Incidence of Alzheimer's Disease in a Large Mental Hospital

Abstract

SYSTEMATIC histologic studies by means of silver-staining techniques of large numbers of brains from autopsies at St. Elizabeths Hospital have demonstrated the widespread distribution of argyrophilic plaques and neurofibrillary changes in a proportion of persons larger than had been anticipated. The brains of such patients were in general smaller than the average and showed varying degrees of atrophy and mild or advanced ventricular dilatation without obstruction to the flow of cerebrospinal fluid. Sclerotic or atheromatous plaques were often observed in the walls of large vessels, but the vascular changes did not appear to be of sufficient magnitude to account for the clinical picture. Only in rare instances were focal lesions observed in this group.Many of the patients were above the age limits to which Alzheimer's disease is generally attributed. A large number had entered the hospital at an advanced stage of their illness, when neurologic signs were prominent. The most commonly mentioned manifestations of central nervous system pathology were forced crying and laughing, or emotional lability, forced grasping, pseudobulbar paralysis, and speech disturbances. These appeared late in the disease. The clinical histories were indica¬ tive of a long progressive mental deterioration, with no disturbance in the motor sphere in the early phases.Few articles on Alzheimer's disease have appeared in the literature in recent years, although in previous decades the condition occupied the interest of many neuropathologists. In these early reports two schools of thought emerged : those who believed that Alzheimer's disease was a presenile form of senile dementia with a similar clinicopathologic picture, but one which occurred in an earlier age group and showed more intense histologie changes ; and those who arrived at the conclu¬ sion that the characteristic microscopic alterations could be the result of etiologic factors other than senility and that many senile persons did not show "senile" plaques or Alzheimer's neurofibrillary changes. Since opinion is apparently still divided as to the classification of Alzheimer's disease, it seemed pertinent, especially in view of the current interest in geriatric problems, to restudy the subject. METHOD AND MATERIALThis presentation is based on the histologie study of the brains of 210 patients at St. Eliza¬ beths Hospital. For 100 of these patients the diagnosis was psychosis with cerebral arterio¬ sclerosis, and for 50, senile psychosis ; and 60 were chosen from miscellaneous categories. The

A Comparative Study of the Neuropathologic Findings in Senile Psychoses and in “Normal” Senility*

“…Despite Gellerstedt's reservations, however, a number of subsequent investigators drew the definite inference from his study that, as stated previously, “no significant relation exists between brain alterations, thinking and behavior.”For example, Rothschild (3) emphasized that since discrepancies exist between the severity of the clinical and pathologic findings in cases of senile and arteriosclerotic psychoses, the anatomic factor is of lesser importance than the social and psychologic factors which ultimately determine the ways in which different people compensate or not for brain damage. Contradictory findings continue to be reported in the literature concerning the presence or absence of brain changes in association with the normal aging process, both in human and animal material (4–10). A major deficiency in such investigations has been their lack of statistical value, as pointed out in a recent monograph by Corsellis (11), who sought to overcome this drawback by investigating statistically a large amount of material.…”

A Comparative Study of the Neuropathologic Findings in Senile Psychoses and in “Normal” Senility*

“…Despite Gellerstedt's reservations, however, a number of subsequent investigators drew the definite inference from his study that, as stated previously, “no significant relation exists between brain alterations, thinking and behavior.”For example, Rothschild (3) emphasized that since discrepancies exist between the severity of the clinical and pathologic findings in cases of senile and arteriosclerotic psychoses, the anatomic factor is of lesser importance than the social and psychologic factors which ultimately determine the ways in which different people compensate or not for brain damage. Contradictory findings continue to be reported in the literature concerning the presence or absence of brain changes in association with the normal aging process, both in human and animal material (4–10). A major deficiency in such investigations has been their lack of statistical value, as pointed out in a recent monograph by Corsellis (11), who sought to overcome this drawback by investigating statistically a large amount of material.…”

Parkinson disease, dementia, and alzheimer disease: Clinicopathological correlations

“…The clinical history and pathological features (presence of Lewy bodies with no FTs in the midbrain) of our cases practically rule out these other conditions. SPs and FTs are also found in normal elderly individuals, making the histological differential diagnosis between aging and A D quantitative rather than qualitative [4,11,32,[49][50][51].…”

The past, present and future of Alzheimer's disease – part 1: the past

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32 33…”

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32,33 The paper by Roth, Tomlinson, and Blessed (1966) was very important because they used clinical and pathological data to confirm the correlation between the number of senile plaques and dementia severity. 34 Two other papers were also very important.…”

A Comparative Study of the Neuropathologic Findings in Senile Psychoses and in “Normal” Senility*

“…Despite Gellerstedt's reservations, however, a number of subsequent investigators drew the definite inference from his study that, as stated previously, “no significant relation exists between brain alterations, thinking and behavior.”For example, Rothschild (3) emphasized that since discrepancies exist between the severity of the clinical and pathologic findings in cases of senile and arteriosclerotic psychoses, the anatomic factor is of lesser importance than the social and psychologic factors which ultimately determine the ways in which different people compensate or not for brain damage. Contradictory findings continue to be reported in the literature concerning the presence or absence of brain changes in association with the normal aging process, both in human and animal material (4–10). A major deficiency in such investigations has been their lack of statistical value, as pointed out in a recent monograph by Corsellis (11), who sought to overcome this drawback by investigating statistically a large amount of material.…”

Parkinson disease, dementia, and alzheimer disease: Clinicopathological correlations

“…The clinical history and pathological features (presence of Lewy bodies with no FTs in the midbrain) of our cases practically rule out these other conditions. SPs and FTs are also found in normal elderly individuals, making the histological differential diagnosis between aging and A D quantitative rather than qualitative [4,11,32,[49][50][51].…”

The past, present and future of Alzheimer's disease – part 1: the past

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32 33…”

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32,33 The paper by Roth, Tomlinson, and Blessed (1966) was very important because they used clinical and pathological data to confirm the correlation between the number of senile plaques and dementia severity. 34 Two other papers were also very important.…”

A Comparative Study of the Neuropathologic Findings in Senile Psychoses and in “Normal” Senility*

“…Despite Gellerstedt's reservations, however, a number of subsequent investigators drew the definite inference from his study that, as stated previously, “no significant relation exists between brain alterations, thinking and behavior.”For example, Rothschild (3) emphasized that since discrepancies exist between the severity of the clinical and pathologic findings in cases of senile and arteriosclerotic psychoses, the anatomic factor is of lesser importance than the social and psychologic factors which ultimately determine the ways in which different people compensate or not for brain damage. Contradictory findings continue to be reported in the literature concerning the presence or absence of brain changes in association with the normal aging process, both in human and animal material (4–10). A major deficiency in such investigations has been their lack of statistical value, as pointed out in a recent monograph by Corsellis (11), who sought to overcome this drawback by investigating statistically a large amount of material.…”

Parkinson disease, dementia, and alzheimer disease: Clinicopathological correlations

“…The clinical history and pathological features (presence of Lewy bodies with no FTs in the midbrain) of our cases practically rule out these other conditions. SPs and FTs are also found in normal elderly individuals, making the histological differential diagnosis between aging and A D quantitative rather than qualitative [4,11,32,[49][50][51].…”

The past, present and future of Alzheimer's disease – part 1: the past

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32 33…”

“…After the Second World War, a series with more than 140 cases was published, which showed that there was no reason to separate AD from senile dementia. 32,33 The paper by Roth, Tomlinson, and Blessed (1966) was very important because they used clinical and pathological data to confirm the correlation between the number of senile plaques and dementia severity. 34 Two other papers were also very important.…”