From “Senile Old Fool” to “Alzheimer’s Patient”
A Brief Look Back at a Great Misunderstanding
If the history of Alzheimer’s disease were a fairy tale, a short story, we could tell it in three acts. In the first, we would describe a situation common to every era: the older person “loses their mind,” their behaviour becomes strange and inexplicable. A timeless phenomenon, observed throughout history and still surprising us today. In the second act, the concept of “dementia” would make its appearance, beginning to take shape roughly 2,000 years ago. And in the third, we would have the first presentation and recorded description of “Alzheimer’s disease” as a clinical entity, in 1910.
The thread unspools and the story begins. Three stops to follow it.
1. The “Senile Old Fool”
The strange and unsettling behaviours of older people have been described since the beginning of written record. The Egyptian Ebers Papyrus, one of the oldest medical texts in the world, refers to “the loss of mind and the fact that we forget in old age.” Many centuries later, in the 1st century AD, the Roman satirical poet Juvenal writes: “A misery worse than any bodily decline — the old man no longer has his wits. He no longer remembers the names of his slaves, cannot recognise the face of the friend with whom he ate and drank the day before, nor the children he fathered and raised.” And from 1550 BC to 1550 AD, when Montaigne writes his essays, the picture he presents is not far from what the ancient Egyptians recorded in their papyrus: “Sometimes the body surrenders first to old age. And other times, the mind goes first; I have seen many whose heads weakened long before their stomachs or their legs.”
This “weakening of the head” causes unease. To describe such a condition, from ancient Greece to the present day, we reach for a metaphor: the older person “loses their mind.” In common understanding, old age becomes directly associated with madness. The language itself is far from innocent: the Greek words for “senile fool,” “crazy old man,” “demented elder” all make vivid what the underlying assumption is. The idea that there is some kinship between old age and madness finds its most colourful expression in the vocabulary we use.
2. The Concept of “Dementia”
The term “dementia” (from the Greek privative “a” plus “nous,” mind) first appears in ancient Greek literature as far back as Homer, though not with its current meaning. It is used initially to denote rashness, superficiality. As a disease, dementia appears for the first time in the work of Galen, the most important physician after Hippocrates, who classifies it among the “diseases of the mind,” alongside ecstasy, stupor, vertigo and phrenitis.
In the modern era, dementia appears for the first time as a medical term in 1800, in the work of French psychiatrist Philippe Pinel. Pinel describes it as a state of discontinuity between mental functions — a disorder of the integrative capacity. His student Esquirol would elaborate further on the weakening of memory and offer the first detailed description: “dementia is a cerebral affliction characterised by weakening of perception, intelligence and will.” Esquirol also established the first diagnostic criteria: dementia is chronic and irreversible. Around the same time, the concept of “senile dementia” emerged and the question began to be approached anatomically. Scientists such as Broca and Wernicke searched the brain for the lesions responsible for each symptom. For a long time, however, dementia attracted little scientific interest, considered simply an atypical form of cognitive decline related to ageing and affecting a small number of people.
Well into the late 20th century, scientific opinion distinguished two types of dementia: pre-senile, brutal and aggressive, and senile, slower and more progressive. The DSM-IV diagnostic manual, published in 1994, brought greater precision. Cognitive deficit would need to include above all memory disturbances, alongside other disorders such as agnosia, apraxia, aphasia and executive dysfunction. A significant, previously unobserved difficulty in the activities of daily living was also established as a diagnostic criterion.
Today, dementia is not considered a distinct disease but a “condition,” a cluster of symptoms that can result from many different causes. The term remains fairly broad and ambiguous, and is frequently confused with Alzheimer’s.
3. Alzheimer’s Disease
The real history of the disease begins on 26 November 1901 at the municipal asylum in Frankfurt, where German neuropathologist and psychiatrist Alois Alzheimer carries out the clinical examination of a 51-year-old woman, Augusta D. Alzheimer notes severe disturbances in her immediate memory, significant disorientation in time and space, prosopagnosia (impaired recognition of faces), language disorders, and on some occasions delusional states and hallucinations. In his observation notebook he writes: “The patient remembers her name, age and date of birth, but cannot recall her place of birth or her place of residence. She does not know what day it is, nor how long she has been here.”
Alzheimer continues to follow his patient for years. Her condition deteriorates steadily. By 1905, Augusta D. spends most of her time in bed, legs drawn up to her chest, crying out frequently and resisting every clinical examination. A few months later, in the spring of 1906, she dies at the age of 56. After her death, Alzheimer performs a brain autopsy and observes two types of lesion that are still considered the morphological hallmarks of the disease today. He presents his findings to the scientific community, and in 1910 “Alzheimer’s disease” is recorded for the first time as a clinical entity in the diagnostic manuals of the era.
During the second half of the 20th century, the disease ceases to be a matter of isolated cases and becomes a public health issue. Diagnostic criteria are proposed, official documents drawn up, risk factors, trajectories and intervention techniques studied. Newspapers, radio and television speak of “the epidemic of the century.” Famous patients such as Rita Hayworth and Ronald Reagan bring the disease into public consciousness. The word “Alzheimer’s” enters everywhere — the media, everyday vocabulary — gradually acquiring a political dimension as well. In this way the disease becomes detached from old age. It is no longer seen as an illness of the elderly, but as something that concerns all of us, each one individually.
Madness, dementia, Alzheimer’s. Every era describes in its own terms a deeply human, subjective experience. Those who would once have been called “crazy old fools” are today called patients. The shift in perspective has led us to speak primarily of deficits and losses, of minus signs and absences. Now that this strange and difficult word “Alzheimer’s” is everywhere, the challenge remains singular: let us not hold ready-made ideas about the disease. Let us remember that each case manifests and is lived very differently by each person. Let us believe that even in the most severe memory loss, the subject is still there. And let us finally take the step of not losing the person behind the illness.
