Alzheimers case report

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A full transcription of Alzheimer's questions and Auguste D.'s answers appears in previous publications as well as in a biography of Alzheimer (Maurer and Maurer 1998), and will not be printed here in their entirety. Alzheimer's notes in the file begin on November 26,1901. He asked very simple questions and wrote down the dialogues systematically. His questioning continues on four handwritten pages, dated through November 30,1901 (Fig. 9).

Auguste Deter
Fig. 8. Portrait of Auguste D. aged 51

November 26,1901

Alzheimer's note: She sat on her bed with helpless expression.

Alzheimer: What is your name? Auguste D.: Auguste. Alzheimer: Last name? Auguste D.: Auguste.

Alzheimer: What is your husband's name? Auguste D.: Auguste, I think.

Ofc, vi

Fig. 9. Findings on admission of November 26,1901

Alzheimer: Your husband?

Auguste D.: Ah, my husband? [Sbe looks as if she doesn't understand tbe question.]

Alzheimer: Are you married?

Auguste D.: To Auguste.

Auguste D.: Yes, Auguste D.

Alzheimer: How long have you been here? [She seems to be trying to remember.] Auguste D.: Three weeks.

Alzheimer: What ist his? [I showed her a pencil.] Auguste D.: A pen.

Alzheimer's note: A purse, a key, a diary, a cigar are named correctly. At lunch she eats cauliflower and pork. Asked what she was eating, she answers "spinach." As she was chewing the meat and was asked what she was eating, she answered "potatoes" and then "horseradish." When objects were shown to her, after a short time she did not remember what objects had been shown. In between she always speaks about "twins." When she is asked to write, she holds the book in such a way that one has the impression that she has a reduction of the right visual field.

Asked to write "Mrs. Auguste D.," she tries to write "Mrs." and forgets the rest. It is necessary to repeat every word. Amnestie writing disorder ("Amnestische Schrift-storung"). In the evening her spontaneous speech is full of paraphrasic derailments and perseverations.

November 28

She continuously looks helpless, anxious, and says, "I do not want to be cut." She behaves as if blind, touching other patients on their faces while they fight her. When asked what she is doing, she replies: "I must tidy up." She had been brought into an "isolation room," where she behaved very quietly.

November29

Alzheimer's note: Helpless, refuses everything.

Alzheimer:... What is your name?

Alzheimer: When were you born?

Auguste D.: Eighteen hundred and ...

Alzheimer: Your birthday?

Auguste D.: This year, a past year.

Alzheimer: When born?

Auguste D.: Eighteen-hundred, I don't know.

Alzheimer: What did l ask you?

Alzheimer: Do you have children?

Auguste D.: One daughter.

Alzheimer: What is her name?

Auguste D.: Thekla.

Alzheimer: How old is she?

Auguste D.: She is married in Berlin, Mrs. S.

Alzheimer: Where does she live?

Auguste D.: We live in Kassel.

Alzheimer: Where does your daughter live?

Auguste D.: Waldemarstreet, no different.

Alzheimer: What is the name of your husband?

Auguste D.: I do not know how I came to this. I cannot go on this way.

Alzheimer's note: She seems not to understand the question.

Alzheimer: What is the name of your husband?

Alzheimer: What is your husband's name?

Auguste D.: My husband is not here at this time.

Alzheimer: What is the name of your husband?

Alzheimer's note: She suddenly and quickly answered, "August Wilhelm Carl. I don't know if I can say that."

Alzheimer: What is your husband?

Auguste D.: Office clerk. I am so wrong, so wrong. I cannot...

Alzheimer: How long have you been here?

Auguste D.: Rather long.

Alzheimer: Where are you now?

Auguste D.: But this is Wilhelmshohe.

Alzheimer: Where is your flat?

Auguste D.: In Frankfurt am Main.

Alzheimer: Which street?

Auguste D.: Not the Waldemarstreet but another one. ... Just wait, I am very, very ... Alzheimer: Are you ill? Auguste D.: Well, more the spine. Alzheimer: Do you know me?

Auguste D.: I think you have seen me two times. Please excuse me. .I cannot .in this way.

Alzheimer: What is the current year? Auguste D.: 1800. Alzheimer: Are you ill? Auguste D.: Second month.

Alzheimer: What are the names of the patients? [She answers quickly and correctly.] Alzheimer: Which month is it now? Auguste D.: The eleventh.

Alzheimer: What is the name of the eleventh month?

Auguste D.: The last one, if not the last one.

Alzheimer: Which one?

Alzheimer: What color is the snow?

Auguste D.: White.

Alzheimer: The soot?

Auguste D.: Black.

Alzheimer: The sky?

Auguste D.: Blue. Alzheimer: The meadows? Auguste D.: Green.

Alzheimer: How many fingers do you have?

Auguste D.: Five.

Alzheimer: Eyes?

Alzheimer: Legs?

Alzheimer: How many dimes are in a mark? Auguste D.: 100.

Alzheimer: How many marks are in one thaler?

Alzheimer: How much does an egg cost?

Auguste D.: Six or eight.

Alzheimer: Six or eight, what?

Alzheimer: Six or eight marks?

Alzheimer: What does a pound of meat cost?

Auguste D.: Twenty.

Alzheimer: Twenty, what?

Alzheimer: One roll?

Auguste D.: Three dimes.

Alzheimer: If you buy six eggs for seven dimes, how much does it cost?

Auguste D.: Differently.

Alzheimer: On what street do you live?

Auguste D.: I can tell you. I must wait a little bit.

Alzheimer: What did I ask you?

Auguste D.: Well, this is Frankfurt am Main.

Alzheimer: On which street do you live?

Alzheimer: When did you get married?

Auguste D.: I don't know at present. The woman lives on the same floor. Alzheimer: Which woman?

Auguste D.: The woman where we are living. [The patient calls] Mrs. G., Mrs. G., here a step deeper. She lives ...

Alzheimer's note: Ishowher akey, apencil, andabookandshenames them correctly.

Alzheimer: What did I show you? Auguste D.: I don't know, I don't know. Alzheimer: It is difficult, isn't it? Auguste D.: So anxious, so anxious. Alzheimer: How many fingers? Auguste D.: Three. Alzheimer: Are you still anxious?

Alzheimer: How many fingers did I show you? Auguste D.: Well, this is Frankfurt am Main.

Alzheimer's note: The patient was asked to recognize objects by touch, closing her eyes. A toothbrush, a sponge, bread, a roll, a spoon, a brush, a glass, a knife, a fork, a plate, a purse, a mark, a cigar, a key

She recognizes them quickly and correctly.

By touch, she calls a brass cup "a milk jug" and "a teaspoon," but when she opens her eyes she immediately says, "a cup." She writes as we have already described. When she has to write, "Mrs. Auguste D.," she writes "Mrs.," and we must repeat the other words because she forgets them. The patient is not able to progress in writing, and repeats, "I have lost myself."

Reading, she passes from one line to the other and repeats the same line three times. But she correctly reads the letters. She seems not to understand what she reads. She accents the words in an unusual way. Suddenly she says, "Twins." "I know Mr. Twin." She repeats the word twin during the whole interview

The pupils accommodate to light without delay. The tongue has normal mobility and is dry, yellow-red-brown. No disturbance in speech articulation. She frequently interrupts herself about the pronunciation of words during the interview as if she would not know if she said something correctly. She carries a denture. No facial nerve differences. Muscular strength on the left side is considerably reduced in comparison with the right side.

Patellar reflex is normal. Radial reflex is a bit (but not relevantly; rigid. Cardiac ictus is not felt. Cardiac obtusity is not enlarged. The second pulmonary and aortic tones are not accentuated.

During the physical examination she cooperates and does not show anx-iety. She suddenly says, "Just now a child called. Is he there?" She hears her calling...; she knows Mrs. Twin. When she was brought from the isolation room to the bed, she became agitated, screamed, and was noncooperative. She shows great fear and repeats, "I don't want to be cut." "I do not cut myself."

November 30

She frequently stays in the living room, touches the faces of other patients, and hits them. It is difficult to figure out what she wants. Therefore, she must be isolated. When we try to speak with her, she says, "I do not have either the will or the time. I don't want ."

Alzheimer: How are you?

Auguste D.: During the last days I was very good. Alzheimer: Where are you?

Auguste D.: Here and everywhere. Here and now. You don't mind.

Alzheimer: Why are you here?

Auguste D.: We are going to live there.

Alzheimer: Where is your bed?

Auguste D.: Where should it be?

Alzheimer: How did you sleep?

Auguste D.: Very good.

Alzheimer: Where is your husband?

Auguste D.: In the clerk's office.

Alzheimer: How old are you?

Auguste D.: Fifty-seven years.

Alzheimer: Where are you living?

Auguste D.: Waldemarstreet.

Alzheimer: Have you already eaten today?

Auguste D.: Soup and other things.

Alzheimer: What are you doing?

Auguste D.: To clean and something like that.

Alzheimer: Why didn't you put on your clothes?

Auguste D.: I had something to do.

Alzheimer: How long have you been here?

Auguste D.: You did write it, fifty-seven?

Alzheimer: Fifty-seven what?

Auguste D.: With the years.

Alzheimer's note: The behavior of the patient indicates that she is suspicious. She says to the doctor, "You do not have anything to do here."

After that she greets him in a friendly way. "Please have a seat. I did not have time." She wants to live, screams terribly, like a small child. She shows signs of occupational delirium. She takes some bedspreads and folds them up or puts them under the bed. "I am making order." Sometimes she sweats profusely and calls, "Karl" or "Thekla" (the names of her husband and daughter). If she is asked to name her husband, she normally says, "Auguste." When asked where she is, she says, "at home" and after that, "at the hospital." When asked to knit, she pulls out the needles from the work and begins to pick up the single loops. When asked what a bedside table is, she answers, "This is a bedside chair, and needs a cover."

Alzheimer's hand-written report ends November 30, 1901. The other two copies, written in German old script and Latin, continue to document the course of the patient's disease from January 1902. The Latin copy contains a registration from 1902 to the beginning of 1906.

Shortly before Auguste D.'s death, the file states: "Tendency to decubitus since the beginning of 1906. Development of a sacral and left trochanteric ulcer. Very weak, high fever up to 40 °C within the last days. Pneumonia of both inferior lobes."

The last documentation is dated April 8, 1906: "Within the morning, exitus letalis. Cause of death: Septicemia due to decubitus. Anatomical diagnosis: Moderate external and internal hydrocephalus. Cerebral atrophy. Arteriosclerosis of the small cerebral vessels. Pneumonia of both inferior lobes. Nephritis."

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