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It was not so many years ago that a diagnostic approach to dementias was limited to the exclusion of potentially reversible causes. It is becoming increasingly clear that clinicians now need to be able to differentiate not only between reversible and irreversible causes but also between the primary degenerative dementias themselves. The past decade has seen great advances in our understanding of the basic science of the dementias, particularly Alzheimer's disease, bringing us not only a theoretical basis for different symptomatic conditions in different dementias, but also the promise of future therapies that may act directly on the molecular underpinnings of these diseases.
If clinicians are to be able to make these clinical distinctions and initiate appropriate therapy, then unless they are neurologists with a specialist interest in dementias, they may need a little help. Robert Green's book, Diagnosis and management of Alzheimer's disease and other dementias, provides that help and a whole lot more. Although in its introduction Dr Green claims that his manual is aimed at the primary care physician it is also informative and useful enough to provide excellent back up to neurologists in training and neurologists whose area of specialisation lies outside the realm of dementias.
One of the greatest difficulties in reviewing this publication has been to find what was missing. For several weeks this volume has been carried around in my briefcase with regular checks to see if it included certain aspects of the management of dementing illnesses. From the appropriate dose of vitamin E, the debate on the use of ginko biloba, the use of CSF biomarkers in diagnosis, to advice on handling the emotionally charged issue of driving, each time, this small book was informative.
Essentially, the book is divided in four parts. The first, on general aspects of dementing disorders, opens with definitions and the epidemiology of dementias. The following section on the evaluation of the older patient with cognitive problems usefully emphasises issues such as the importance of taking a corroborative history, and the assessment of functional capabilities or activities of daily living. The appropriateness of ancillary investigations such as neuroimaging, neuropsychology, CSF analysis, and electroencephalograpy are discussed as well as aspects of a bedside mental status examination. If I had one minor quibble it would be the absence of instructions for a few specific tests of neuropsychological function that can be used at the bedside. Although we all know that we should assess short term memory, few of us can administer a simple list learning task at the bedside or in the clinic. The first part concludes with a chapter on cognitive disorders not due to Alzheimer's disease and is particularly useful in detailing the differentiation of Alzheimer's from delirium, depression, frontotemporal dementia, and dementia with Lewy bodies.
Part two of the book is devoted to Alzheimer's disease, its genetics, natural history, neuropathology, and emerging treatment options. In the third part, practical and behavioural issues are addressed and it is here that we really benefit from the experience accumulated by Dr Green and his team in Boston in caring for many patients and their families through the course of these devastating illnesses. The final section of the book is devoted to resources for clinicians and families, over 400 references, and a comprehensive index.
In summary, on the basis of its content, this book is well written, well structured, comprehensive, and above all useful. For me however, its strongest feature is that is packs all this into a slim volume measuring only 19×10 cm, which was easily carried around in my case.
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