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2. Johann F.: The Historical Relevance of the Case for the Concept of Alzheimer Disease
- Johns Hopkins University Press
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2 Johann F. The Historical Relevance of the Case for the Concept of Alzheimer Disease Hans-Jurgen Möller and Manuel B. Graeber 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 and the neuropathologic background of the disease (Alzheimer 1911). This chapter describes the 1911 paper in detail and analyzes its significance for the conceptualization of the disease. In this context the rediscovery of the neurohistopathologic stains of the patient Johann F., whose description is the center of the 1911 publication, is of special interest. THE CASE RECORD OF JOHANN F. In contrast to Alzheimer’s brief report published in 1907, his 1911 paper describes fully his conceptualization of the disease and contains numerous illustrations, mainly drawings, which include several examples of the histopathology of the first case together with a second case report, that of Johann F. This case report seemed most important to Alzheimer. It is not known whether Kraepelin ever saw Auguste D., but Kraepelin was probably familiar with Johann F., because after Alzhei- Johann F.: Historical Relevance for Alzheimer Disease 31 FIGURE 11. Epicritical report of Johann F. Source: Archives of the Psychiatric Hospital, Munich; Graeber et al., 1997 mer moved to Munich, Kraepelin and Alzheimer used to work together very closely, as Kraepelin gratefully acknowledged in the introduction to the second volume of his textbook (Kraepelin 1910). Alzheimer provided ample clinical, biographical, and neuropathologic data on this patient, which allowed us not only to find the short case record of this patient in the archives of the Psychiatric Hospital of the University Munich but also to identify neurohistopathologic stains found among archives at the Institute of Neuropathology of the University of Munich (Graeber et al. 1997). According to the epicritical report (Figure 11), the patient, a 56year -old laborer, was admitted to the Psychiatric Hospital on September 12, 1907. The report further states: Wife died two years ago. Quiet; since half year very forgetful, clumsy, could not find his way, was unable to perform simple tasks or carried these out with difficulty, stood around helplessly, did not provide himself with lunch, [54.160.244.62] Project MUSE (2024-03-19 14:34 GMT) 32 Hans-Jurgen Möller and Manuel B. Graeber was content with everything, was not capable of buying anything by himself and did not wash himself. Very dull, slightly euphoric, slow in comprehension , unclear. Slowed speech, rare answers, frequent repetition of the question. PTR (patellar tendon reflex) l. more pronounced than r. Sticking when naming things, motor apraxia, imitates in a clumsy way. Paraphasia, ideational apraxia, paragraphia, able to copy writings and drawings. Does not realize contradictions in speech, can read. Blurred demarcation of the r. optic disk, veins very filled, wavy. Does not find the toilet. Heart rate 68. Blood pressure 98–168. Eats a lot. Is tugging at his sheets. Repeats sentences without problems. The patient died on October 3, 1910, of pneumonia after three years of hospitalization in the Psychiatric Hospital of the University of Munich. Interestingly, Johann F. was admitted under the diagnosis of possible vascular dementia. The initial clinical diagnosis, probably written by Alzheimer, reads ‘‘organische Hirnerkrankung (Arteriosklerose?)’’ (organic brain disease [arteriosclerosis?]). But the autopsy book states ‘‘Alzheimersche Krankheit’’ (Alzheimer disease). The notation of the patient’s diagnosis in the autopsy book was apparently written by Alzheimer (Figures 12 and 13). In the publication from 1911, Alzheimer gave a detailed description of the clinical history of Johann F. (Alzheimer 1911, 358–61). Because of the special relevance of this case in the conceptualization of AD, the case report is presented here nearly in full—not only to show the individual history of the case but also to demonstrate Alzheimer’s clinical diagnostic approach (trans. Förstl and Levy 1991). The 56-year-old laborer Johann F. was admitted to the psychiatric clinic on 12 November 1907. There was no history of excessive drinking. Two years FIGURE 12. Alzheimer’s signature (upper part of the figure) taken from his curriculum vitae, which was written after he had joined the Psychiatric Hospital in Munich. For comparison, the diagnosis written in the autopsy book has been enlarged (lower part of the figure). Source: Graeber et al. 1997 Johann F.: Historical Relevance for...