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Vascular cognitive impairment: preventable dementia
  1. J Snowden

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    Edited by John V Bowler and Vladimir Hachinski. Published by Oxford University Press, Oxford, 2003, pp 337, £79.50 (hardback). ISBN 0-19-263267-1

    This book is an authoritative account of vascular cognitive impairment written by a host of international figures in the field of cerebrovascular disease. The title, Vascular cognitive impairment, is significant. The editors regard the more widely used term vascular dementia as having outlived its usefulness. The latter presupposes problems in memory, which are not invariably present, and it defines people relatively late in the course of disease, preventing early diagnosis and treatment. The editors propose adoption of the concept of vascular cognitive impairment and argue for a wholesale revision of current diagnostic criteria.

    Despite the title, most of the book is devoted to vascular dementia and its causes and consequences. This emphasis reflects the fact that the chapters, which include the themes of subtypes, cognitive assessment, neuroimaging, histopathology, genetics, and treatment, are predominantly reviews or meta-analyses of published literature. A feature that consistently emerges is the clinical and pathogenic heterogeneity of vascular dementia. Moreover, the reader becomes aware of the obscuration that arises from treating vascular dementia as a uniform entity. For example, whereas cognitive studies X and Y reveal better performance on tests A and B in patients with vascular dementia than patients with Alzheimer’s disease, study Z shows the reverse finding. The group data obstruct identification of distinct profiles of impairment relevant to individual patients. It becomes evident why a radical overhaul of thinking about vascular cognitive impairment is required.

    My quibble is that like many multi-author texts there is information overlap across chapters. There are also occasional errors overlooked at the proof reading stage. However, in general the book provides a useful, state of the art guide to vascular cognitive impairment. Particularly enjoyable are the editors’ lucidly written introductory and concluding chapters, which have a strong personal flavour, and a sense of mission.