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On the left is Willeke, on the right Annemieke. The twin sisters Kwakkel (67), their maiden name, have the same short blonde hair, the same mackled glasses and their voices sound the same. As soon as they start talking – say immediately – you have to pay attention who starts the sentence and who finishes it. The one, Willeke van Zelst, is the elderly psychiatrist. The other, Annemieke Rozemuller, is a neuropathologist. In her house, a detached house in Bosch and Duin, we sit at the table under a dome -shaped ceiling. On the walls all around, the previous residents had portraits painting of nineteenth-century scientists: Albert Einstein, Charles Darwin, Galileo Galilei and Marie Curie. Annemieke: “We only had Marie Curie done.” Isaac Newton was underneath.
They were in 4-gymnasium when they thought they wanted to study medicine later. And yes, why was that? Their mother was often and a lot sick. Rheumatism-like complaints, once a stroke [een beroerte]the cardia [met het hart] Was everything wrong, medicines for anything and everything. And their father, representative for a company in home furnishings, was scooped by a truck at the age of 47 and was never completely recovered. Willeke: “Now you call something like non-congenital brain injury.” He, Annemieke says, became 92 with it. They were 12 when the accident happened and from that moment they had to do – the second and third of five children – at home what their parents could no longer do well. Cleaning, cooking. The “trigger” for their interest in diseases – why does someone get sick, what makes someone sick, what influence the environment – is they think, in their atypical childhood.
They studied together at the VU University in Amsterdam, at the same time walked co-shells and together wrote their doctoral thesis on Pick’s disease, a form of dementia that is more in behavioral changes than in memory problems. Willeke: “Then we said to each other: that dementia is a sausage where everyone puts something in.” One flag to explain all symptoms, all abnormalities, all complaints and symptoms and to give a name.
The twins were split in the fourth year of co-shelves. Willeke: “One of our supervisors, Pieter Eikelenboom, a psychiatrist, said:” I’m going to explain now how things are going on the lab. Who of you has time? ” Well, she had time. ” She points to Annemieke.
He says: “I went to the petri dishes, she stayed with the patient. And so it always stayed.”
Willeke became the main trainer of psychiatry and elderly psychiatrist at the UMC Groningen, Annemieke became professor of Neurodegenerative diseases – breakdown diseases of the brain – at Amsterdam UMC. The diseases that one as a psychiatrist established in the consultation room saw the other in wafer -thin brain tissue slices under the microscope. And what often happened: Annemieke saw in tissue of deceased patients that they had suffered from another disease than had been diagnosed in life. Twenty-five years ago, when Annemieke started, just like a neuropathologist, almost half of the diagnoses in post-mortem investigation turned out to be incorrect. In the meantime, she says, that is one in four, five.
Still a lot.
Willeke: “The strange thing is that we were not surprised at all.”
Annemieke: “We always thought that in medical science far too much was thought in mind stalls. As a student we learned so much nonsense. So simplistic: these symptoms belong to Alzheimer’s, you see this at Parkinson’s, and as a then this is not how it works. We now know that many diseases can be disease with another disease.” A patient has Parkinson’s and Alzheimer’s. Depression and dementia. Frontotemporal dementia (FTD) and ALS. That is a disease of the nerve cells that control the muscles from the brain. ”
Willeke: “You wrote about that in your dissertation, huh. You quoted Claude Bernard, 1927 …”
Annemieke: “We know that scientific ideas are temporary. If a disease does not fit in the box that has ever been thought of, you have to throw the box away.”
Willeke: “Actually everything is cell biology. All diseases start there, and various diseases can give the same solution.”
Annemieke: “So many factors influence one clinical picture. Environment, lifestyle, construction. We only really see that when we investigated families with one dominant genetic defect. How could a sister hit the most eighty dement and her brother was already on his 45th? How such a hereditary disease is in one go.”
Willeke: “This is how we look at patients and their brains, isn’t it?”
Annemieke: “I belonged to the first in the world who demonstrated how Alzheimer’s originates.”
Willeke: “You had the Tau icon and Baptists?”
Annemieke: “[Hersenonderzoeker Dick] Swaab was Tau-Ist. He said: Alzheimer’s is caused by a clumping of tau proteins in the brain. He is right of course, but it really starts with beta-amyloid, also a protein. I all had Alzheimer’s in my freezer, and on those coupes [plakjes hersenweefsel] I could show beautiful how you first got beta and then tau. On my farewell he admitted that my hypothesis was right. “
Willeke: “If you are right, you are right.”
Annemieke: “It was long thought that if you gave a lot of blood pressure lowers, your dementia could prevent. Accumulation of amyloid proteins in the blood vessels indeed gives mini infarctions in the brain and that can cause neurological disorders. But that you are pure by vasodes, that is never dehare and state of your thing rarely. you have to verify hypothesis with your tissue. “
Willeke and Annemieke: “Tissue is the issue.”
They call every evening. First they talk about husband and children, short. Annemieke has a son and a twin son and daughter. Willeke has two daughters and a son. After that it is about work, even now that they are (almost) retired. And when they hang, they say, exactly 45 minutes is over.
Annemieke: “If you live so far apart, you must have it from the phone. The need to speak to each other is very great. That seem to have more twins.”
Willeke: “If twins you have a better memory …”
Annemieke: “… more reflection, always a different perspective and you keep each other’s past sharp.”
Willeke: “We just said to each other: those phone calls have the effect of a shrink [psychiater]. Now I am a Shrink of course … ”
A Shrink for old people.
Willeke: “Especially for people with memory problems.”
You go to the neurologist with that, right?
Willeke: “Our department was multi-disciplinary and I did the intake if the complaints seemed psychiatric. And because of what I all know about Mieke, I looked differently. In something small the clou can be. Apparently loose symptoms can be an indication that something completely different is going on.” Does a patient have memory problems and constipation? Then you think of Parkinson’s. Smell loss? Parkinson’s. Do the eyes flash enough, does the arm move with the shoulder, has something changed when urinating? Parkinson’s.
Willeke: “We had a man in the sixties at the consultation hour, he looked right through you and only enjoyed pink cakes.”
Annemieke: “Ha, that was one from the book.”
Willeke: “That man has been treated for years in psychiatry for depression, while, the image was obvious.”
Annemieke: “Frontotemporal dementia.”
Willeke: “The need for sweet food, talking staccato, repetitive behavior, little vocabulary, he used the word ‘thing’ for everything. Yes, he made a gloomy impression, but he was not depressed. His two sisters were diagnosed with MS [multiple sclerose, een aandoening van het centrale zenuwstelsel].”
Annemieke: “supposedly ms.”
Willeke: “That turned out to be if something like that is in the family, you know: in 50 percent of people with ALS you also see frontotemporal dementia.”
Annemieke: “It is the same gene. You get either as or ftd and often both.”
Willeke: “And afterwards you could see that it had already started at work. He had pulled out his pants there and had sat down in his underpants. Disrupted. Then soon it is thought: psychiatry. And then they come to me.”
Annemieke: “A lot of psychiatry is actually neurology.”
Willeke: “Early deviations are often not understood by doctors, so it will be in the head.”
Annemieke: “It is also in your head, but different.”
Willeke: “The whole image suited FTD. He was just young demented.”
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The photographer had the interviewees taken photos with a self -timer
Photos Merlin Doomernik
Is it important for this patient to know if he also has?
Willeke: “I think so. Much of those if it sits in the spinal cord. And if people start to fall, I learned that from you, it is: pay attention. This is the beginning of something.”
Annemieke: “So often I see abnormalities in the brain in someone who has not yet clinically had symptoms. If you notice the first signs, you have been compensating for a long time.”
Can you still look at people without diagnosing them?
Willeke: “A psychiatrist talks a lot with people and then you look at faces …” She puts her fingers on her cheek. “Do you see such a muscle shaking here. Then you think: there we go, is this like?”
And do you pay attention to each other?
Willeke: “If she forgets something, I think: would it have begun?”
Annemieke: “I can imagine, if you are retired, all the things you do on your spinal cord, all the easy patterns that go naturally, that it will be less.”
Willeke: “We are no longer busy mothers with three children, everyone to school, go through with the car, cooking with a toddler on each leg. That was spinal cord work.”
Are you actually identical twins?
“Willeke:” We are mirrored. “
Annemieke: “I am left -handed and right -legged, they are right -handed and left -legged.”
Willeke: “Even Google cannot keep our faces apart.”
Your teeth are not the same
Annemieke: “I had a tumor there. Non-heritage. An odontoma. Besides. It was a big operation, everything had to be shifted. At the end of twenty I was. In the past …”
Willeke: “… all the assistants of the dentist had to come and see how exactly the same thing was with us. On a Sunday afternoon my father brought one with a toothache to the dentist. An hour later the other had a toothache in the same molar.”
Annemieke: “I also had leukemia, she didn’t.”
Willeke: “Twelve years ago now?”
Annemieke: “The good type. Chronic myeloid leukemia. There were just new medicines.”
Willeke: “You came to me in Groningen, you didn’t look. I thought: this is a cancer head until the contrary is proven.”
Annemieke: “My children said so too. Mama has cancer.”
Willeke rubs her forearms: “You had cables of barrels.”
Annemieke: “You said,” If you don’t go to the doctor on Monday, I will bring you personally. “
Why didn’t you go to the doctor yet?
Annemieke: “I had organized a congress, a world congress about prions.” Prions are proteins and prional disease can also cause dementia and movement disorders.
Willeke: “She was an important session for.”
Annemieke: “I thought: if that is over, I go to the doctor. And then it was over and I had a headache. Then I first went to you in Groningen.”
Willeke: “You still wanted to take a huge walk.”
Annemieke: “I then went to the doctor. I had bronchitis and fever. There had only been just blood pricked or the lab called …”
Willeke: “496.”
Annemieke: “A hundred times more leukos [witte bloedlichamen] Then normal. I already had thrombosis, I already had eye attacks. ”
Willeke: “That blood becomes syrup. That’s why you had those thick barrels. You understand why someone doesn’t look. Afterwards.”
Annemieke: “I always thought: with leukemia you are very sick. But it goes so gradually. You think: I am a bit faster.”
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The photographer had the interviewees taken photos with a self -timer
Willeke: “Later we started facetimen for a while, to keep an eye on her.”
Annemieke: “I got rid of it merciful.”
Willeke: “You got someone on the table …”
Annemieke: “Pretty soon I went to work again and I got someone on the table-the same age as I, the same Diag-Nose, as many leukocytes. But she was dead. If you look at such a brain, I understand that I had a headache.”
Willeke: “I still wanted to give my cells to you. But they would rather not do that, transplant at Gemini. There must be something of a mismatch to build up a defense against leukemia cells.”
Annemieke: “Environmental factors also play a role, eh, if you get it. I have been in aircraft a lot, there is always more radiation.”
Willeke: “I thought it was so stinking in the lab, and you were always in it. All those benzene -like substances, the formaldehyde, that could not have been good for leukemia.”
Annemieke: “There are so many substances that we still have to do. We now know that you can put the cards on top of each other of areas where pesticides are used and where Parkinson’s occurs.”
“Cookie?”, Annemieke asks and she walks to the kitchen. She comes back with bowls of carrots, bell pepper and cucumber. What they do themselves to slow down the decline: healthy eating, exercising a lot. And little salt.
Annemieke: “My grandfather died of salt poisoning and my father is almost. Salt is not a natural substance, it is an addition and you get used to it.”
Willeke: “How was it again? Whoever loves his kidneys, eats less salt.”
Why are you so interested in old -age diseases?
Willeke: “The interest was always there. And in our time, early eighties, crisis – there was only one in forty doctors a job for one in forty doctors. So choose something that always remains: elderly and aging. The big gray wave was yet to come.”
What is the most common complaint in the elderly?
Willeke: “Depression anyway. Sometimes sec and on its own. Sometimes as a side effect of a neurological disease.”
Annemieke: “There is a lot of depression in Parkinson’s. It sometimes starts with that. Or with constipation and then through, to the brain area that causes depression. The Prince Claus story.”
How do you determine depression?
Willeke: “There are criteria for that.”
You say that criteria have also been thought of?
Willeke: “You have to feel the depression in the consultation room, I always say. Someone can cry spontaneously, but that can also be epilepsy.”
Annemieke: “Or forced areas.”
Willeke: “A person’s story must be tangible. What makes it difficult is that irritability, or a sad mood, or reduced facial expression can also indicate a neurological disorder. Then the is the proof of the pudding: Give medication. ”
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And if medication does not work, were you not depressed?
Willeke: “Then you have a 50 percent chance that the next medicine will work. And so you continue to means number five. I myself am very in favor of Elektro Convulsion.” Electroshocks.
Annemieke: “You have seen people spectacularly refurbish.”
Willeke: “It was always such a fight and oh, for patients like that. Then I say: If a surgeon cuts someone from top to bottom, it’s such a pear.” She raises a thumb. “But if I make people completely better with the power of a bicycle light with the power of a bicycle light and you don’t see it anymore, am I an inhuman?”
Annemieke: “Parkinson’s patients can also refurbish it.”
Willeke: “I got a man on the clinic, a former car mechanic. He said nothing more, did nothing more, a zombie. He was demented. I suspected it might be depression. We put him on the machine. After a few weeks he says to his wife:” The cat has been eating. Haha, April 1! ” He made jokes again, looked under the hood again, he had his life back. “
Annemieke: “As often as early Alzheimer’s is still held for a burnout. The techniques improve at lightning speed. In the blood you can now see if there are markers, in a small piece of skin you can find Parkinson’s.”
You have remarkably smooth skin.
Willeke: “My mother too. Never smoked, always a hat against the sun. She was 78 when she died, but in the coffin her face was still completely cool.”
Annemieke: “She died of lung fibrosis.”
Willeke: “There was everything wrong about her, but her lungs, we thought he was good. She turned out to have cryptogenic organizing pneumonia afterwards. It is hereditary. My daughter is becoming pulmonologist and she had just been lecturing on it. It is unknown how it arose, there are few initials, but most of the time she said and then I said and I said and I said and I said and I said and I said and then I” ”” ”” ”” ”” ”” “
Annemieke: “Yes, you have to cough a lot, yes. So if it gets worse …”
