Hans Förstl


Alois Alzheimer:

Beitrag zur pathologischen Anatomie der Seelenstörungen des Greisenalters

Allg Z Psychiat 1899; 56:272-3. Neurol Centralbl 1899;18:95-6.

A contribution concerning the pathological anatomy of mental disturbances in old age.

In senile psychoses, apart from dementia senilis, in which diffuse changes are evident in the cerebral cortex, we can identify various forms of focal disease, with the common cause of cerebrovascular arteriosclerosis.

1. Senile sclerosis of the cerebral cortex is a disease which, in its pure form, exclusively affects the cerebral cortex and results from arteriosclerotic degeneration of the small cortical vessels. It leads to development of small degenerated cortical areas with a breakdown of nervous elements and the substitution of connective tissue. The old foci are often wedge-shaped, with the broad base touching the surface. Together with diffuse senile changes, this form of senile psychosis is common in old age and occurs only rarely in severe arteriosclerosis in younger persons.

2. Arteriosclerotic atrophy of hemispheric white matter was described by Binswanger as encephalitis subcorticalis chronica. The cause of this disease is arteriosclerotic degeneration of the long vessels supplying the white matter. In fresh foci, the degenerated vessel is surrounded by numerous granular cells. Old foci show decay of myelin fibers and glial proliferation replacing the nervous substance. In pure cases, the cortex is affected only secondarily. The white matter atrophy can be excessive. This form occurs more often in middle age and in early senescence with severe, generalized arteriosclerosis.

3. Arteriosclerotic dementia which Binswanger and I described earlier essentially differs from the second form only in degree. The long vessels of the white matter are again the major target of disease, leading to secondary degeneration of the myelin fibers. Widespread destroction ofthe white matter is rare, however. Mild, focal vascular changes in the cortex are almost invariably present. This form is also most frequent in the age range of 45-60 years.

4. Perivascular gliosis, which I described earlier, shows a striking similarity to encephalomalacia and appears to occur mainly in the territories of the larger brain arteries. I recently showed in such a case that the vessel supplying the affected gyros had degenerated markedly and was much narrower than the other arteries. Severe degeneration of a large vessel, which has not yet led to occlusion, but has resulted in undemourishment in the corresponding cortical area, must therefore be considered the cause of perivascular gliosis. Consequently, atrophy of the nervous tissue restricted to a few cortical gyri together with a peculiar glial proliferation is evident.
All these forms must be considered subtypes of arteriosclerotic brain atrophy, however. (Alzheimer's presentation was illustrated by numerous microphotographs.)

(Translated by Hans Förstl and Barbara Beats.
Alois Alzheimer worked and published extensively on organic mental syndromes caused by arteriosclerotie brain disease. He summarized his thoughts about the neuropathologic nature of different forms of arteriosclerotie brain atrophy in this paper read at the 26th Conference of the South-German Alienists. In 1899, it was published twice in identical form. This translation is unabridged.)