Dementia, Second Edition

Editors: O'Brien J, Ames D, Burns A.
Oxford University Press, 2000.

Reviewed by: Christian Bocti, MD, FRCPC, Cognitive Neurology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON.

There has been a tremendous increase in the pace of discoveries related to the dementias in the last two decades. For a clinician, it is difficult to keep up with all this new information. Few textbooks on the topic attempt to integrate all fields of knowledge in a comprehensive manner--from basic neurochemistry and neurobiology to clinical approach and neuropsychology, and from pharmacotherapeutic strategies to multidisciplinary management and community services for patients with dementia. Although there are good textbooks available that cover some of these individual aspects, Dementia, Second Edition is the most ambitious textbook presently available, with the many advantages and few drawbacks that such a vast undertaking implies.

The book has 70 chapters (17 more than the first edition) organised in seven parts, which provides a user-friendly structure. There are 133 contributors, mostly from the U.K. but also from continental Europe, North America and Australia. The editors have accomplished a monumental task in coordinating the work of this large number of authors.

General aspects of dementia are reviewed in the first part, which constitutes a full third of this book. Diagnostic criteria for Alzheimer disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB) are discussed, as well as related concepts such as age-associated cognitive decline (AACD). However, the absence of consensus criteria for frontotemporal dementia (FTD) in this section is surprising (they are presented in a later chapter). Clinical aspects of dementia are then presented, including a brief overview of neuropsychology and a more elaborate chapter on neuropsychiatric features. Reflecting the increasing importance of neuroimaging in the differential diagnosis of the dementias, there is a series of chapters that provides a good synthesis of neuroimaging techniques currently in clinical use (CT, SPECT and MRI).

Following, there is an elaborate section on familial, social, cultural and economical aspects of dementia care, as well as a review of services for patients with dementia available in many parts of the world, including developing nations. Most notable are the chapters on sexuality and dementia, and on ethical and legal aspects of dementia care--seldom-discussed issues that can have significant impact on the quality of life of patients.

The second part of the book provides a detailed review of Alzheimer disease, starting with definitions, risk factors and epidemiology. The natural history is described, and the neurobiology section includes very good chapters on the cholinergic system and the neuropathology of AD. Disturbances in other neurotransmitter systems are exposed more succinctly, and genetic factors and even animal models of AD are reviewed in some detail. Therapeutic strategies are presented next, and the use of cholinergic drugs are put in a humbling historical perspective. There also is an extensive review of treatments for behavioural and psychological symptoms, both pharmacological and psychosocial. The chapter on pharmacological approaches provides a well-structured and rational clinical methodology to treating behavioural disorders, with a remarkably comprehensive review of published studies.

The third, fourth and fifth parts of the book cover VaD, DLB and FTD, respectively; all these chapters are written by leaders in the field and provide clear, concise overviews of each entity. Controversial issues, including the importance of leukoaraiosis in cognitive impairment are well discussed. The section on FTD provides good perspective on the different sub-syndromes and clarifies conflicting terminology used by various authors in the literature.

The sixth part briefly reviews neuropsychiatric disorders associated with dementia. The prototypical disorder, Huntington's disease, is well synthesized. There is very little elaboration, however, on dementia in Parkinson's disease. Other chapters provide overviews of cognitive dysfunction in schizophrenia, depression and alcoholism. The inclusion of these chapters in a textbook on dementia is a welcome step forward to a unified conceptualisation of brain-behaviour relationships. The last part provides a brief overview of Creutzfeldt-Jakob disease, HIV-associated dementia and other uncommon dementias.

Overall, this is a comprehensive, authoritative and accessible textbook that anyone involved in the care of patients with dementia will find very useful. It goes well beyond what is found in any other work on dementia, and it presents a good balance of basic science and clinical and psychosocial aspects. In such a wide-ranging text, certain topics are inevitably presented in less detail than others, but globally, this is an excellent textbook. In the decades to come, dementia will become one of the major challenges facing our society and, despite exciting recent developments, there is still much work to be done to meet these challenges.