Box 2.
Arteriosclerotic atrophy of the brain: the 2nd group encompassing “severe progressive arteriosclerotic brain degeneration”.9,12
| This group encompasses cases of Progressive
arteriosklerotische Hirndegeneration (Progressive arteriosclerotic brain degeneration) and includes cases related to the “severe form of arteriosclerosis of the central nervous system”, which manifests with multiple softenings, according to Jacobsohn’s concept, based on neuropathology and clinical cases.14 Besides arteriosclerotic lesions of the basal ganglia and the medulla oblongata, Jacobsohn’s main interest, multiple bleedings and softenings in the cerebral cortex and hemispheric white matter, among other structures, were described.3,12 |
| Here, Alzheimer observed that initial symptoms
resembled the “Nervous form”. However, severe psychic symptoms soon appeared, in cases where the disease had not begun with these symptoms. Episodes of irritability, inflexible stubbornness, and also states of uncontrollable restlessness, could also emerge. The interaction with the patient showed only minor real impairments. Attention was severely disturbed, while older memories still retained substantial material, revealed by means of arduous questioning. Interests diminished, but some motivation could improve the patient’s attitude, e.g., a visit from relatives. A mournful depressed mood was often seen. Sensory illusions and delusions can appear. Ideas of grandiosity were not evident. The patient gradually merged into a progressively deeper and blunter dementia (Verblödung), however parts of the former personality remained evident for a long period. Following apoplectic-like attacks, focal manifestations, such as asymbolic behavior, language impairment, visual field changes, cortical movement disturbances, could be observed, and pupils rarely lost reactivity. Attacks could also manifest solely in the psychic domain, such as transient states of stupor, perplexity, hallucinatory excitation states, and disorientation with maniacal excitation. Awareness of the disease was clearly maintained for a long period.9 |