Dementia - Hardcover

John O'Brien, Professor of Old Age Psychiatry, University of Newcastle upon Tyne. David Ames, Associate Professor of Psychiatry of Old Age, The University of Melbourne. Alistair Burns, Professor of Old Age Psychiatry, University Department of Psychiatry, Withington Hospital, Manchester.

Age-related loss of memory and other cognitive abilities has been recognized since antiquity. However, the need to understand the causes and consequences of dementia has become urgent over the past quarter-century because of the large and increasing proportion of persons in the world's population who live into their 9th and 10th decades -- the ages at which people are at greatest risk for dementia. Dementia is now one of the most common and feared conditions of old age and is a major public health problem throughout the world. The condition demands more than a basic understanding on the part of nearly all health care professionals.

Dementia is the second edition of a multiauthored book on the subject. The book has 70 chapters organized in 7 sections. About a third of the book is devoted to general aspects of dementia, a quarter to Alzheimer's disease, and the rest to vascular dementia, dementia with Lewy bodies, focal dementia (e.g., Pick's disease and progressive aphasia), dementia associated with neuropsychiatric disorders (e.g., depression, schizophrenia, alcoholism, and Huntington's disease), and other types of dementia (e.g., dementia in Creutzfeldt-Jakob disease and in human immunodeficiency virus infection). The book does not represent the American view of dementia: only 18 authors from 10 U.S. institutions are included among the 132 authors.

This second edition of the book has been published a mere six years after the first edition. Most persons outside the field may not be cognizant of the tremendous advances that have occurred over this relatively short period, especially in our understanding of the molecular biologic and genetic aspects of dementia. The editors state that the combination of exciting recent progress and continued challenges was the chief driving force behind this second edition. ``Our aim,'' they state, ``was to produce fully comprehensive and up-to-date coverage of all aspects of dementia within a single text, which would prove accessible to clinicians, researchers and allied professional groups.'' There is indeed something for everyone in this book, including clinicians, researchers, and allied health professionals.

The book has much to offer practicing clinicians. There are readable chapters on the diagnosis and assessment of dementia, the management of dementia, and the role of primary care physicians in its management. There are also clinically relevant overviews of neuroimaging and candid discussions of sexuality, legal competence, and driving. In addition, the current nosology of the major dementing illnesses is skillfully described. The chapters on the treatment of Alzheimer's disease are comprehensive and relatively up to date; the chapter on treatments for behavioral problems, a substantial problem in the care of persons with Alzheimer's disease, is both practical and well referenced. The section on prion diseases has an adequate discussion of bovine spongiform encephalopathy. Although this disease is exceedingly rare, its coverage in the international media makes it an important topic. Noticeably absent are discussions of syphilis, hypothyroidism, vitamin B(sub 12) deficiency, and normal-pressure hydrocephalus. Although these conditions do not account for a large proportion of cases of dementia, they are treatable and are prominently addressed in the training received by most clinicians. Thus, a summary of current views about these conditions would have been beneficial. In addition, given the widespread availability of neuropsychological testing, the chapter on neuropsychological assessment should have included a more detailed discussion of cognitive testing; there is an overemphasis on the Cambridge Neuropsychological Test Automated Battery, an instrument developed by the chapter authors that is not widely used.

Researchers will find excellent, up-to-date reviews of the role of tau protein in Alzheimer's disease and the frontotemporal dementias. There is a thoughtful and balanced discussion of animal models of Alzheimer's disease. The chapters on structural and functional imaging are comprehensive, as are the chapters on the neuropathology and neurophysiology of the different dementias and findings on magnetic resonance spectroscopy. In contrast, the discussions of the role of (beta)-amyloid, in particular the processing of amyloid precursor protein and the secretases and the genetic aspects, although excellent, are relatively brief. The discussion of the role of (alpha)-synuclein is difficult to find and also relatively brief. Given that these topics constitute one of the field's major areas of progress over the past several years, more of the text could have been devoted to them. The book would also have been improved by the inclusion of a chapter on study design and statistical issues. The 24 color plates, including those showing neuropathological findings, are of high quality and informative.

This book offers a wealth of information for allied health professionals. In addition to all the chapters that are relevant for practicing clinicians, there are chapters on the roles of family caregivers, nurses, social workers, and occupational therapists in the management of dementia. A chapter on creating a residential environment that is appropriate for patients with dementia includes floor plans and photographs. This is a very important issue now that experts in dementia are becoming more involved in helping long-term care facilities develop plans to house the increasing number of frail and demented elderly persons. An interesting section on services for persons with dementia and family caregivers includes brief chapters on the approaches used in many countries with varying economic resources.

Overall, the editors have achieved their aim remarkably well. Although I have highlighted areas in which the book could have been improved, my purpose is primarily to point out areas in which more information is available elsewhere in the literature, rather than to criticize the editors for their oversights. This book covers dementia in greater depth and breadth than any other work on the subject.

David A. Bennett, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.