Senile Dementia of the Alzheimer Type: Diagnostic and Differential Diagnostic Features with Special Reference to Functional Assessment Staging

Abstract

At the time we embarked on our investigations into the clinical symptomatology of senile dementia of the Alzheimer type (SDAT) approximately 6 years ago, little was known about this disorder. Old age as a cause of dementia had been recognized by Aretaeus of Cappadocia and popularized by Galen in the second century A.D. (Adams 1861; Galen 1821–1833). This conception does not appear to have advanced further until Rush’s seminal description of a patient with “the marks of second infancy” (Rush 1793). In 1838, Esquirol provided a more general definition of “démence sénile” as an illness: (a) in which there occurs a weakening of the memory for recent experiences and a loss of drive and willpower; (b) which appears gradually; and (c) which may be accompanied by emotional disturbances. At approximately the same time, Prichard (1837) described an entity he called “senile incoherence”, which he divided into four successive stages: (a) impaired memory; (b) loss of reasoning power; (c) incomprehension; and (d) loss of instinctive action. In 1907, Alzheimer described the case of a woman who succumbed to the illness in her fifties.