Book Review

Concepts of Alzheimer Disease: Biological, clinical, and cultural perspectives

N Engl J Med 2000; 343:975September 28, 2000

Article

Concepts of Alzheimer Disease: Biological, clinical, and cultural perspectives
Edited by Peter J. Whitehouse, Konrad Maurer, and Jesse F. Ballenger. 341 pp., illustrated. Baltimore, Johns Hopkins University Press, 2000. $55. ISBN: 0-8018-6233-7

The first sentence of this excellent book sums up both its content and the reason one should read it: “It is ironic that the professional and popular discourse surrounding Alzheimer disease (AD), whose most dreadful feature is the obliteration of memory, proceed with little awareness of its past.” And if Santayana's often-quoted statement about those who cannot remember the past is true, what does this mean for studies of dementia? This book attempts to answer the question and does so very successfully.

The origin of this collection of essays was a 1997 symposium held to celebrate the life, legacy, and work of Alois Alzheimer, who described the disease in 1907. One of the first chapters of the book tells the fascinating story of how the case notes for Alzheimer's article were recently discovered in the archives of his department in Frankfurt.

Originally, Alzheimer considered the condition to be a presenile phenomenon and thus a disease, a point that is relevant to many of the discussions in this book. By contrast, he interpreted the same symptoms in the elderly (“senile dementia”) as merely signs of normal aging. We learn that only in the late 1970s was the disease renamed “senile dementia of the Alzheimer's type” in order to unify these two concepts. How we got from Alzheimer's original concept to the current view that memory loss with aging is not normal is the subject of many of the essays in this book.

The book contains a short biography of Alzheimer and describes his early work and that of his colleagues and competitors, a veritable neurologic hall of fame, including Binswanger, Pick, Jakob, Creutzfeldt, Wernicke, and Lewy, to name just a few. We learn that Alzheimer's mentor and promoter, Emil Kraepelin, authorized the eponym “Alzheimer's disease” on the basis only of Alzheimer's 1907 report and a few case reports by another worker. Kraepelin may have acted quickly to credit Alzheimer because he truly believed that Alzheimer had discovered a “new” disease, but the book offers a more interesting explanation. Apparently, there was some rivalry between Kraepelin's laboratory and that of Pick, his competitor. Also, Kraepelin wanted to refute the theories of Freud and the psychoanalysts by proving that mental disease has an organic, not psychodynamic, basis. The discovery of a new neurologic–psychiatric entity by a member of Kraepelin's own circle would serve to enhance his status.

In a book focused on the history of Alzheimer's disease, we can see the evolution of our concepts of this disease. It was described clinically at first and then pathologically. In the 1970s and 1980s, the disorder was viewed as a neurochemical entity (the cholinergic hypothesis). Today, we consider Alzheimer's disease a genetic disorder (related to chromosomes and apolipoprotein E). How will we view it in the future?

A.M. Clarfield, M.D.
Sarah Herzog Memorial Hospital, Jerusalem 91351, Israel