Konrad Maurer - Böcker

The very name Alzheimer is sure to bring a shudder. Thirty to forty million people are now afflicted with Alzheimer's disease, a degenerative brain disorder that strips its victims of their identity and leaves families bereft and social services strained. Despite considerable research, the underlying causes of Alzheimer's disease remain shrouded in mystery. So, too, does the man after whom it was named. Alois Alzheimer (1864-1915) was practicing medicine at the Frankfurt Asylum in 1901 when he met a patient, who would become known as "Auguste D.," whose condition perplexed and intrigued him. Alzheimer is more than a biography; it is a story of scientific discovery at a crucial stage in the history of medical psychiatry.

As the essays in this volume show, conceptualizing dementia has always been a complex process. With contributions from noted professionals in psychiatry, neurology, molecular biology, sociology, history, ethics, and health policy, Concepts of Alzheimer Disease looks at the ways in which Alzheimer disease has been defined in various historical and cultural contexts. The book covers every major development in the field, from the first case described by Alois Alzheimer in 1907 through groundbreaking work on the genetics of the disease. Essays examine not only the prominent role that biomedical and clinical researchers have played in defining Alzheimer disease, but also the ways in which the perspectives of patients, their caregivers, and the broader public have shaped concepts.

As the essays in this volume show, conceptualizing dementia has always been a complex process. With contributions from noted professionals in psychiatry, neurology, molecular biology, sociology, history, ethics, and health policy, Concepts of Alzheimer Disease looks at the ways in which Alzheimer disease has been defined in various historical and cultural contexts. The book covers every major development in the field, from the first case described by Alois Alzheimer in 1907 through groundbreaking work on the genetics of the disease. Essays examine not only the prominent role that biomedical and clinical researchers have played in defining Alzheimer disease, but also the ways in which the perspectives of patients, their caregivers, and the broader public have shaped concepts.

Dementia of Alzheimer type (DAT), multiinfarct dementia (MID) and dementia occurring in the course of Parkinson's disease (PD +D) now make up one of the largest categories of chronic diseases in the elderly. In addition to the burden those illnesses impose on the affected individuals and their families they consume large socio-economic re- sources. In the light of all the above mentioned features, it seemed to us that a Symposium on behalf of the 125th Anniversary of Birth of Aloys Alzheimer was particularly well-suited to help to advance research on Alzheimer's disease and other dementias. This International Symposium combined with a Satellite Symposium about "Clinical Aspects of Alz- heimer Dementias" took place in June 1989 in Wiirzburg and has been organized by the Psychiatric Departments of the Universities of Wiirzburg and Munich (H. Beckmann, K. Maurer, P. Riederer, H. Hippius and H. Lauter) and the Department of Pathochemistry and General Neurochemistry of the University of Heidelberg (S. Hoyer).In the chapters which follow, thorough reviews of recognized authorities in the field of dementia are given in the four main fields of epidemiology, neuropathology, neurochemistry and clinics. This Symposium and the edition of this book would not have been possible without the generous support of E. Merck, Darmstadt. In particular we gratefully acknowledge the efforts undertaken by Mr. Hernandez-Meyer to organizing this symposium and to publish this book. Furthermore we are grateful to the secretarial help by Mrs. Moeslein, Miss Philipp and Miss Grabner.

Imaging procedures have been used for many years and are becoming increasingly important in a number of medical disciplines. This is due to recent technological advances, primarily computerization. The meth­ ods employed in CNS diagnostics are collectively referred to as "neu­ roimaging" and include procedures for investigating both cerebral morphology and cerebral function, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomogra­ phy (PET), and single-photon emission computed tomography (SPECT). Topographic mapping of electroencephalograms (EEG) and evoked potentials represents one of the functional procedures and per­ mits topographic imaging of EEG, evoked potentials, and magnetic fields. The latter application includes not only magnetic fields evoked by stimuli relating to different sensory modalities, but also endogenous and motor fields resulting from spontaneous brain magnetic activity, as recorded by magnetoencephalograms (MEG), the magnetic comple­ ment of the EEG. The advantage of recording electric and magnetic fields over other neuroimaging procedures is that these techniques are completely noninvasive and have extremely short analysis times (in the millisecond range). The aim of this book is to clarify the current state of this emerging technology, to assess its potential for substantive contributions to brain research, to delineate areas for further research and, over all, to envis­ age clinical applications in disciplines such as psychiatry, neurology, and neuropsychology.

From its discovery in 1929 by Hans Berger until the late 1960s, when sensory visual and auditory evoked potentials were dis­ covered and became popular, the EEG was the most important method of neurophysiological examination. W-ith the advent of computer technology in the 1980s, it became possible to plot the potential fields of the EEG onto models of the scalp. This plot­ ting of information as neuroimages followed the structural and functional techniques of Cf, MRI, PET and SPECf. The success of this method, which began in the early 1980s, has led to the brain mapping of EEGs and EPs being increasingly used for di­ agnosistic purposes in neurology, psychiatry and psychopharma­ cology. The pioneers of this method believed in it and were commit­ ted to its success. However, many traditionalists felt that it gave no new information and so regarded the method with scepticism. Some found both the coloured maps and the mapping technique misleading, which led to unnecessary conflict between mappers and their chromophobic oponents. Emotions have run so high that some professional bodies have justifiably adopted guidelines and warned of the misuse of the method.

In the last two decades imaging of the brain, or neuroimaging, has become an integral part of clinical and research psychiatry. This is due to recent advances in computer technology, which has made it relatively easy to generate brain images representing structure and function of the central nervous system. Currently used clinical diagnostic imaging modalities, such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI) , provide predominantly anatomic information. CT images reflect X-ray attenuation distribution within the brain, whereas MRI signals depend primarily on proton sensitivity and tissue relaxivity. The chapter "Structural Imaging Methods" reviews CT and MRI studies on schizophrenic and affective disorders and degenera­ tive central nervous system diseases. The impact of fast three­ dimensional (3-0) imaging and the automatic transfer from 3-D elements in the brain to artificial diagrams based on this information is considered. Since the original report of the findings of Ingvar and Franzen in 1974 and the introduction of regional cerebral blood flow (rCBF) measurements, single photon emission computed tomography (SPECT) has been gaining acceptance as one of the major imaging techniques, and it is available in most nuclear medicine depart­ ments. The section "Functional Imaging Methods (Cerebral Blood Flow - CBF, Single Photon Emission Computerized Tomography - SPECT)" describes rCBF studies with the 133Xe inhalation method utilizing a 254 detector system and rCBF images measured by SPECT using the tracer 99mTc-HMPAO.