Auguste Deter

Auguste Deter (German pronunciation:[aʊ̯ˈɡʊstəˈdeːtɐ], née Hochmann; 16 May 1850 – 8 April 1906) was a German woman notable for being the first person to be diagnosed with Alzheimer's disease.

Deter was born in Kassel, Hesse-Kassel on May 16, 1850. Born into a working-class family, Auguste had three siblings and was a daughter of Johannes Hohmann.

Deter's father died when she was young. Even though Deter's family was impoverished, she was well-educated. She attended school in Cassell, and it is speculated that she may have been a student of Alois Alzheimer's grandfather, Johann. He was a schoolmaster in Cassell during the time Deter attended school. Further education was not possible for Auguste due to social norms and her family's financial situation.

Deter started work as a full-time seamstress assistant at the age of 14. She continued this career until she married Carl August Wilhelm Deter on 1 May 1873, at the age of 22.

In 1888, Carl began work as a railway clerk. After marrying Carl, Deter moved to Frankfurt, Germany, where she was a full-time housewife. Carl described their marriage as "happy and harmonious". The couple had one daughter named Thekla.

Deter became ill in the spring of 1901 at the age of 50. She was admitted to a psychiatric hospital later that year in November, where she lived for the rest of her life.

Auguste and Carl were married for 33 years until her death on 8 April 1906 at the age of 55, just five weeks shy of her 56th birthday.^[1]

During the late 1890s, Deter exhibited a rapid escalation in memory loss and started showing symptoms of dementia, such as loss of memory, delusions, and even temporary vegetative states.^[2] In March 1901, Auguste's behavior started to become out of control. She began to accuse Carl of being adulterous and soon became jealous. Auguste started to become inattentive with housework, purposely hid objects and lost her capacity to cook. She also developed insomnia, which caused her to drag sheets outside the house and scream for hours in the middle of the night. She became paranoid over neighbors and strangers as she believed someone was out to kill her.

As a railway worker, Carl was unable to provide adequate care for his wife and was given recommendations by a local doctor to admit her into a mental hospital. She later was admitted to a mental institution, the Institution for the Mentally Ill and for Epileptics (Irrenschloss) in Frankfurt on 25 November 1901. There, she was examined by Alois Alzheimer.

Carl visited Deter whenever possible, though he struggled to make payments for her care and stay. It would have been more financially efficient to spend the time at work. Having difficulty keeping up with the payments, Carl continued insisting on getting her into a more affordable facility. Such a transfer would remove Deter from Alzheimer's care, but Carl continued to persist in transferring Deter. When asking Alzheimer for an arrangement of hospital transfers, Alzheimer discouraged him from such a decision; instead, he offered him an agreement for her to continue to receive care without cost in exchange for her medical records and brain after death, to which Carl gave a signed consent.^[3]

Alzheimer asked her many questions, then later asked again to see if she would remember. He asked her to write her name. She tried to, but would forget the rest and repeat: "I have lost myself." (German: Ich habe mich verloren.) He later put her in an isolation room for a while. When he released her, she would run out screaming, "I will not be cut. I do not cut myself."^[4]

Después de muchos años, quedó completamente aturdida por la demencia, murmurando para sí misma. Murió el 8 de abril de 1906. Más de un siglo después, su caso fue reexaminado con tecnologías médicas modernas, donde científicos de Gießen y Sydney encontraron una causa genética para su enfermedad . Los resultados se publicaron en la revista The Lancet Neurology . Según este artículo, se encontró una mutación en el gen PSEN1 , que altera la función de la gamma-secretasa y se conoce como una posible causa de la enfermedad de Alzheimer de inicio temprano . ^{[ 5 ]} Sin embargo, los resultados no pudieron replicarse en un artículo más reciente publicado en 2014 donde "el ADN de Auguste D no reveló ninguna indicación de una mutación heterocigota u homocigota no sinónima en los exones de los genes APP , PSEN1 y PSEN2 que comprenden las mutaciones familiares de EA ya conocidas ". ^{[ 6 ]} Se sugiere que la hija de Auguste, Thekla, habría tenido un 50% de probabilidad de heredar el gen PSEN1 y desarrollar Alzheimer, aunque no hay información registrada de que haya desarrollado dicha enfermedad. ^{[ 7 ]}

Alzheimer concluyó que ella había perdido la noción del tiempo y del espacio. Apenas recordaba detalles de su vida y con frecuencia daba respuestas incoherentes y sin relación con la pregunta. Su estado de ánimo cambiaba rápidamente entre ansiedad , desconfianza, retraimiento y quejas constantes. No podían dejarla deambular por las salas porque acosaba a otros pacientes, quienes a su vez la agredían. No era la primera vez que Alzheimer observaba una degeneración psicótica completa en pacientes, pero anteriormente estos habían tenido setenta años. Deter despertó su curiosidad porque ella era mucho más joven. En las semanas siguientes, continuó interrogándola y registrando sus respuestas. Ella respondía con frecuencia: "¡Oh, Dios!" y "Me he perdido, por así decirlo". Parecía ser plenamente consciente de su impotencia. Alzheimer la denominó la "enfermedad del olvido".

In 1902, Alzheimer left the Irrenschloss (Castle of the Insane), as the institution was known colloquially, to take up a position in Munich, but he made frequent calls to Frankfurt inquiring about Deter's condition. On 9 April 1906, Alzheimer received a call that Auguste Deter had died. He requested that her medical records and brain be sent to him. Her chart recorded that in the last years of her life her condition had deteriorated considerably. Her death was the result of sepsis caused by an infected bedsore. With the aid of the Italian physicians Gaetano Perusini and Francesco Bonfiglio, he carefully examined her brain to discover senile plaques and neurofibrillary tangles. These are the hallmark of Alzheimer's disease as scientists know it today. Deter would have been diagnosed with early-onset Alzheimer's disease if seen by a modern doctor.^[8]

In 1996, Konrad Maurer and his colleagues, Stephan Volk and Hector Gerbaldo, rediscovered the medical records of Auguste Deter.^[9] In these documents, Alzheimer had recorded his examination of his patient, including her answers to his questions:

"What is your name?" "Auguste." "Family name?" "Auguste." "What is your husband's name?" - she hesitates, finally answers: "I believe... Auguste." "Your husband?" "Oh, my husband." "How old are you?" "Fifty-one." "Where do you live?" "Oh, you have been to our place." "Are you married?" "Oh, I am so confused." "Where are you right now?" "Here and everywhere, here and now, you must not think badly of me." "Where are you at the moment?" "We will live there." "Where is your bed?" "Where should it be?"

Around midday, Deter ate pork and cauliflower.

¿Qué estás comiendo? Espinacas. (Estaba masticando carne.) ¿Qué estás comiendo ahora? Primero como patatas y luego rábano picante. Escribe un '5'. [Alemán: fünf ] Ella escribe: "Una mujer" [ Frau ] Escribe un '8'. [ acht ] Ella escribe: " Auguse " ( sic , mientras escribe dice repetidamente: "Me he perdido, por así decirlo").

• Works by or about Auguste Deter at the Internet Archive
• Alois Alzheimer Who Named It?
• Alzheimer's: 100 years on
• Alois Alzheimer's Biography. International Brain Research Organization
• Laboratory for Neurodegenerative Disease Research at LMU Munich – Christian Haass
• Bibliography of secondary sources on Alois Alzheimer and Alzheimer's disease, selected from peer-reviewed journals.
• Graeber Manuel B. "Alois Alzheimer (1864–1915)". International Brain Research Organization
• "The Story of Auguste Deter"^[1]