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Book Review   |    
Joseph Tonkonogy
Psychiatric Services 2010; doi:
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edited by Myron F. Weiner, M.D., and Anne M. Lipton, M.D., Ph.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2009, 575 pages, $125

Dr. Tonkonogy is a clinical professor of psychiatry, Department of Psychiatry, University of Massachusetts Medical School, Worcester.

This book is a guide to help practicing psychiatrists navigate through the constantly growing body of knowledge on Alzheimer's disease and other dementing illnesses. Based on the reviews of historical and current information, the book provides extensive coverage of clinical manifestations, diagnostic evaluations, and treatments of dementia as well as basic research of its causes.

The contributors of the book's six parts and appendices include a team of leading investigators with clinical and research experience in the field of various types of dementias and cognitive impairments in general. That team includes the book's editors, Myron Weiner from Southwestern Medical Center in Texas and Anne Lipton from Presbyterian Hospital of Dallas, well known for their contributions to the study of dementia and other types of cognitive impairments.

The book first takes readers through a short chapter on the history of clinical and epidemiological study of dementia, describing the evolution from the concept of senile dementia to the modern clinical description and theory of Alzheimer's disease and other dementias. Part 2 of the book describes diagnostic evaluation of dementia, considered as a type of neuropsychiatric assessment and diagnosis. This approach allows the authors to enrich the assessment of dementia by comparing it with other types of cognitive impairments; neuropsychiatric and medical evaluations—clinically very important—are included in lists of required assessment of patients with various types of cognitive abnormalities. The chapter on neuropsychological assessment briefly describes the content and limitations of the eight most frequently used dementia screening tests. The reader will find very useful the next chapter describing neuroimaging and its role in diagnostic evaluation of cognitive disturbances. In general, part 2, along with a series of scales described in the appendices, provides a set of very useful data for organization of diagnostic assessment of patients with cognitive problems.

Several chapters in part 3 discuss the clinical features, course, pathology, and genetics of Alzheimer's disease and other dementias. Special attention is given to recent studies of mild cognitive impairment, especially its role as a prodromal stage of Alzheimer's disease. The reader will find in part 3 a perfect clinical description of the main features of Alzheimer's disease and Lewy body dementia and discussion of possible roles in the development of synucleopathies. Description of frontotemporal dementia includes the important outlines of its two types, the frontal-behavioral and language variants. Differences in recently revealed roles of tau and ubiquitin immunohistochemistry are stressed as important factors in classifying the subtypes of frontotemporal dementia. This section of the book gives special attention to the clinical and pathological analysis of vascular cognitive disorder, discussing the cerebral vascular pathology and histopathological changes typical for Alzheimer's disease in relation to the development of so-called mixed dementia. This section also serves as a helpful manual to use in clinical psychiatric practice, providing the main data concerning the other major dementias caused by degenerative and infectious diseases, such as Hungtington disease, hepatolenticular degeneration, Parkinson's disease with dementia, and various types of encephalitis.

Main directions in the development of dementia treatment are highlighted in part 4. Of special interest is a discussion of history and current trends in the use of cholinesterase inhibitors as a way to increase acetylcholine levels in the brain in order to improve or at least to slow down the progression of cognitive impairments from Alzheimer's disease. Unfortunately, the positive results of that approach have been transitional, and no pharmacological treatment reverses or stops the progression of dementia. Part 5 of the book is devoted to caregiving, legal, and ethical issues. Part 6 discusses the future of research for biomarkers and prevention, treatment of dementia, and cognitive decline. The book includes appendices containing forms and scales that are useful in practical evaluation of and research on Alzheimer's disease and other dementias.

Later editions of the book may benefit from more detailed description of nonamnesic clinical features of dementia, such as aphasia, agnosia, and apraxia. Those features are included in the DSM-IV-TR definition of dementia, but the definition should be clarified to enable comparison with classification and clinicoanatomical description of aphasia, agnosia, and apraxia in the classical neurological and neuropsychological literature on patients who do not have dementia but have local, primarily cerebrovascular pathology. It may also be useful for diagnosis and treatment if future editions were to more fully discuss vascular issues, especially small vessel disease, in Alzheimer's disease and in mixed dementia, as well as the amnesic and nonamnesic forms of mild cognitive impairments.

In general, the book may help practicing psychiatrists and other clinicians to navigate the maze of complex research and clinical findings that are important in the care of patients with Alzheimer's disease and other types of cognitive impairments. The text is an important resource for psychiatrists and other mental health professionals, whether they are reading it from cover to cover or using it as a reference.

The reviewer reports no competing interests.




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