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Concepts of Alzheimer Disease

Biological, Clinical, and Cultural Perspectives

edited by Peter J. Whitehouse, M.D., Ph.D., Konrad Maurer, M.D., Ph.D., and Jesse F. Ballenger, Ph.D.

Publication Year: 1999

As the essays in this volume show, conceptualizing dementia has always been a complex process. With contributions from noted professionals in psychiatry, neurology, molecular biology, sociology, history, ethics, and health policy, Concepts of Alzheimer Disease looks at the ways in which Alzheimer disease has been defined in various historical and cultural contexts. The book covers every major development in the field, from the first case described by Alois Alzheimer in 1907 through groundbreaking work on the genetics of the disease. Essays examine not only the prominent role that biomedical and clinical researchers have played in defining Alzheimer disease, but also the ways in which the perspectives of patients, their caregivers, and the broader public have shaped concepts.

Published by: The Johns Hopkins University Press

Title Page, Copyright

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For Luigi Amaducci, 1932–1998

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pp. vii-x

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pp. xi-xvi

It is ironic that the professional and popular discourses surrounding Alzheimer disease (AD), whose most dreaded feature is the obliteration of memory, proceed with little awareness of its past. As with individuals, large-scale social enterprises such as the research, policy, and caregiving efforts that surround AD ...

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pp. xvii-xviii

First, we would like to thank Eli Lilly and Company for generous support at every stage of this project, and especially for providing the contributors of this book with the rich environment of Alois Alzheimer’s birthplace to begin the process. In particular, we owe thanks to Robert Postlethwait, Jochen Becker, ...

List of Contributors

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pp. xix-xx

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Part I: The Cases of Auguste D. and Johann F.: Origins of the Modern Concept of Alzheimer Disease

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pp. 1-4

As we enter a new millennium, neuroscience seems the most modern, forward-looking of endeavors in biomedicine, generating stunning insights into the molecular basis of brain function, which are then applied to problems of human behavior that have vexed humanity throughout history—problems such as age-associated progressive dementia. ...

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1. Auguste D.: The History of Alois Alzheimer’s First Case

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pp. 5-29

The year 1997 marked the ninetieth anniversary of Alois Alzheimer’s remarkable publication, ‘‘A Characteristic Disease of the Cerebral Cortex’’ (Alzheimer 1907). This two-page article, and the subsequent publications by Bonfiglio (1908), Perusini (1909), and again Alzheimer in 1911, led to the eponym Alzheimer’s disease first used by Emil Kraepelin ....

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2. Johann F.: The Historical Relevance of the Case for the Concept of Alzheimer Disease

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pp. 30-46

After the short report on Auguste D. (Alzheimer 1907), Alois Alzheimer left the task of producing a more detailed publication on the disease later named after him to Perusini (Perusini 1910). In 1911 Alzheimer turned his attention back to the disease and published a long paper of his own on the clinical picture ...

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Part II: From Alzheimer to the Present

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pp. 47-52

The concept of disease begins with people and their minds. First, the notion of disease, or ‘‘dis-ease,’’ implies that we start with the suffering of an individual human being. Lay concepts of illness are critical to understanding the behavior of patients and their families, and it is these ideas that largely determine ....

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3. Neurofibrillary Changes: The Hallmark of Alzheimer Disease

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pp. 53-71

A major criterion essential for postmortem diagnosis of Alzheimer disease (AD) is the presence of somatic neurofibrillary tangles (NFTs) and dendritic neuropil threads (NTs) in specific subsets of nerve cells. Individuals who have a history of cognitive decline but no NFTs or NTs are classified in the heterogeneous group ...

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4. Contributions of German Neuroscience to the Concept of Alzheimer Disease

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pp. 72-82

During the first half of the twentieth century, the concept of Alzheimer disease was written about entirely in German. A new staining method described by Bielschowsky (1903) allowed Alois Alzheimer to demonstrate a new kind of argentophilic intraneuronal fibrillary tangle (1906, 1907) ...

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5. Beyond the Characteristic Plaques and Tangles: Mid-Twentieth Century U.S. Psychiatry and the Fight Against Senility

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pp. 83-103

The conceptual history of Alzheimer disease (AD) is usually discussed within an implicit three-part chronology. There is the classical period, in which the clinical and histopathologic acumen of Alzheimer and Perusini brought the disease into scientific focus ...

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6. The Rediscovery of Alzheimer Disease During the 1960s and 1970s

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pp. 104-114

The modern era of Alzheimer research began in 1948 with R. D. Newton’s argument on the clinical identity of Alzheimer disease (AD) and senile dementia but was not continued until the reports on the ultrastructure of the plaque and tangle by Terry (1963; Terry, Gonatas, and Weiss 1964) and Kidd (1963, 1964) ...

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7. The History of the Genetics of Alzheimer Disease

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pp. 115-124

This chapter reviews the major advances in the genetics of Alzheimer disease (AD), together with several issues that have proved inseparable from the discovery of the genes themselves. For diseases of unknown gene product, gene discovery is often the first step in understanding disease pathogenesis. ...

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Part III: Alzheimer Disease as a Social and Cultural Entity

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pp. 125-128

Social Construction. These two words succinctly evoke an intellectual battle that has raged over the meanings and boundaries of nature, society, and science in the modern world. Although the intellectual approaches to this problem are in fact quite diverse, the tendency of the combatants to engage in caricature ...

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8. Alzheimer Disease: Epistemological Lessons from History?

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pp. 129-157

In analyzing the history of Alzheimer disease (AD), two approaches can be taken. First, one can focus on the consecutive events and the agents that brought them about. This is important in order to know what happened and who was involved. In this general approach two focuses can be distinguished. ...

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9. Aging, Culture, and the Framing of Alzheimer Disease

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pp. 158-180

Alzheimer disease (AD) has assumed almost mythic proportions in American society. This disease affects over four million people and has stimulated the expenditure of substantial public and private resources in the search for the key to its complex and probably multiple etiologies, its threat to fundamental sources of human identity, ...

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10. Narrative Practice and the Inner Worlds of the Alzheimer Disease Experience

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pp. 181-204

Alzheimer disease has been formally recognized as a diagnostic category for nearly a century, dating back to the case history of a 51-year-old female patient, Auguste D., presented by physician Alois Alzheimer at a meeting of German psychiatrists in 1906. The case was ‘‘peculiar’’ because signs of dementia were being exhibited ...

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Part IV: Politics, Policy, and the Perspectives of the Caregiver and Patient

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pp. 205-208

Since the recovery (described in Chapter 1) of the original file of Auguste D., Alzheimer’s first patient, her haunting photograph has begun to attain iconic status in professional lectures on the disease around the world—indicating the significance attached to the perspective of the patient. ...

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11. The Role of the Concept of Alzheimer Disease in the Development of the Alzheimer’s Association in the United States

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pp. 209-233

Biological, clinical, and epidemiological characterizations feature prominently in social scientific analyses of human disease and infirmity. In some instances, these conceptualizations are viewed critically as sociohistorically derived representations of biomedical phenomena ...

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12. The History of the Alzheimer’s Association: Future Public Policy Implications

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pp. 234-244

The Alzheimer’s Association was originally named the Alzheimer’s Disease and Related Disorders Association (ADRDA), a cumbersome name cobbled together to address the concerns of the founding organizations for the preservation of their respective identities. ...

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13. The Concept of Alzheimer Disease in a Hypercognitive Society

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pp. 245-256

Is the difference between Alzheimer disease (AD) and the cognitive decline associated with normal aging qualitative or quantitative? Does AD dementia differ from the normal loss of capacities associated with aging only in its order of magnitude? ...

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Part V: Progress and Its Problems The Future of Alzheimer Disease

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pp. 257-260

Inside every large problem are a dozen small ones struggling to get out. This corollary to Murphy’s law might well seem applicable to progress in Alzheimer disease (AD), except that in this case it is difficult to discern if the problems solved are bigger than the ones set loose. ...

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14. Alzheimer Disease and the New Biology

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pp. 261-268

Clinical research begins with the definition of a ‘‘case.’’ This generally starts as an empirical collection of clinical signs and symptoms that evolves over time into an accepted description of a distinct disease entity or syndrome. Clinical nosology is an iterative, almost evolutionary discipline that often leads to improved methods of diagnosis ...

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15. The Genetics of Alzheimer Disease: Some Future Implications

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pp. 269-290

The genetics of Alzheimer disease (AD), as well as genetics in general, will eventually lose its novelty and become a science that is taken for granted. Genetic techniques will be thought of, not as ways to look one by one for a gene that transmits diseases that are clearly passed within a family as Mendelian traits, ...

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16. History and the Future of Alzheimer Disease

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pp. 291-306

Alzheimer disease (AD) is a malignant threat to the quality of life of affected individuals as well as to the quality of life of the human race in the future. Our ability to recognize the challenges and dangers that lie ahead will be critical in determining whether we can make appropriate personal and social responses to this condition. ...


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pp. 307-321

Production Notes

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E-ISBN-13: 9780801877155
E-ISBN-10: 0801877156
Print-ISBN-13: 9780801877575
Print-ISBN-10: 0801877571

Page Count: 344
Illustrations: 13 halftones, 4 line drawings
Publication Year: 1999