By Betty Weiss

Exactly one hundred years ago, in 1906, a woman died in Frankfurt-am-Main, Germany.  Known as Frau Auguste D., she had been admitted to the Municipal Mental Asylum there in 1901, when she was 51.  The senior physician at the hospital was Dr. Alois Alzheimer.  By the time she died five years later, Dr. Alzheimer had taken a position at the Anatomical Laboratory of the Royal Psychiatric Clinic at Munich University.  Her brain was sent to him for examination.

His findings of "plaques and fibrules" (now called plaques and tangles) formed his hypotheses that there was an organic cause for the condition.  Plaques are clumps of protein fragments that accumulate outside of the brain's nerve cells.  Tangles are twisted strands of another protein that form inside brain cells.  This was not new, but a paper he presented about Frau Auguste at the 37th Conference of Southwest German Psychiatrists was the first to describe a clinical case of dementia.  Eventually, his name became attached to the disease.     

He described Frau Auguste's symptoms, including disorientation, aphasia (problems with language), auditory hallucinations, paranoia, unpredictable behavior, and pronounced psychosocial impairment; the same things families deal with today.  Any social or environmental context to explain her condition was never addressed. 

In spite of what we've learned in the past century, Alzheimer's root cause is still a mystery.  Many theories abound, but the same plaques and tangles continue to appear.  I believe Alzheimer's has been around for hundreds of years, certainly longer, so I don't think it's anything in our modern life style that brings it on.  Frau Auguste did not drink soda from an aluminum can, she did not consume fluoride, saccharine, processed foods, eat veggies with pesticides or have mercury fillings.  She was one of countless patients in asylums at the time, and it is hardly a stretch to believe that most suffered a variety of brain diseases, other illnesses or injuries.

Alzheimer's is called a 'disease of aging,' but that's not wholly accurate.  Alzheimer's attacks the brain decades before overt symptoms show up, it's already lingered for a long time--silent, unseen, undetected, ignored.  Cells were dying while the patient was young with little effect on daily living.   It appears to start with aging because, today, we live long enough for it to become full blown--too many cells are finally lost.  Generations ago people who had it died young, well before it could show up.

Nor do I subscribe to the 'use it or lose it' theory.  Ask anyone whose Mom has Alzheimer's and you'll likely be told that Mom was an unusually bright woman with an important job, busy at church, active in organizations, well-groomed, healthy, funny, a college graduate.  Few ever say Mom was a dullard, a dropout, a couch potato who spent her days watching TV, munching chocolates.

My husband was a healthy, brilliant engineer who ran his own business designing and manufacturing units for all the early space shots.  Incredibly active, mentally and physically, he 'used it' all the time.  Hoping to avoid Alzheimer's, people do crossword puzzles, take classes, learn tricky dance steps, gulp supplements, exercise regularly, all to the good--but does that really work?  So, if it's not what we eat, do or don't do, education, microwaves, high-tension wires--what does cause this mysterious malady?

Familial Alzheimer's: A small number of Alzheimer's patients, about 7%, have inherited certain genes that mutate and lead to Alzheimer's.  You can get tested, but even if you have these familial genes, you may never get Alzheimer's.  Problems with testing are that you could be denied insurance, job opportunities, (medical records can be subpoenaed), and maybe impact serious relationships. 

Sporadic Alzheimer's: For the vast majority, the cause is unknown.  Of the hundreds of people in my husband's extended family, only one elderly woman was known to have dementia.  Was it Alzheimer's?  Possibly--no one knows.  But my husband wasn't elderly when he got it.  It doesn't appear to be in the family.

My layman's opinion is that many people carry recessive genes connected to Alzheimer's that may lie dormant throughout life or until something awakens them.  Surprisingly, many of us have plaques and tangles in our brains, but we never get Alzheimer's.  Go figure.    

Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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