Ending a 2-year search, German scientists have uncovered a piece of science history: brain samples from Auguste D., the first Alzheimer's patient ever to be described in medical literature. The finding, published this week in Neurogenetics, is likely to put an end to lingering doubts that she suffered not from Alzheimer's, but from another, rarer brain disease.
Researchers have been hunting for Auguste's brain since psychiatrist Konrad Maurer and two colleagues from the University of Frankfurt found her original hospital file at an institute of the university (Science, 5 July 1996, p. 28). When they published their findings last year, the trio still nursed hopes of also finding her brain somewhere in Frankfurt. But they were looking in the wrong place. Last September, a rival team led by neuropathologist Manuel Graeber of the Max Planck Institute for Neurobiology in Munich discovered more than 250 slides of Auguste's brain in a basement of the University of Munich. There is no doubt about the brain's authenticity, says Graeber: The arrival of the brain was recorded in the hospital's autopsy book, and every single slide is labeled with Auguste's last name--a very rare one in Germany.
In searching for samples of Auguste D.'s brain, both teams had studied the history of her case and the movements of Alois Alzheimer himself in the early years of this century. Auguste D. was admitted to the Hospital for the Mentally Ill and Epileptics in Frankfurt in 1901. Then only 51 years old, she did not understand the world around her, had hallucinations, and was disoriented, paranoid, and hardly able to speak. Alzheimer, a doctor at the hospital since 1888, studied her intensively and continued to follow her progress from a distance after his research career took him to the Royal Psychiatric Clinic in Munich in 1903. After Auguste's death in April 1906, the hospital's director sent her brain to Alzheimer in Munich for investigation. He presented her case at a psychiatry meeting in Tübingen 7 months later and published it in 1907, thus assuring Auguste a place in medical history.
A fresh look at Auguste's brain dispels allegations that she may have suffered from something other than Alzheimer's, Graeber says. Some neurologists have speculated that she was ailing from a rare metabolic disorder called metachromatic leukodystrophy. Although Graeber says the rediscovered slides show no evidence of this, her cortex does display the two classic pathological signs of Alzheimer's disease: amyloid plaques and neurofibrillary tangles. "It's exactly what you would expect," Maurer says.