She was fifty-one
The dementia counter is a disease of old age. The woman it was named for was 51, and she died of an infected bedsore.
This counter is dementia, Alzheimer's disease and the dementias of old age that travel with it. The Ledger rounds it to 2.3 million deaths a year. A WHO estimate for 2021, already cited on this site, put Alzheimer's disease and other dementias at about 1.8 million. Both are estimates. The gap is rounding and method, not two different diseases. The card is the loss of memory and judgement severe enough to be written as the cause of death.
The woman it was named for does not match that description. She was not old.
Frankfurt, Germany, 1901
On 25 November 1901, Auguste Deter was admitted to the asylum in Frankfurt, Germany. She was 51. Over the previous year she had become jealous, frightened of people she knew, and unable to hold on to what had just happened. Alois Alzheimer examined her the next day and wrote down what he asked and what she answered. Her name? Auguste. Her last name? Auguste. Her husband's name? Auguste, she thought. Was she married? To Auguste. He addressed her as Mrs D, and she agreed: yes, Auguste D. He showed her a pencil. She called it a pen. At lunch she ate cauliflower and pork, and when he asked what she was eating she said spinach. He asked her to write her name. She managed a fragment, stopped, and said she had lost herself.
The line is not a caption written later for a film. It is in the case file, in the notes of that admission. The file then went missing. It turned up again in 1995, in Frankfurt, unseen since 1909.
The brain, and the name
Alzheimer left Frankfurt in 1903 and followed Emil Kraepelin to Munich, Germany. He kept track of her from there. She declined quickly for a dementia. She became bed-bound. On 8 April 1906, she died of blood poisoning from bedsores. The notes also record pneumonia. Alzheimer had the brain sent to Munich. In it he found the plaques and the tangled fibres that still define the disease under a microscope.
He described the case in Tübingen, Germany, in November 1906. The published text calls her a woman of 51 and does not give her name. The chairman of the session did not think the paper needed discussion, and moved on. Kraepelin, in the 1910 edition of his textbook, attached Alzheimer's name to the illness. For a long time that name meant the rare, fierce version that struck people in middle age, because the famous patient had been 51. The common loss of memory in old age was spoken of as something else. Later work showed the same findings in the brains of the old. The name spread to cover them. The card on this site is that later, larger meaning.
Why the counter climbed
Her death, were it certified the way many are now, might have said dementia. In 1906 it was the infected bedsore that killed her, with pneumonia in the lungs. That is still how a lot of these deaths actually end. What changed is the willingness to name the dementia underneath, and the number of people who live long enough to have one. England and Wales now record dementia as the leading cause of death. Very little of that climb is a new disease appearing. It is age, and it is paperwork. What actually kills people goes further into that. This piece is about the person the paperwork was named for, and about how unlike the counter she was.
This is not health advice. It is a story about a population statistic. It says nothing about any one person's risk. If you have concerns about your health, speak to a doctor.
Sources
- Maurer, Volk and Gerbaldo, The Lancet, 1997, on the rediscovery of Auguste Deter's file.
- Alzheimer's 1907 paper, “Über eine eigenartige Erkrankung der Hirnrinde”.
- Emil Kraepelin, Psychiatrie, 8th edition, 1910, where the illness is given Alzheimer's name.
- The WHO figure of about 1.8 million deaths is the one already used in What actually kills people.
- The annual figure used on the counter is the Ledger's own rounding, set out on the methodology page.