In 1906 Dr. Alois Alzheimer discovered a new disease that was named after him. It was defined as a very rare dementia afflicting people in their forties and fifties and characterized by plaques and tangles in the brain. Cause Unknown.
From then until the middle of the twentieth century, medical schools taught as gospel that this dementia of the middle-aged was clearly distinct from senile dementia - a relatively common condition affecting the elderly (sixties and older) - and caused by cerebral arteriosclerosis, that is, hardening of the arteries in the brain.
A serendipitous discovery
The discovery that these dementias are not distinct, but the same, and that senile dementia is a disease and not an unfortunate side effect of old age was made in the early 1950s. It was made serendipitously. Meta Neumann, a neuropathologist at St. Elizabeth's Hospital in Washington, D. C., received news that an elderly colleague of hers had died. His death came without warning. That very morning he had led a vigorous meeting of the hospital staff.
The day after his sudden death, Neumann performed an autopsy on her old colleague. She found that the arteries in his brain were severely clogged with fatty deposits, like the vessels of the heart in cardiovascular disease. This was a surprise to her because, like every one else in the medical establishment at the time, she believed that senile dementia, the dementia of old age, was caused by cerebral arteriosclerosis, the slow build up of fat in the brain's arteries over time. Her colleague's brain was a classic case of such sclerosis.
From what Meta Neumann found, her colleague should have died in a befuddled haze. Yet prior to his death, he had exhibited no signs or symptoms of senile dementia: On the day he died, Neumann and her husband, Robert Cohn, also a neuropathologist at St. Elizabeth's (they had met, appropriately enough, during an autopsy), had spoken with their elderly colleague and found him to be clear and cogent.
Their colleague was not senile; yet he had cerebral arteriosclerosis. Therefore, Meta Neumann reasoned, cerebral arteriosclerosis must not cause senility. But then, what does? Neumann was in a position to find out. St. Elizabeth's at the time was the premier mental hospital in the United States. It had an archive of twenty-three hundred brains taken from deceased residents. Meta Neumann and Robert Cohn autopsied the brains of two hundred and ten victims of senile dementia. The found that few of the brains showed sclerosis (fatty deposits). But the majority of them had plaques and tangles, the signature calling cards of Alzheimer's.
In the conclusion of their landmark article published in 1953 in the Archives of Neurology and Psychiatry, they wrote, "There is no difference in the clinical or pathological picture in the various age groups."
A paradigm shift
Their data were compelling. But they did not change the mind set of the psychiatric community. In the perception of that community, Alzheimer's remained a very rare disease of the middle-aged. And senility remained a natural part of aging.
To think otherwise would have required a paradigm shift, a conceptual change in preconceived notions that the medical establishment was not ready to accept, just as the world was not ready to accept that the earth revolved around the sun rather than vice versa in the time of Copernicus. What finally did cause the medical community to change its collective mind? The world changed and, with it, their world view. How did the world change?
The portion of the population living to eighty-five or beyond had tripled since 1900; the elderly were becoming conspicuous for the first time in human history. So many people were living to eighty-five or older that senility didn't seem so normal or inevitable anymore.
In the mid-sixties, two other neuropathologists made the same discovery that Meta Neumann and Robert Cohn had made. Robert Terry and Robert Katzman of the Albert Einstein College of Medicine in New York saw plaques and tangles turning up in many brain samples. They realized that Alzheimer's disease was very common and that most senile dementia was not due to small artery disease. Alzheimer's was not a rare disease after all. It was the leading cause of dementia, by far, in people of all ages. Katzman made speeches and wrote editorials in the early 1970s on these observations. This time the medical community was ready to listen. This time, the time was right.
In 1974, congress passed the Research on Aging Act. The National Institute on Aging was then established, and Alzheimer's became its top priority. Finally, senility was seen as a disease and not a natural inevitability of aging. The search was on to find the cause because diseases have causes. And if the cause could be found, then maybe the disease could be prevented or even reversed. The search for the cause will be the subject of next week's column.
Mary Lou Williams, M. Ed., is a writer and lecturer in the field of nutrition. She welcomes inquiries. She can be reached at 267-6480.