Although Alzheimer’s “disease name was not common before [the] 1970s,”[1] disorders of the mind have been noted since ancient times. You can trace a flow of concepts from Galen’s ánoia (literally, “mindlessness”); to the early notions of “idiocy,” “insanity” and “lunacy”; to impressive-sounding conditions such as “dementia præcox,” “presbyophrenia,” and “senility” that are the theoretical precursors of Alzheimer’s and other sorts of dementias that are recognized by modern medicine.
It is sheer speculation as to whether or not these conditions are related – or identical. If they are merely different names for the same condition, then Alzheimer’s has been around since at least the times of Ancient Greece and Rome. If the conditions are not the same, then Alzheimer’s is a recent – say, 20th-21st-century development.
I cannot settle these questions. But the history is interesting in its own right.
Premodern Era
Several investigators have argued that Alzheimer’s – or at least some sort of age-related dementia – was known to ancient authors.[2] I’ll just give one example.
The famed 2nd-3rd– century Greco-Roman medical researcher and physician Galen of Pergamon left us with several important works.[3] Galen described a set of Alzheimer’s-like conditions that he designated morosis and moria. “They involve memory loss, often connected with reduced capacity for reason. …Galen also mentions the condition of anoia, which is the complete failure of the intellect and the memory. …[H]e advances the cooling of the brain as an explanatory factor. The hazardous use of such intoxicating substances as opium is also mentioned. Finally, he associates complete memory loss and the cooling of the brain with old age. At an advanced age, some individuals can no longer recite the alphabet or know their own names.”[4]
Modern Era
Pre-Twentieth Century
Prior to the 20th century, dementia was treated as a type of “insanity” or “lunacy.”
Vocabulary: The word “lunacy …literally [means] moon-madness. Nearly every culture has believed such external forces as the ‘evil’ moon arbitrarily caused madness. The word ‘lunatic’ – one who is moonstruck – derives from the Latin Luna, the moon goddess. Such explanations for insanity were common even in sophisticated Europe until the 18th Century.”[5]
Philippe Pinel, an 18th-19th-century French doctor who has sometimes been called the “father of modern psychiatry,”[6] revised the way in which mental disorders were classified. On Pinel’s scheme, insanity had “four principal divisions – mania, melancholy, dementia, and idiocy. [18th-19th-century French psychiatrist Jean-Étienne Dominique] Esquirol added monomania. …Drunkenness is considered as one of the most powerful causes of insanity…”[7]
Twentieth Century
Around the turn of the 20th century, dementia was spoken of as a precursor to death.
“The signs of approaching D[eath] require a brief notice. The mind may be affected in various ways; there may be dullness of the senses, vacancy of the intellect, and extinction of the sentiments, as in natural D[eath] from old age; or there may be a peculiar delirium, closely resembling dreaming, which is usually of a pleasing and cheerful character. …In dreadful contrast with such visions, are those which haunt the dying minds of others, when it would sometimes almost appear as if the sinner’s retribution commenced even on his death-bed.
“Dementia or imbecility sometimes comes on shortly before D[eath], and manifests itself by an incapacity of concentrating the ideas upon any one subject, and by an almost total failure of memory. The mental weakness is often exhibited by the pleasure which is derived from puerile amusements.”[8]
Otherwise, dementia was subsumed under the heading of “insanity,” meaning, basically, “unsoundness of mind.” “The different forms of insanity are usually considered under the following divisions: 1. Melancholia; 2. mania; 3. Dementia; 4. Imbecility; 5. Idiocy; 6. General Paralysis… .”[9]
It is somewhat difficult to follow a description of this thinking. But some features of this progression towards “general paralysis” are worth rehearsing.
“The subjects are nearly always males. A man is observed to depart suddenly from his ordinary habits; he seems to have lost his conscience; will make no apology for misconduct, of which he is constantly guilty. He fails to keep appointments, is often extremely immodest, and is easily roused to uncontrollable passion. As the disease advances he becomes sullen and more excitable, so that before long his friends are obliged to put him under restraint. …The speech becomes defective, accompanied by a peculiar stammer… The last stage, that of dementia, is truly pitiable; there is constant tremor, he loses his power to swallow, and will often cram food into his mouth until his cheeks are no longer capable of distension.”[10]
Of course, the 19th-20th-century “German psychiatrist and neuropathologist Alois Alzheimer …is credited with being the first to identify and describe the pathological features of Alzheimer’s disease in 1907.”[11]
1910s
“In 1911, the Swiss psychiatrist Eugen Bleuler published the historic work Dementia Præcox; or the Group of Schizophrenias. Bleuler has devoted years of painstaking effort to the observation and description of the symptoms of psychotic patients…”[12]
Vocabulary: “Dementia præcox is the name provisionally applied [circa 1904] to a large group of cases which are characterized in common by a pronounced tendency to mental deterioration of varying grades.”[13]
1920s
In the title of a dissertation published in French in the 1920s, I found a reference to Alzheimer’s as a “senium præcox,” that is (roughly), a schizophrenia-like psychiatric malady afflicting people in the final stage of life.[14] This appears to be a variant, and possible refinement, of the previously mentioned dementia præcox.
Vocabulary: “Senium” is “the final period in the normal life span”[15] of a human being.
1940s
It seems that in the 1940s, Alzheimer’s-like cognitive afflictions were referred to as “senile dementia.” One [] ventured its opinion that “the diseases of the senium (psychosis with arteriosclerosis and senile dementia) are on the increase.”[16]
1960s
During the 1960s, Alzheimer’s was often grouped together with forms of “psychosis,” or “a mental disorder or disease characterized by defective insight, decrease or loss of contact with reality, and alterations in the personality structure; a psychosis is to be distinguished from a neurosis, in which the personality and grasp on reality remain largely intact.”[17]
Specifically, Alzheimer’s was considered a “Psychosis Caused by Disease,” and it was lumped in with other conditions such as Pick’s. “Presenile dementias, such as Pick’s disease and Alzheimer’s disease, are marked by rapidly progressive mental deterioration.”[18]
However, there was also a category of “Senile Psychoses. Senile Psychoses are caused by widespread and ill-defined degenerative changes in the aging brain, and usually occur after the age of 65. They develop gradually, with increasing loss of efficiency and impairment of memory, particularly for recent events. Irritability, restlessness, insomnia, and anxiety are common, but deep depressions seldom occur. Lack of orientation, confusion, incoherent speech, and mental deterioration are typical. They are classified according to typical symptoms. The presbyophrenic type (literally ‘old brain’) is marked by loquacity and fabrications; the paranoid type by delusions of persecution and grandeur.”[19]
Vocabulary: “Presbyophrenia” is “a form of senile dementia characterized by loss of memory and sense of location, disorientation, and confabulation.”[20]
1990s
By the end of the 20th century, Alzheimer’s was being mentioned alongside conditions like Frontotemporal Dementia[21] (frontotemporal-lobar atrophy), Lewy body dementia,[22] Parkinson’s Disease,[23] and Vascular Dementia[24] (a.k.a. Multi-Infarct Dementia[25]). It is worth noting that physicians also currently recognize “Mixed Dementia” — being a combination of other, diagnosable dementias — as well as “Unspecified Dementia” — which, as its name suggests, is unable to be definitely named. Additionally, the phrase “senile dementia” still crops up in the literature from time to time.[26]
Further Resources
“What Is Alzheimer’s Disease? A Brief Overview”
“Does Alzheimer’s Disease Have Three Stages or Seven Stages?”
“Is Alzheimer’s Disease a Terminal Illness?”
Notes:
[1] Douglas Harper “Alzheimer’s,” Online Etymology Dictionary, 2019, <https://www.etymonline.com/word/Alzheimer’s%20disease>.
[2] The professors who really got into this were Nicole Berchtold and Carl Cotman in their scholarly article “Evolution in the Conceptualization of Dementia and Alzheimer’s Disease: Greco-Roman Period to the 1960s,” Neurobiology of Aging, vol. 19, no. 3, 1998, pp. 173-189
[3] Including On the Natural Faculties and De motu musculorum.
[4] Christian Laes, Disabilities and the Disabled in the Roman World: A Social and Cultural History, Cambridge: Cambridge Univ. Press, 2018, pp. 70-71, <https://books.google.com/books?id=Q0FPDwAAQBAJ&pg=PA70>.
[5] “The Mind Under Stress and in Disarray,” John Rowan Wilson, et al., eds., The Mind, Life Science Library, New York: Time Inc., 1964, p. 58.
[6] Other times, this title has been reserved for Emil Kraepelin, a 19th-20th-century German psychologist who pioneered the studies of manic-depression, schizophrenia, and – along with his colleague, Alois Alzheimer – Alzheimer’s Disease. See Kraepelin’s Psychiatrie; ein Lehrbuch für Studierende und Ärzte (“Psychiatry: A Textbook for Students and Doctors”), Leipzig: Barth, 1909-1915.
[7] “Insanity,” Harry Thurston Peck, Selim Hobart Peabody, and Charles Francis Richardson, eds., The International Cyclopædia: A Compendium of Human Knowledge, vol. 8, New York: Dodd, Mead and company, 1900, p. 36, <https://books.google.com/books?id=1lQKAQAAMAAJ&pg=PA36>.
[8] “Death,” Harry Thurston Peck, Selim Hobart Peabody, and Charles Francis Richardson, eds., The International Cyclopædia: A Compendium of Human Knowledge, vol. 4, New York: Dodd, Mead and company, 1900 p. 654, <https://books.google.com/books?id=UVIKAQAAMAAJ&pg=PA654>.
[9] “Insanity,” loc. cit., p. 37.
[10] “Insanity,” loc. cit., p. 38.
[11] Blurb, “Alois Alzheimer,” <https://books.google.com/books/about/Alois_Alzheimer.html?id=ymTWuAEACAAJ>.
[12] Glenn Shean, Schizophrenia: An Introduction to Research and Theory, Lanham, Md.: Univ. Press of America, 1978; 1987, p. 20, <https://books.google.com/books?id=stZrAAAAMAAJ>.
[13] Ibid., p. 19.
[14] See Jean Cuel, La maladie d’Alzheimer. Senium præcox. Démence pré-sénile avec symptomes de lésions en foyer (“Alzheimer’s Disease. Senium Præcox. Pre-Senile Dementia With Symptoms of Focused Lesions.), Paris: n.p., 1924.
[15] “Senium,” Merriam-Webster Dictionary, online, 2019, <https://www.merriam-webster.com/medical/senium>.
[16] American Psychopathological Association, Trends of Mental Disease, New York: King’s Crown Press, 1945, p. 9, <https://books.google.com/books?id=RsNrAAAAMAAJ>.
[17] Beatrice Van Rosen, “Psychosis,” William Halsey and Louis Shores, eds. Collier’s Encyclopedia, vol. 19, [New York:] Crowell-Collier Publ. Co., p. 473.
[18] Ibid., p. 474.
[19] Ibid.
[20] “Presbyophrenia,” Merriam-Webster Dictionary, online, 2019, <https://www.merriam-webster.com/medical/presbyophrenia>.
[21] Bradford Dickerson, Hodges’ Frontotemporal Dementia, Cambridge: Cambridge Univ. Press, 2016.
[22] For more on this, see Alastair Gray, The Comparative Neuropsychology of Alzheimer’s Disease and Dementia With Lewy Bodies, dissertation, Newcastle upon Tyne : University of Newcastle upon Tyne, 2002.
[23] See Steven Huber and Jeffrey Cummings, Parkinson’s Disease: Neurobehavioral Aspects, Oxford: Oxford Univ. Press, 1992 and American Parkinson Disease Association, Greater St. Louis Chapter, The Parkinson Journey: From Diagnosis to Treatment to Cure, St. Louis, Mo.: Washington Univ., 2012.
[24] See Patricia Cornett, Risk Factors for Vascular Dementia, [Denton, Tex.]: Univ. of North Texas, 2005.
[26] See W. Danielczyk, “Various Mental Behavioral Disorders in Parkinson’s Disease, Primary Degenerative Senile Dementia, and multiple Infarction Dementia,” Journal of Neural Transmission, vol. 56, nos. 2-3, 1983, pp. 161-76, <https://www.ncbi.nlm.nih.gov/pubmed/6864207>.