Brain, Vol. 123, No. 12, 2567-2568,
December 2000
© 2000 Oxford University Press
Book reviews |
EARLY DIAGNOSIS OF ALZHEIMER'S DISEASE.
.
Addenbrooke's Hospital, Cambridge, UK
Early Diagnosis of Alzheimer's Disease is a 359-page, multi-author text published by Humana Press. Twenty contributors are listed, all North American—11 from Harvard Medical School. The contributors include some of the best-known names in dementia research.
There are 12 chapters covering clinical, neuropsychological, radiological and pathological diagnosis, genetic testing, peripheral markers of Alzheimer's disease and ethical issues. The chapters are extensively referenced, for example, with 426 references for the chapter on peripheral markers. The chapters have been completed recently, and the book published promptly. There are many references to work published in 1998 and several to work published in 1999. An appendix contains a consensus report of a working party on molecular and biochemical markers of Alzheimer's disease. The reason for including this statement as an appendix is not immediately apparent.
The book is addressed to a `broad audience' comprising three groups: clinicians with an interest in dementia; researchers interested in new therapies; and policy makers concerned with caring for an ageing population.
The topic chosen by the authors is timely. Intensive research is currently aimed at finding drugs that alter the course of the disease and there is surprisingly little information available to help the clinician diagnose early Alzheimer's disease promptly and accurately. The development of effective treatments for Alzheimer's disease would produce a huge demand for early diagnosis—a demand that health services in many parts of the world would struggle to cope with.
All the major topics concerning Alzheimer's disease are covered. Any clinician wanting a contemporary American view of Alzheimer's disease would not be disappointed. Selkoe gives a succinct and clear view of the molecular pathophysiology of Alzheimer's disease; Blacker and Tanzi give an excellent account of the possibilities of genetic testing in Alzheimer's disease. There are very useful chapters on structural and functional imaging in Alzheimer's disease. There is a good account of the problems of assessing early cognitive decline in the ageing population in the chapter by Rentz and Weintraub. A whole chapter devoted to the pupillary response to dilute tropicamide in detecting early Alzheimer's disease is perhaps excessive, particularly as the author concludes that the practical utility of the test remains in doubt. The clinical chapter by Kirk Daffner brings together much useful published information, but is too brief and superficial in the critical sections concerning the clinical diagnosis of early Alzheimer's disease.
Initially, I was disappointed with this book. This was not because of any intrinsic deficit in the book, but because the title raised expectations that the book did not fulfil. The title suggests that the book will help in the diagnosis of early Alzheimer's disease. The early diagnosis of Alzheimer's disease is a common clinical problem. The earlier the diagnosis of Alzheimer's disease is attempted the more difficult it becomes. Common problems in early diagnosis include trying to decide whether a patient's cognitive problems are due to dementia or depression, and whether a patient has Alzheimer's disease or one of the rarer degenerative dementias. Many patients who present with cognitive decline have problems such as vascular disease, alcohol abuse, anxiety and depression. Trying to diagnose Alzheimer's disease accurately in these groups is difficult. Despite its title, this book deals briefly with such problems. The neuropsychology chapter has an excellent section on the cognitive changes of ageing, normal and abnormal, but fails to discuss adequately the routine differential diagnosis of Alzheimer's disease—depression, frontotemporal dementia, dementia with Lewy bodies, etc. Most of the chapters suffer the same fault. A check of the index shows a scattering of references to depression but striking few to frontotemporal dementia (two plus the table of the Manchester/Lund diagnostic criteria) or Lewy body dementia (two). Furthermore, the information that is contained on the early diagnosis of Alzheimer's disease is hard to find. I would not expect this book to lie, well thumbed, on the shelves of the memory clinic. A final summary chapter, highlighting the major features from each section that help the early diagnosis of Alzheimer's disease, would have increased the practical value of the book.
A second fault lies in the editing. Different authors are allowed to go over the same topic. In particular the chapter on peripheral markers of Alzheimer's disease occupies 78 pages—one-quarter of the whole book. Much useful information on peripheral markers is contained in this chapter. However, the chapter also covers topics such as genetic testing in Alzheimer's disease and the pupillary response that are better covered elsewhere. The genetic markers are discussed again in the final chapter on ethics.
These faults disguise the appeal of what is an excellent modern guide to Alzheimer's disease. I would recommend this book for the neuroscientist wanting a multi-disciplinary update on the current state of research into Alzheimer's disease. It would also appeal to clinicians dealing with patients suffering with dementia who want to know more about the current state of research in Alzheimer's disease. The practical guide to the early diagnosis of Alzheimer's disease remains to be written.
Notes
Edited by Leonard F. M. Scinto and Kirk R. Daffner. 2000. Totowa, NJ: Humana Press. Price $99.50. Pp. 359. ISBN 0-89603-452-6.
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