Alzheimer, Parkinson and Multiple Sclerosis: As nerves whither away

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In this blog we feature three diseases of the nerves – Alzheimer’s, Parkinson’s, and Multiple sclerosis and their related philately. In all the three, nerve cells in our brain or spinal cord get affected. Individuals and their families need to relentlessly cope up with slow but progressive failure of the nerves. While the similarity between the three may end here, all these conditions have led to tremendous medical research, in an attempt to mend what can be saved. Lets explore these three further.

Alzheimer’s Describes Dementia

Alzheimer’s Disease is a progressive degeneration of nerve cells, that help us think and remember. The disease was first described in 1907 by Alois Alzheimer, a German psychiatrist, who was working in an Asylum in Munich. Six years before, in 1901 he came across a 51 year old lady named Auguste Deter. She was loosing her memory, and as the time progressed, she became more disoriented, loosing her language skills, motivation, and had mood swings. In order to keep her in an expensive asylum, her family pledged her brain and medical records to Alzheimer. When she died in 1906, her medical records and Brain were brought to Alzheimer.

The reason for Alzheimer’s Disease remains unknown

Alzheimer dissected the Brain, and saw it under a microscope. He discovered peculiar folded protein deposits we know as amyloid plaques, and neuro-fibrillary tangles in the brain tissue. While we donot know why these proteins accumulate in the brain, they start damaging surrounding neurons. Today we diagnose Alzheimer’s disease based on clinical presentation, advanced brain imaging, and detection of abnormal proteins in CSF or blood.

Alzheimer’s Disease International (ADI) is an international federation of Alzheimer and dementia associations around the world. ADI was set up in 1984. However advocacy efforts were accelerated after a former US President Ronald Regan (1981-89) Announced that he has Alzheimer’s Disease in 1994. In the same year ADI announced 21st September is foundation day as World Alzheimer’s Day.

There is no specific treatment for Alzheimer’s disease. However, since last few years, anti-amyloid-beta monoclonal antibody based medicines have become available for its treatment. These include Lecanemab (approved January 2023) and Donanemab (Approved July 2024). Efficacy of these drugs is limited and costs are high, so still early days for this therapy.

Parkinson describes a movement disorder

James Parkinson (1755-1824) was a British Physician. In 1817 he wrote a monograph An Essay on the Shaking Palsy. In this monograph he described six individuals, who had tremors. He writes in this monograph “Involuntary tremulous motion, with lessened muscle power, in parts not in action and even when supported; with propensity to bend forward and to pass from walking to running phase; the sense and intellect being uninjured.“

In 1861 Jean Charcot gave the name of this disease as Parkinson’s disease. He replaced the description of motor palsy with bradykinesia (or slow movements) and popularized a triad of Tremors, Rigidity and Bradykinesia as hallmarks of this disease.

What causes Parkinson’s disease

While Parkinson’s disease was known even before its formal description in 1877, its cause was unclear. In 1912, Frederic Lewy described microscopic particles in affected brains of individuals with this disease. As cells in substantia-nigra die, more and more amyloid Lewy bodies accumulate. There occur changes in dopamine signaling in mid-brain. These were identified in the 1950s, largely by Arvid Carlsson and Oleh Hornykiewicz. Carlson was awarded with Nobel Prize in Medicine on his work on Dopamine in the year 2000.

While there is no cure for Parkinson’s disease, medicines are available that can reduce the symptoms of bradykinesia and rigidity. Key medication if oral levo-dopa and carvidopa combination, that transiently increases levels of dopamine in circulation. Other drugs are Dopamine agonists, and anticholinergics that provide symptom relief. Deep Brain therapy is a novel treatment modality for the disease.

The Red Tulip connection

Red tulips are a global symbol of Parkinson disease awareness. This symbol was adopted in 1980 when J.W.S. Van der Wereld, a Dutch horticulturalist with Parkinson’s, developed a red and white tulip named “Dr. James Parkinson” to honor the doctor who first described the disease.

Multiple Sclerosis

The word multiple sclerosis means “many plaques”. While the descriptions of the disease are ancient, a Dutch mystic St Lidwina is portrayed as one of the first patients with this disease. Individuals with multiple sclerosis can have a variety of neurological deficits, that sometimes recover or progress.

For instance a person may have a sudden painless visual loss, that recovers over time, or a limb paralysis. They may have sensory loss over the limbs, or limb weakness or loss of balance or double vision or a swallowing difficulty. In 1868, Jean Charcot recognized all these manifestations due to a single disease. He and other had discovered that these individuals have thickened areas across their nervous system. Hence Charcot called the disease sclerose en plaques

The story of First Postage stamp on Multiple Sclerosis

The story of the first postage stamp on Multiple sclerosis begins in 1947. This is the year when a multiple sclerosis society had formed in the United States. Coincidentally in early 1950s, Grace Kelly was a Hollywood star actress. It is reported that her first date, Harper Davis, died in 1953 after being diagnosed with multiple sclerosis. Harper Davis was a US combatant in World War II. Gradually Grace Kelly became an active member of the society. While in 1956, Grace left Hollywood and married Prince Rainier III of Monaco she continued her connect with multiple sclerosis. The brochure of the first 1962 postage stamp from Monaco carries a message from Grace (now Grace de Monaco)

Advances in our understanding of the disease

We currently define Multiple Sclerosis, based on Clinical and imaging criteria. One key requirement of diagnosis is presence of nerve plaques disseminated in space and disseminated in time. This 1965 concept has been revised and today we use the version last updated in the year 2017 (called McDonald criteria).

Multiple sclerosis is a immune mediated disease. Immune cells (triggered by some unknown insult) destroy myelin shealth, that surrounds nerve cells. As a result of this insult, electrical impulses in the nerves is disturbed, leading to clinical disease. As these areas of destroyed myelin heal, they form plaques. We use various immune mediated medications to treat this disease, and research for novel approaches is ongoing.

The Unknown three

All the three conditions – Alzheimer’s disease, Parkinson’s disease and multiple sclerosis are disabling. They impact individuals and their families. Care for them is a constant struggle between disease, medication, behavioral abnormalities, rehabilitation and social support. While the exact cause of all these is yet undefined, and manifestations numerous, our struggles to overcome them need a lot of human efforts and cooperation.