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SCIENCE AND MEDICINE IN THE SPOTLIGHT: ALZHEIMER'S DISEASE AS AN EXAMPLE PETER V. RABINS* Alzheimer's disease (AD) has exploded into public and scientific consciousness . In the past 5 years it has been featured on the cover of Newsweek, in the New York Times Sunday Magazine, and on the Phil Donahue television show (twice). During this same period of time the number of articles and letters published on AD in the New England Journal ofMedicine and Science has quadrupled: eight are listed in their indexes between 1975 and 1979, while 32 are cited between 1980 and 1984. This dramatic increase in interest in a disorder once believed to be rare has resulted from the concurrence of three diverse factors: advances in biomedical techniques and knowledge; recognition by public officials of future sociodemographic shifts; and the power of the disease model to mobilize the American public's interest. While unique in some ways, AD illuminates the function of each of these themes in shaping Americans' attitudes, viewpoints, and policies toward illness. It also illustrates the new visibility of medical research and the perils of research under public scrutiny. Historical Background and Biomedical Advances The condition known as senility has been recognized for millenia. It was mentioned by Solon in 500 B.c. [1] and noted by Cicero [2]. The modern description of the failing brain, however, dates to the early nineteenth-century writings of Esquirol [3]. He suggested that disorders that affect thinking be considered a single group of entities which he labeled with Pinel's term démence, literally, "from the mind." Esquirol Work was supported in part by NIMH grant K07 MH00505, the T. Rowe and Eleanor Price Foundation, and NIMH grant TOI MH18316. *Associate professor of psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.© 1988 by The University of Chicago. All rights reserved. 0031-5987/88/3102-0577$01.00 Perspectives in Biology and Medicine, 31, 2 · Winter 1988 \ 161 described a progressive disorder beginning with recent memory difficulty and progressing to severe, generalized mental and physical impairment. This syndromic approach ofSydenham and the later correlation of these clinical symptoms with neuropathologic abnormalities led to the identification in the nineteenth and early twentieth centuries of many distinct conditions that cause a decline of the intellect. "Garden variety" senility was, by and large, neglected, however. For example, Jean Charcot, one of the true masters of the syndromic approach, made no mention of senile dementia in his celebrated textbook on the neurology ofold age published in 1868 [4]. On the other hand, the first American textbook of geriatrics (a book by the originator of the term "geriatrics ") offered conflicting information, both describing the condition as an inevitable part of aging and noting that many elderly individuals never developed it [5]. The discovery of silver staining at the turn of the century led to the identification of a new neuropathologic marker of dementia, the neurofibrillary tangle, by Alois Alzheimer, an Alsatian psychiatrist, neurologist , and pathologist. In 1907 [6] he reported the case of a woman who died at age 55 after a 4-year illness. She presented with delusional jealousy at age 51 and thereafter progressively developed impairments in memory, praxis, and language. Alzheimer highlighted two neuropathologic abnormalities: numerous neuritic plaques, lesions that had been described about 20 years previously and that were known to be present in several neurologic disorders as well as in normal elderly; and neurofibrillary tangles, argentophilic intracellular inclusions described for the first time by Alzheimer. Several other neuropathologic hallmarks were subsequently described and have been recently discussed by Katzman [7]. Kraepelin later named this disorder Alzheimer's disease (AD) in honor of his pupil and emphasized its "presenile" (i.e., beginning before age 60 or 65) onset. Medical opinion retained this idea until the late 1960s. The entity of senile dementia generated little interest in the medical and scientific communities. Probably because both senile dementia and arteriosclerosis are age-related conditions, many clinicians, scientists, and lay people assumed that lack of brain blood flow because of arteriosclerosis was the likely cause of senile dementia. This assumption was sometimes presented as fact [5]. However, there was disagreement about whether presenile and senile dementia...

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Additional Information

ISSN
1529-8795
Print ISSN
0031-5982
Pages
pp. 161-170
Launched on MUSE
2015-01-07
Open Access
No
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