'s case file in the Frankfurt archives; he and colleagues wrote about it in The Lancet in 199710203-8). Brain slides from both patients were then found in Munich and re-examined with modern methods. The conclusion, Hippius and Neundörfer write, was that the plaques-only and plaques-with-tangles cases were different stages of the same disease process.
How common is it today?
The World Health Organization reports that 57 million people were living with dementia worldwide in 2021, more than 60% of them in low- and middle-income countries, with nearly 10 million new cases each year. Alzheimer disease is the most common form and may contribute to 60 to 70% of cases. WHO also stresses that dementia is more common after 65 but is not an inevitable part of ageing.
If someone in your family is having new trouble with memory or daily tasks, the right step is to see a doctor. Families caring for a relative with dementia often need support too, and a doctor or local hospital can point you to it.
What can a student take from Alzheimer's way of working?
Keep records you could hand to someone else. His notes on Auguste D. were still worth studying more than 90 years later.
Link levels of explanation. He tied behaviour he saw on the ward to structures he saw on a slide. In biology, the strongest answers join the organism to the cell.
Do not let a cold reception stop you. He kept collecting cases after Tübingen, and the evidence won.
Nerve cells and neurotransmission come up across your biology courses; for the experiment that proved chemical signalling between nerves, see our post on Otto Loewi. If neuron structure still feels shaky, the Fermi Concept Library covers every concept in physics, chemistry, biology, mathematics and computing.
Next step: draw a labelled neuron from memory, then check it against your textbook and fix every part you missed.
